Download Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder
(OCD)
Definition
Do you wipe off the doorknobs in your home each time someone touches them?
Do you go to great lengths to avoid stepping on cracks in the sidewalk? Or do
you feel compelled to wash your hands so often that they've become raw and
chapped?
Feeling driven to perform such rituals over and over may indicate that you have
obsessive-compulsive disorder (OCD). If you have obsessive-compulsive
disorder, ritualistic behaviors may literally take over your life. You have
distressing, unwanted thoughts or images that don't make sense to you. These
thoughts or images keep coming back despite your efforts to ignore them. You
may strive to hide OCD from friends and co-workers for fear of being labeled
"crazy."
But obsessive-compulsive disorder, a type of anxiety disorder, is probably more
common than you think. And it can affect both adults and children. Because the
obsessions and compulsions can be so hard to disregard, OCD can become
disabling and chronic. But the good news is that treatment can help bring
obsessive-compulsive disorder under control.
Symptoms
Obsessive-compulsive disorder symptoms include both obsessions and
compulsions. OCD symptoms can be severe and time-consuming. For instance,
someone who feels that his or her hands have become contaminated by germs
— an obsession — may spend hours washing them each day — a compulsion.
The focus on hand washing may be so great that he or she can accomplish little
else.
Obsessions
OCD obsessions are repeated, persistent, unwanted ideas, thoughts, images or
impulses that you experience involuntarily and that appear to be senseless.
These obsessions typically intrude when you're trying to think of or do other
things.
Typical OCD obsessions revolve around:
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Fear of contamination or dirt
Repeated doubts
Having things orderly and symmetrical
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Aggressive or horrific impulses
Sexual images
OCD symptoms involving obsessions may include:
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Fear of being contaminated by shaking hands or by touching objects
others have touched
Doubts that you've locked the door or turned off the stove
Repeated thoughts that you've hurt someone in a traffic accident
Intense distress when objects aren't orderly, lined up properly or facing the
right way
Images of hurting your child
Impulses to shout obscenities in inappropriate situations
Avoidance of situations that can trigger obsessions, such as shaking
hands
Replaying pornographic images in your mind
Dermatitis because of frequent hand washing
Skin lesions because of picking at the skin
Hair loss or bald spots because of hair pulling
Compulsions
Compulsions are repetitive behaviors that you feel driven to perform. These
repetitive behaviors are meant to prevent or reduce anxiety or distress related to
your obsessions. For instance, if you believe you ran over someone in your car,
you may return to the scene over and over because you just can't shake your
doubts. You may even make up rules or rituals to follow that help control the
anxiety you feel when having obsessive thoughts.
Typical compulsions revolve around:
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Washing and cleaning
Counting
Checking
Demanding reassurances
Repeating actions over and over
Arranging and making items appear orderly
OCD symptoms involving compulsions may include:
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Washing hands until the skin becomes raw
Checking doors repeatedly to make sure they're locked
Checking the stove repeatedly to make sure it's off
Counting in certain patterns
Causes
What causes obsessive-compulsive disorder isn't fully understood. Main theories
include:
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Biology. Some researchers believe OCD is a result of changes in your
body's own natural chemistry.
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Environment. Some researchers believe that OCD stems from behavior
habits that you learn over time.
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Insufficient serotonin. An insufficient level of serotonin, one of your
brain's chemical messengers, may contribute to obsessive-compulsive
disorder. Some studies that compare images of the brains of people who
have obsessive-compulsive disorder with the brains of those who don't
show differences in brain-activity patterns. In addition, people with
obsessive-compulsive disorder who take medications that enhance the
action of serotonin often have fewer symptoms.
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Strep throat. Some studies suggest that some children develop OCD
after infection with group A beta-hemolytic streptococcal pharyngitis —
strep throat. Some research suggests that an antibody against strep throat
bacteria sometimes mistakenly acts like a brain enzyme. This disrupts
communication between neurons in the brain and may trigger OCD.
However, these studies are controversial and more evidence is needed
before strep throat can be blamed.
Risk factors
It was once thought that obsessive-compulsive disorder was a rare condition. But
it's now known to be more common than many other mental illnesses. In fact,
about 2.2 million Americans have obsessive-compulsive disorder, according to
the National Institute of Mental Health.
Obsessive-compulsive disorder doesn't affect just adults. The disorder often
begins during adolescence or early childhood, usually around age 10. In adults,
OCD typically begins around age 21.
Several factors can increase the risk of developing obsessive-compulsive
disorder, including:
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Family history. Having parents or other family members with the disorder
can increase your risk of developing OCD. However, researchers haven't
identified any genes responsible for obsessive-compulsive disorder.
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Stressful life events. If you tend to react strongly to stress, your risk may
increase. This reaction may, for some reason, trigger the intrusive
thoughts, rituals and emotional distress characteristic of obsessivecompulsive disorder.
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Pregnancy. Some studies show that pregnant women and new mothers
are at increased risk, but it's not clear why. In these cases, OCD
symptoms center mainly on thoughts of harming the baby.
When to seek medical advice
There's a difference between being a perfectionist and having obsessivecompulsive disorder. Perhaps you keep the floors in your house so clean that
you could eat off them. Or you like your knickknacks arranged just so. That
doesn't necessarily mean that you have obsessive-compulsive disorder.
