Your Health - Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

(OCD)

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

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

Causes

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 )
Hypochondriasis
Substance abuse

Risk Factors

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

Age: late adolescence, early adulthood
Family members with a history of OCD
Other anxiety disorders
Depression
Organic brain syndrome
Schizophrenia
Tourette syndrome
Personality disorder
Attention deficit disorder

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
Persistent worries about a tragic event

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. Most commonly, treatment is a combination of medication and cognitive behavioral therapy.

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:

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 )

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

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.

Therapy

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.
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

Future Treatment

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.

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:

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed July 15, 2009.

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 November 2009 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.