Overview
More than 7 million people in the United States are affected by Obsessive-Compulsive Disorder (OCD), a mental illness that causes patients to have consistent worry and intrusive, stressful thoughts that they compensate for by performing compulsive rituals to alleviate the worries.
A common example is a patient who has an obsession about germs and cleanliness, and compensates by ritual hand washing or cleaning, or a patient who obsesses over their safety in their home, and will repeatedly check the locks on the house.
Obsessions can also be persistent and unwanted thoughts of committing violence, or thoughts that are prohibited by their religion. When the obsessions and rituals cause an interference in daily living or start to harm relationships, treatment is warranted with anti-depressant (Prozac, Zoloft, Lexapro, Paxil, Celexa) and anti-anxiety (Klonopin, Ativan, Xanax) medications, along with cognitive behavioral therapy aimed at changing thoughts, behaviors, and facing and understanding fears. Diagnosis is made after symptoms persist for six months or longer.
Symptoms
People with OCD generally:
- Have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; acts of violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly tidy
- Do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again
- Can't control the unwanted thoughts and behaviors
- Don't get pleasure when performing the behaviors or rituals, but get brief relief from the anxiety the thoughts cause
- Spend at least 1 hour a day on the thoughts and rituals, which cause distress and get in the way of daily life
Diagnosis
First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn't causing the symptoms. The doctor may refer you to a mental health specialist.
Only a trained healthcare provider can diagnose a person with OCD. The severity of the disease is typically measured on a numerical scale gauging the impact thoughts and actions have on daily life.To be diagnosed with OCD, a person must have obsessions, compulsions, or both, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The Quick Reference to the 2000 edition of the DSM suggests that several features characterize clinically significant obsessions and compulsions. Such obsessions, the DSM says, are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and that cause marked anxiety or distress. These thoughts, impulses, or images are of a degree or type that lies outside the normal range of worries about conventional problems. A person may attempt to ignore or suppress such obsessions, or to neutralize them with some other thought or action, and will tend to recognize the obsessions as idiosyncratic or irrational.
Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress. Therefore, while many people who do not suffer from OCD may perform actions often associated with OCD (such as ordering items in a pantry by height), the distinction with clinically significant OCD lies in the fact that the person who suffers from OCD must perform these actions, otherwise they will experience significant psychological distress. These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or they are excessive.
In addition, at some point during the course of the disorder, the individual must realize that their obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day) or cause impairment in social, occupational, or scholastic functioning.
Treatments
First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn't causing the symptoms. The doctor may refer you to a mental health specialist.
OCD is generally treated with psychotherapy, medication, or both.
Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating OCD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively. One type of therapy called exposure and response prevention is especially helpful in reducing compulsive behaviors in OCD.
Medication. Doctors also may prescribe medication to help treat OCD. The most commonly prescribed medications for OCD are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.
Antidepressants are used to treat depression, but they are also particularly helpful for OCD, probably more so than anti-anxiety medications. They may take several weeks—10 to 12 weeks for some—to start working. Some of these medications may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.
It's important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A "black box"—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.
Some people with OCD do better with cognitive behavior therapy, especially exposure and response prevention. Others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.
Causes
Obsessive-compulsive disorder (OCD) is more common than was once thought. Most people who develop it show symptoms by age 30.There are several theories about the cause of OCD, but none have been confirmed. Some reports have linked OCD to head injury and infections. Several studies have shown that there are brain abnormalities in patients with OCD, but more research is needed.
OCD sometimes runs in families, but no one knows for sure why some people have it, while others don't. Researchers have found that several parts of the brain are involved in fear and anxiety. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.
About 20% of people with OCD have tics, which suggests the condition may be related to Tourette syndrome. However, this link is not clear.
Getting Help
If unsure where to go for help, talk to someone you trust who has experience in mental health—for example, a doctor, nurse, social worker, or religious counselor. Ask their advice on where to seek treatment. If there is a university nearby, its departments of psychiatry or psychology may offer private and/or sliding-scale fee clinic treatment options. Otherwise, check the Yellow Pages under "mental health," "health," "social services," "crisis intervention services," "hotlines," "hospitals," or "physicians" for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for a mental health problem, and will be able to tell you where and how to get further help.
Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.
- Family doctors
- Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
- Religious leaders/counselors
- Health maintenance organizations
- Community mental health centers
- Hospital psychiatry departments and outpatient clinics
- University- or medical school-affiliated programs
- State hospital outpatient clinics
- Social service agencies
- Private clinics and facilities
- Employee assistance programs
- Local medical and/or psychiatric societies
Related Information
People with OCD may be diagnosed with a number of other conditions, including:
- Major depressive disorder
- Generalized anxiety disorder
- Anorexia nervosa
- Social anxiety disorder
- Bulimia nervosa
- Tourette syndrome
- Asperger syndrome
- Compulsive skin picking
- Body dysmorphic disorder
- Trichotillomania
- Obsessive compulsive personality disorder
There is some research demonstrating a link between drug addiction and OCD as well. Many who suffer from OCD also suffer from panic attacks. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among OCD patients may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among sufferers of OCD.
Individuals with OCD have also been found to be affected by delayed sleep phase syndrome at a substantially higher rate than the general public.
Living With
Those living with OCD have a difficult time performing day to day tasks. OCD disrupts daily activities by forcing those suffering from the disorder to perform routines and rituals. In some cases, individuals must perform certain activities in a particular order. If the order is disrupted the individual may have to start over from the beginning or suffer from anxiety about the disruption. The time wasted on rituals and routines makes it difficult to accomplish other tasks.
Those suffering from OCD often are aware that the rituals and routines are illogical but they are not able to stop following them. These individuals generally have repeated thoughts or images that won't stop appearing. These thoughts and images can be positive or negative and can have great affects on those suffering from OCD.
If you or someone you know is suffering from OCD it is important to contact a medical professional in order to be assessed and begin treatment.
