Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is characterized by anxious thoughts or rituals you feel you can't control. People with OCD are plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. Symptoms of OCD include:

• being obsessed with germs or dirt (washing hands over and over)
• feeling the need to check things repeatedly
• preoccupation with thoughts of violence
• fear of harming people that are close to you
• spending long periods of time touching things or counting
• preoccupation with order or symmetry
• persistent thoughts of performing sexual acts that are repugnant to you
• being troubled by thoughts that are against your religious beliefs.

The disturbing thoughts or images are called obsessions , and the rituals that are performed to try to prevent or dispel them are called compulsions . The person with OCD gets no pleasure in carrying out the rituals they are drawn to, only temporary relief from the discomfort caused by the obsession.

A lot of healthy people can identify with having some of the symptoms of OCD, such as checking the stove several times before leaving the house. But the disorder is diagnosed only when such activities consume at least an hour a day, are very distressing, and interfere with daily life. Most adults with this condition recognize that what they're doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their behavior is out of the ordinary.

If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home, but more often it doesn't develop to those extremes. Left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a chronic, relapsing illness. Fortunately, effective treatments have been developed to help people with OCD.

How common is OCD?

About 2% of the U.S. population has OCD in a given year. OCD typically begins during adolescence or early childhood. At least one-third of the cases of adult OCD began in childhood. Roughly 1 in 50 people develop OCD and it affects men and women in approximately equal numbers. It can appear in childhood, adolescence, or adulthood, but on the average it first shows up in the teens or early adulthood. A third of adults with OCD experienced their first symptoms as children.

The course of the disease is variable-symptoms may come and go, they may ease over time, or they can grow progressively worse. Evidence suggests that OCD might run in families. ]]>Depression]]> or other anxiety disorders may accompany OCD. Some people with OCD have ]]>eating disorders]]> . In addition, they may avoid situations in which they might have to confront their obsessions. Or they may try unsuccessfully to use alcohol or drugs to calm themselves.

What causes OCD?

There is growing evidence that OCD has a neurobiological basis. It is no longer attributed to family problems or to attitudes learned in childhood - for example, an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable.

Instead, the search for causes now focuses on the interaction of neurobiological factors and environmental influences. Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioral therapy and medication produce changes in the caudate nucleus, a part of the brain. This is graphic evidence that both psychotherapy and medication affect the brain.

What treatments are available for OCD?

A combination of the two therapies is often an effective method of treatment for most patients. Some individuals respond best to one therapy, some to another.

Pharmacotherapy

Clinical trials in recent years have shown that drugs that affect the neurotransmitter serotonin can significantly decrease the symptoms of OCD. These drugs include fluvoxamine , paroxetine , sertraline , clomipramine and fluoxetine . All these serotonin reuptake inhibitors (SRIs) have proven effective in treatment of OCD. If a patient does not respond well to one SRI, another SRI may give a better response. For patients who are only partially responsive to these medications, research is being conducted on the use of an SRI as the primary medication and one of a variety of medications as an additional drug (an augmenter). Medications are of great help in controlling the symptoms of OCD, but often, if the medication is discontinued, relapse will follow. Most patients can benefit from a combination of medication and behavioral therapy.

Behavior therapy

Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not helpful for OCD. However, a specific behavior therapy approach called " exposure and response prevention " is effective for many people with OCD. In this approach, the patient is deliberately and voluntarily exposed to the feared object or idea, either directly or by imagination, and then is discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand washer may be urged to touch an object believed to be contaminated, and then may be denied the opportunity to wash for several hours. When the treatment works well, the patient gradually experiences less anxiety from the obsessive thoughts and becomes able to do without the compulsive actions for extended periods of time.

Studies of behavior therapy for OCD have found it to produce long-lasting benefits. To achieve the best results, a combination of factors is necessary: The therapist should be well trained in the specific method developed; the patient must be highly motivated; and the patient's family must be cooperative. In addition to visits to the therapist, the patient must be faithful in fulfilling "homework assignments." For those patients who complete the course of treatment, the improvements can be significant. With a combination of pharmacotherapy and behavioral therapy, the majority of OCD patients will be able to function well in both their work and social lives. The ongoing search for causes, together with research on treatment, promises to yield even more hope for people with OCD and their families.

What other physical or emotional illnesses can accompany OCD?

OCD is sometimes accompanied by depression , eating disorders , substance abuse , attention deficit hyperactivity disorder , or other anxiety disorders. When a person also has other disorders, OCD is often more difficult to diagnose and treat. Symptoms of OCD can also coexist and may even be part of a spectrum of neurological disorders, such as Tourette's syndrome. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD.