Overview
Obsessive-Compulsive Disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things, or cleaning, can significantly interfere with a person’s daily activities and social interactions.
Obsessions
These are upsetting thoughts or impulses that repeatedly occur.
People with OCD may try to ignore or suppress them, but they may be afraid that somehow the thoughts might be true.
The anxiety associated with suppression can also become too great to endure, making them engage in compulsive behaviors to decrease their anxiety.
Compulsions
These are repetitive acts that temporarily relieve the stress and anxiety brought on by an obsession. Often, people who have compulsions believe these rituals will prevent something bad from happening.
How Is OCD Diagnosed?
Therapists will look for three things:
■ The person has obsessions.
■ He or she does compulsive behaviors.
■ The obsessions and compulsions take a lot of time and get in the way of important activities the person values, such as working, going to school, or spending time with friends.
Cause
Health care providers do not know the exact cause of OCD. Factors that may play a role include head injury, infections, and abnormal function in certain areas of the brain. Genes (family history) seems to play a strong role. A history of physical or sexual abuse also appears to increase the risk for OCD.
Parents and teachers often recognize OCD symptoms in children. Most people are diagnosed by age 19 or 20, but some do not show symptoms until age 30.
Symptoms
People with OCD have repeated thoughts, urges, or mental images that cause anxiety. These are called obsessions.
Examples are:
• Excessive fear of germs
• Forbidden thoughts related to sex, religion, or harm to others or self
• Need for order
They also perform repeated behaviors in response to their thoughts or obsessions.
Examples include:
• Checking and rechecking actions (such as turning out the lights and locking the door)
• Excessive counting
• Ordering things in a certain way
• Repeatedly washing the hands to ward off infection
• Repeating words silently
• Praying silently over and over
Not everyone who has habits or rituals they like to perform has OCD. But, the person with OCD:
• Is not able to control their thoughts or behaviors, even when they understand that they are excessive.
• Spends at least an hour a day on these thoughts or behaviors.
• Does not get pleasure from performing a behavior or ritual, other than perhaps brief relief of anxiety.
• Has major problems in daily life due to these thoughts and rituals.
People with OCD may also have a tic disorder, such as:
• Eye blinking
• Facial grimacing
• Shoulder shrugging
• Head jerking
• Repeated clearing of the throat, sniffing, or grunting sounds
Treatment
Cognitive-Behavioral Therapy
One effective treatment is a type of cognitive-behavioral therapy known as exposure and response prevention. During treatment sessions, patients are exposed to situations that create anxiety and provoke compulsive behavior or mental rituals. Through exposure, patients learn to decrease and then stop the rituals that consume their lives. They find that the anxiety arising from their obsessions lessens without engaging in ritualistic behavior. This technique works well for patients whose compulsions focus on situations that can be re-created easily. For patients who engage in compulsive rituals because they fear catastrophic events that can’t be re-created, therapy relies on imagining exposure to anxiety-producing situations. Throughout therapy, the patient follows exposure and response prevention guidelines on which the therapist and patient agree.
Cognitive-behavior therapy can help many OCD patients substantially reduce their OCD symptoms. However, treatment only works if patients adhere to the procedures. Some patients will not agree to participate in cognitive-behavioral therapy because of the anxiety it involves.
Medication – usually a type of antidepressant medicine that can help by altering the balance of chemicals in the brain. The main medicines prescribed are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). An SSRI can help improve OCD symptoms by increasing the levels of a chemical called serotonin in the brain.
Self-help and Coping – Keeping a healthy lifestyle and being aware of warning signs and what to do if they return can help in coping with OCD and related disorders. Also, using basic relaxation techniques, such as meditation, yoga, visualization, and massage, can help ease the stress and anxiety caused by OCD.
Exams and Tests
The diagnosis is made based on an interview of the person and family members. A physical exam can rule out physical causes. A mental health assessment can rule out other mental disorders.
Questionnaires can help diagnose OCD and track the progress of treatment.
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