Obsessive-compulsive disorder (OCD) is an anxiety]]> disorder. The person suffers from unwanted repetitive thoughts and behaviors. These obsessive thoughts and compulsive behaviors are very difficult to overcome. If severe and untreated, OCD can destroy the ability to function at work, school, or home.
The cause is unknown. OCD might be due to neurobiological, environmental, genetic, and psychological factors. An imbalance of serotonin (a brain chemical) may play a major role.
OCD is linked to other neurological disorders, including:
- Tourette syndrome]]>
- Trichotillomania—the repeated urge to pull out scalp hair, eyelashes, eyebrows, or other body hair
- Body dysmorphic disorder—imaginary or exaggerated defects in appearance
- Eating disorders (such as ]]>bulimia]]> or ]]>anorexia nervosa]]> )
- ]]>Substance abuse]]>
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
- Obsessions—unwanted, repetitive, and intrusive ideas, impulses, or images
- Compulsions—repetitive behaviors or mental acts to reduce the distress associated with obsessions
People with OCD may know that their thoughts and behaviors do not make sense. And they would like to avoid or stop them. But they are often unable to block their obsessive thoughts or compulsions.
- Persistent fears that harm may come to self or a loved one
- Unreasonable concern with being contaminated
- Unacceptable religious, violent, or sexual thoughts
- Excessive need to do things correctly or perfectly
- Persistent worries about a tragic event
- Excessive checking of door locks, stoves, water faucets, light switches, etc.
- Repeatedly making lists, counting, arranging, or aligning things
- Collecting and hoarding useless objects
- Repeating routine actions a certain number of times until it feels just right
- Unnecessary rereading and rewriting
- Mentally repeating phrases
- Repeatedly washing hands
OCD is usually diagnosed through a psychiatric assessment. OCD is diagnosed when obsessions and/or compulsions either:
- Cause a person significant distress
- Interfere with a person’s ability to properly perform at work, school, or in relationships
Treatment reduces OCD thoughts and behaviors. But treatment does not completely eliminate them. Most commonly, treatment is a combination of medication and cognitive behavioral therapy.
Selective serotonin reuptake inhibitors (SSRIs) reduce OCD symptoms by affecting the neurotransmitter serotonin. This function is independent of their antidepressant effects. SSRIs include:
***Please note FDA Public Health Advisory for Antidepressants:
The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose. Although the warning is for all antidepressants, of most concern are the SSRI class such as:
- Prozac ( ]]>fluoxetine]]> ), Zoloft ( ]]>sertraline]]> ), Paxil ( ]]>paroxetine]]> ), Luvox ( ]]>fluvoxamine]]> ), Celexa ( ]]>citalopram]]> ), Lexapro( ]]>escitalopram]]> )
Other medications used include ]]>clomipramine (Anafranil)]]> and ]]>clonazepam (Klonopin)]]> . Clomipramine is a tricyclic antidepressant drug that alters serotonin levels. Clonzepam is a benzodiazepine that relieves anxiety.
Behavioral therapy addresses the actions associated with OCD; cognitive behavioral therapy (CBT) addresses both the thought processes and the actions associated with OCD.
Examples of therapies used to treat OCD include:
Exposure and response prevention—helps you gradually confront the feared object or obsession without giving in to the compulsive ritual linked to it
- In patients who are also taking SSRIs, this form of therapy may be more effective than stress management training. ]]>*¹]]>
- Aversion therapy—use of painful stimulus to prevent OCD behavior
- Thought switching—patient learns to replace negative thoughts with positive thoughts
- Flooding—intense exposure to object that causes OCD behavior
- Implosion therapy—repeated exposure to object that causes fear
- Thought stopping—patient learns to stop negative thoughts
An implantable brain device has received limited FDA approval to treat severe cases of OCD. Often called a brain pacemaker, the device delivers mild electrical impulses to the brain to interrupt OCD symptoms.
Anxiety Disorders Association of America
National Institute of Mental Health
National Institutes of Health
Canadian Mental Health Association
Canadian Psychological Association
Fauci AS, Braunwald E, Isselbacher KJ, et al. Harrison's Principles of Internal Medicine . 14th ed. New York, NY: The McGraw-Hill Companies; 2000.
Obsessive-compulsive disorder (OCD). National Institute of Mental Health, National Institutes of Health website. Available at: http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml . Accessed June 8, 2008.
OCD risk higher when several variations in gene occur together. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/science-news/2008/ocd-risk-higher-when-several-variations-in-gene-occur-together.shtml . Accessed April 1, 2009.
Professional Guide to Diseases , 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.
Questions and answers about obsessive compulsive disorders. Obsessive Compulsive Foundation website. Available at: http://www.ocfoundation.org/UserFiles/File/Questions-Answers-About-OCD.pdf . Accessed April 1, 2009.
Reclaim DBS therapy for obsessive compulsive disorder. Medtronics website. Available at: http://www.medtronic.com/ocd/ . Accessed April 1, 2009.
*¹4/16/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Simpson HB, Foa EB, Liebowitz MR, et al. A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. Am J Psychiatry. 2008;165:621-630. Epub 2008 Mar 3.
Last reviewed April 2009 by ]]>Rosalyn Carson-DeWitt, MD]]>
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