Alternative names

Obsessive-compulsive neurosis; OCD

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 (such as handwashing) or a mental act (such as 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.

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.

Similarly, although there are several studies showing brain abnormalities in patients with OCD, but these inconsistent results require more investigation.

Interestingly, 20% of OCD sufferers also have motor tics, suggesting it may be related to Tourette syndrome, but this link is not clear.

Symptoms

The symptoms are obsessions or compulsions that cause significant distress or interference with everyday life, and are not due to medical illness or drug use. The person usually 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 exam is performed to rule out physical causes, and a psychiatric evaluation is given to rule out other psychiatric disorders. Questionnaires, such as the Yale-Brown Obsessive Compulsive Scale, can help diagnosis OCD and track the progress of treatment.

Treatment

OCD is treated using medications and psychotherapy.

The first medication considered is usually an antidepressant, which is often effective and lacks severe side effects. These antidepressants are known as selective serotonin reuptake inhibitors (SSRI). They seem effective in treating OCD by increasing the serotonin available in the brain. SSRIs include fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).

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, difficulty starting urination, dry mouth, and a drop in blood pressure when rising from a seated position.

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.

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. Call if your compulsion is consuming an inordinate amount of time, energy, or resources.

Prevention

There is no known prevention for this disorder.

Reviewed: 01/2006