What is obsessive-compulsive disorder?
Obsessive-compulsive disorder (OCD) is an illness that causes people to have unwanted thoughts (obsessions) and to repeat certain behaviors (compulsions) over and over again. We all have habits and routines in our daily lives, like brushing our teeth before bed. However, people with OCD have patterns of behavior that get in the way of their daily lives.
Most people with OCD know that their obsessions and compulsions make no sense, but they can’t ignore or stop them.
What are obsessions?
Obsessions are ideas, images and impulses that run through the person’s mind over and over again. A person with OCD doesn’t want to have these thoughts and finds them disturbing, but he or she can’t control them. Sometimes these thoughts just come once in a while and are only mildly annoying. Other times, a person with OCD will have obsessive thoughts all the time.
What are compulsions?
Obsessive thoughts make people with OCD feel nervous and afraid. They try to get rid of these feelings by performing certain behaviors according to “rules” that they make up for themselves. These behaviors are called compulsions. (Compulsive behaviors are sometimes also called rituals.) For example, a person with OCD may have obsessive thoughts about being afraid of germs. Because of these thoughts, the person may spend hours washing his or her hands after using a public toilet. Performing these behaviors usually only makes the nervous feelings go away for a short time. When the fear and nervousness return, the person with OCD repeats the routine all over again.
What are some common obsessions?
The following are some common obsessions:
- Fear of dirt or germs
- Disgust with bodily waste or fluids
- Concern with order, symmetry (balance) and exactness
- Worry that a task has been done poorly, even when the person knows this is not true
- Fear of thinking evil or sinful thoughts
- Thinking about certain sounds, images, words or numbers all the time
- Need for constant reassurance
- Fear of harming a family member or friend
What are some common compulsions?
The following are some common compulsions:
- Cleaning and grooming, such as washing hands, showering or brushing teeth over and over again
- Checking drawers, door locks and appliances to be sure they are shut, locked or turned off
- Repeating, such as going in and out of a door, sitting down and getting up from a chair, or touching certain objects several times
- Ordering and arranging items in certain ways
- Counting over and over to a certain number
- Saving newspapers, mail or containers when they are no longer needed
- Seeking constant reassurance and approval
How common is OCD?
For many years, OCD was thought to be rare. The actual number of people with OCD was hidden, because people would hide their problem to avoid embarrassment. Some recent studies show that as many as 3 million Americans ages 18 to 54 may have OCD at any one time. This is about 2.3% of the people in this age group.
What causes OCD?
No one has found a single, proven cause for OCD. Some research shows that it may have to do with chemical messengers in the brain that carry messages from one nerve cell to another. One of these messengers, called serotonin (say “seer-oh-tone-in”), helps to keep people from repeating the same behaviors over and over again. A person with OCD may not have enough serotonin. Many people with OCD can function better when they take medicines that increase the amount of serotonin in their brain.
Are other illnesses associated with OCD?
People with OCD often have other kinds of anxiety, like phobias (such as fear of spiders or fear of flying) or panic attacks. They often experience depression too. About 70% of adults with OCD have an episode of major depression at some time in their lives. Alcohol and drug abuse can become problems when people with OCD turn to these substances for relief.
Only a few disorders seem to be related to OCD. These disorders include hypochondriasis (fear of being seriously ill when you aren’t sick at all), dysmorphophobia (extreme concern with a small or imagined body defect) and trichotillomania (a compulsion to pull out your own hair). They usually respond to the same medicines that are helpful in treating OCD.
How is OCD treated?
Several medicines are available to treat OCD. These medicines include: clomipramine (brand name: Anafranil), fluoxetine(brand name: Prozac), sertraline (brand name: Zoloft), paroxetine (brand name: Paxil) and fluvoxamine (brand name: Luvox). These drugs can cause side effects such as dry mouth, nausea and drowsiness. Sometimes they also affect a person’s sexual performance. It may be several weeks before a person with OCD notices the benefits of his or her medicine.
Under the guidance of a trained therapist, behavioral therapy can also be used to treat OCD. In behavioral therapy, people face situations that produce their obsessions and anxiety. Then they are encouraged not to perform the rituals that usually help control their nervous feelings. For example, a person who is obsessed with germs might be encouraged to use a public toilet without washing his or her hands more than once. To use this method, a person with OCD must be able to tolerate the high levels of anxiety that can result. Over time, behavioral therapy can make the symptoms of OCD go away.
Revision date: July 3, 2011
Last revised: by Jorge P. Ribeiro, MD