Obsessive-Compulsive Disorder
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Definition
Obsessive-compulsive disorder is an anxiety disorder characterized by obsessions or compulsions having one or both is sufficient for the diagnosis. An obsession is a recurrent and intrusive thought, feeling, idea, or sensation. A compulsion is a conscious, recurrent pattern of behavior a person feels driven to perform.
This behavior can be a physical action (e.g., handwashing) or a mental act (e.g., praying, repeating words silently, counting). The behavior is aimed at neutralizing anxiety or distress. One example of this is excessive handwashing intended to ward off infection.
Alternative Names
Obsessive-compulsive neurosis; OCD
Causes, incidence, and risk factors
OCD was previously believed to be rare. However, recent data show that 2-3% of people, or about 7 million Americans, suffer from this disorder. OCD usually is noticed between the ages of 20 and 30, and 75% of those who will develop it show symptoms by age 30.
There are several psychological theories about the cause of OCD, but none has been confirmed. Some reports associate OCD with head trauma or infections, but no link has been proven.
Similarly, although there are several studies showing brain abnormalities in patients with OCD (decreased caudate size, decreased white matter) the results are inconsistent and still under investigation.
Interestingly, 20% of OCD sufferers also have motor tics, suggesting it may be related to Tourette Syndrome, but this link has not been proven or explained.
Symptoms
The symptoms are obsessions or compulsions that cause significant distress or interference with every day life, and are not due to medical illness or drug use. The person recognizes that the behavior is excessive or unreasonable.
Signs and tests
The person’s own description of the behavior usually leads to diagnosis of the disorder. A physical examination is performed to rule out physical causes, and a psychological evaluation is given to rule out other psychiatric disorders. Questionnaires, such as the Yale-Brown Obsessive Compulsive Scale, can help in making the diagnosis.
Treatment
OCD is treated using medications and psychotherapy.
The first medication considered is usually an SSRI antidepressant, since these are often effective and do not have severe side effects. SSRIs, or selective serotonin reuptake inhibitors, treat OCD by increasing the serotonin available in the brain. They include fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).
If an SSRI antidepressant is not effective, clomipramine, a tricyclic antidepressant, may be prescribed. Clomipramine, the oldest medication treatment for OCD, is more effective than SSRI antidepressants but has more numerous and unpleasant side effects, including sedation, urinary retention (difficulty initiating urination), orthostatic hypotension (drop in blood pressure when rising from a seated position), and dry mouth.
In more resistant cases, an SSRI and clomipramine may be combined. While other medications, such as benzodiazepines, may offer some relief from anxiety, they are generally used only in conjunction with the more reliable treatments.
Psychotherapy, which may occur on an individual basis or in a group setting, is used to reduce anxiety, resolve inner conflicts, and provide effective ways of reducing stress.
Behavioral therapies are often employed and may include:
* Exposure/response prevention: the person is repeatedly exposed to a situation that triggers anxiety symptoms, and learns to resist the urge to perform the compulsion.
* Thought stopping: the person learns to stop unwanted thoughts and focus attention on relieving anxiety.
Expectations (prognosis)
OCD is a chronic illness which, like other psychiatric illnesses, has periods of exacerbation followed by periods of relative improvement, though a completely symptom free interval is generally unusual. With treatment, most sufferers have considerable improvement, though total remission is fairly uncommon.
Complications
The most likely long-term consequences of OCD are related to the nature of the obsessions or compulsions. For example, constant handwashing can cause skin breakdown. However, OCD does not ordinarily “progress” into another disease.
Calling your health care provider
Call for an appointment with your health care provider if your obsession is interfering with daily life, work, or relationships; or if your compulsion is consuming an inordinate amount of time, energy, or resources.
Prevention
There is no known prevention for this disorder.
Revision date: June 14, 2011
Last revised: by Janet A. Staessen, MD, PhD
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