In OCD, your quality of life can decrease dramatically as the condition dictates
most of your days and you become consumed with carrying out compulsive
behaviors and rituals. Most adults can recognize that their obsessions and
compulsions don't make sense. Children, however, may not understand what's
wrong. But the lives of both children and adults can be severely affected by OCD.
Children may find it difficult to attend school, and adults may find it difficult to
work. Relationships also suffer.
If your obsessions and compulsions are affecting your life, talk to your health
care professional, such as your primary care doctor or mental health
professional. It's common for people with OCD to be ashamed and embarrassed
about the condition. But even if your rituals are deeply ingrained, treatment can
help.
Tests and diagnosis
A mental health professional can diagnose obsessive-compulsive disorder after a
thorough evaluation. Although there aren't any laboratory tests to diagnose OCD,
your doctor may check for physical problems the condition may cause, such as
dermatitis from frequent hand washing.
It's sometimes difficult to diagnose obsessive-compulsive disorder because it
may resemble generalized anxiety disorder or other mental conditions. To help
diagnose obsessive-compulsive disorder, your doctor will ask you questions
about your obsessions, compulsions and emotional well-being and may talk to
your friends and relatives about your behavior.
To be diagnosed with obsessive-compulsive disorder, someone must meet the
criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders
(DSM). This manual is published by the American Psychiatric Association and is
used by mental health professionals to diagnose mental conditions and by
insurance companies to reimburse for treatment.
For OCD to be diagnosed, you must have either obsessions or compulsions, you
must realize that these obsessions and compulsions are excessive or
unreasonable, and they significantly interfere with your daily routine.
Obsessions must meet these specific criteria:
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Recurrent and persistent thoughts, impulses or images that are intrusive
and cause distress
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The thoughts aren't simply excessive worries about real problems in your
life
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You attempt to ignore or suppress these thoughts, images or impulses
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You recognize that these thoughts, images and impulses are a product of
your own mind
Compulsions must meet these specific criteria:
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Repetitive behavior, such as hand washing, or repetitive mental acts, such
as counting silently, that you feel driven to perform
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These behaviors or mental acts are meant to prevent or reduce distress
about unrealistic obsessions
Complications
Left untreated, obsessive-compulsive disorder can make your life unpleasant and
unenjoyable. You may feel that you're being held hostage by OCD because
you're unable to go about your normal routine and activities. School, work and
social relationships all can suffer as more of your time is devoted to your
obsessions and compulsive behavior.
OCD can also increase the risk of suicide because it can be so demoralizing and
distressing. And it increases the risk of alcohol and substance abuse as people
turn to unhealthy coping mechanisms. In some cases, OCD can cause physical
complications. For instance, you may feel compelled to wash your hands so often
and so harshly that you wind up with dermatitis.
Treatments and drugs
Obsessive-compulsive disorder treatment can sometimes be difficult, and it may
not offer a cure. However, OCD treatment can help you bring symptoms under
control so that they don't rule your daily life.
OCD treatment has two main components: psychotherapy and medications.
Psychotherapy
A type of therapy called cognitive behavior therapy has been shown to be the
most effective form of therapy for OCD in both children and adults. Cognitive
behavior therapy involves retraining your thought patterns and routines so that
compulsive behaviors are no longer necessary. One approach in particular is
called exposure and response prevention. This therapy involves gradually
exposing you to a feared object or obsession, such as dirt, and teaching you
healthy ways to deal with it. Learning the techniques and new thought patterns
takes effort and practice, but it's worth it. Most people with obsessive-compulsive
disorder show improvement of signs and symptoms with cognitive behavior
therapy.
Medications
Most people with OCD benefit from taking certain psychiatric medications. Some
medications have been specifically approved by the Food and Drug
Administration to treat OCD, such as the antidepressants clomipramine
(Anafranil), paroxetine (Paxil), fluvoxamine and sertraline (Zoloft). However,
many other antidepressant medications on the market may also be used to treat
OCD off-label — that is, even if they haven't been specifically FDA approved for
that use. Antidepressants may be helpful for OCD because they may help
increase levels of serotonin, which may be deficient in OCD. All of these
medications have side effects and safety concerns, and you may need to try
several medications before finding one that's both effective and tolerable.
Prevention
There's no specific way to prevent obsessive-compulsive disorder from
developing, since its cause isn't known. However, getting treatment as soon as
possible can help prevent OCD from worsening.
Lifestyle and home remedies
Obsessive-compulsive disorder is a chronic condition, which means it may be
part of your life for the long term. However, psychotherapy, medications and selfcare can help you control OCD symptoms so that you can live a normal life.
Self-care steps you can follow include:
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Sticking to your treatment plan, even if it's sometimes uncomfortable or
challenging
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Taking your medications as directed and talking to your health care
professionals about side effects or other concerns
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Joining a support group to share experiences with others in a similar
situation
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Enlisting support of loved ones who can offer encouragement in tough
times
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Learning about your disorder so that you understand the myths and
realities
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Avoiding alcohol and illicit drugs as coping mechanisms
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Getting involved in social activities, rather than isolating yourself