Obsessive-Compulsive Disorder

Definition

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.

Frontal Lobe

Frontal lobe

This part of the brain is believed to be the area of impulse control.

© 2008 Nucleus Medical Art, Inc.

Causes

The cause is unknown. OCD might be due to neurobiological, environmental, and psychological factors. An imbalance of serotonin (a brain chemical) may play a major role.

OCD is linked to other neurological disorders, including:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

Symptoms

Symptoms:

  • 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.

Common obsessions:

  • 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

Common compulsions:

  • 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

Diagnosis

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

Treatment reduces OCD thoughts and behaviors. But treatment does not completely eliminate them.

Treatments include:

Medications

Selective serotonin reuptake inhibitors (SSRIs) reduce OCD symptoms by affecting the neurotransmitter serotonin. This function is independent of their antidepressant effects. SSRIs include:

  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern, mostly SSRIs (selective serotonin re-uptake inhibitors), are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.

Another medication used is clomipramine (Anafranil). This is a tricyclic antidepressant drug that alters serotonin levels.

Behavior Therapy (Exposure and Response Prevention)

This helps you gradually confront the feared object or obsession without giving in to the compulsive ritual linked to it.

Prevention

There are no guidelines for preventing OCD because the cause is not known. But early intervention may help before it becomes worse.

RESOURCES:

Anxiety Disorders Association of America
http://www.adaa.org/

National Institute of Mental Health
National Institutes of Health
http://www.nimh.nih.gov/

Obsessive-Compulsive Foundation
http://ocfoundation.org/

CANADIAN RESOURCES:

Canadian Mental Health Association
http://www.cmha.ca/

Canadian Psychological Association
http://www.cpa.ca/

References:

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.



Last reviewed December 2007 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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