Q and A: Obsessive-Compulsive Disorder
People with obsessive-compulsive disorder (OCD) suffer from recurrent, unwanted thoughts
(obsessions) or repetitive behaviors (compulsions), which they feel they cannot control.
Rituals such as hand-washing, counting, checking, or cleaning are often performed
in hope of preventing obsessive thoughts or making them go away. Performing these
rituals, however, provides only temporary relief. Not performing them markedly increases
anxiety. Left untreated, obsessions and the need to perform rituals can take over
a person's life. OCD is often a chronic, relapsing illness.
People with these symptoms, may feel ashamed to talk about them. They also worry that
they are crazy, or think that nothing could possibly help. Fortunately, effective
treatments have been developed to help people with OCD.
How common is OCD?
It is estimated that 2.2 million American adults may be affected by OCD during the
course of their lives. This is roughly equally split between men and women. Individuals
with OCD often notice symptoms during childhood. Early onset OCD has been reported
in children as young as 2 years old. Some evidence suggests OCD may run in families.
How does the American Psychiatric Association define OCD?
As the name implies, OCD is characterized by obsessive thoughts and compulsive behaviors.
That means that people with OCD have persistent thoughts about certain things and
incessantly perform certain behaviors.
What are obsessions?
Obsessions include the following:
Recurrent and persistent, intrusive, inappropriate thoughts that cause stress or anxiety.
This leads to efforts to dismiss those thoughts
Thoughts that are not simply excessive worries about real-life problems
Recognition that the thoughts are a product of his or her own mind
What are compulsions?
Compulsions include the following:
Repetitive behaviors (for example, hand-washing) or mental behaviors (for example,
counting and repeating words or phrases)
Behaviors that are aimed at preventing distress. These are not realistically connected
with what they are intended to lessen the effect of.
Other reasons that a person would be considered to have OCD:
The person recognizes the obsessions or compulsions are excessive and unreasonable.
The obsessions or compulsions cause marked distress, are time-consuming, and interfere
with the person’s life.
The particular obsession or compulsion is not a specific symptom of some other mental
The obsessions and compulsions are not due to a substance (alcohol, drugs, or medicines).
What causes OCD?
There is growing evidence that the major basis of OCD is neurobiologic. Family problems
or attitudes learned in childhood—for example, an unreasonable emphasis on cleanliness
or a belief that certain thoughts are dangerous or unacceptable—are no longer considered
primary and may not be involved at all. Genetic predisposition is currently being
studied to establish a family link in this disorder.
Brain imaging studies using a technique called positron emission tomography (PET)
have compared people with and without OCD. Those with OCD have patterns of brain activity
that differ from people with other mental illnesses or people with no mental illness
at all. In addition, PET scans show that in patients with OCD, both behavioral therapy
and medicines produce changes in the brain. This is graphic evidence that both psychotherapy
and medicines affect the brain.
What treatments are available for OCD?
Both medicines and psychotherapy have proven to be effective in most cases of OCD,
and a combination of both is even more effective.
Several medicines are effective in helping people with OCD. These include clomipramine
(a tricyclic antidepressant), or the SSRI (selective serotonin reuptake inhibitors),
and antidepressants. Fluoxetine, fluvoxamine, sertraline, citalopram, escitalopran, and
paroxetine are examples of antidepressants. If one medicine is not effective, others
should be tried.
A type of behavioral therapy known as "exposure and response prevention" is very useful
for treating OCD. In this approach, a person is voluntarily exposed to whatever triggers
the obsessive thoughts. He or she is then taught techniques to avoid performing the
compulsive rituals and to deal with the anxiety. Cognitive psychotherapy also can
Can people with OCD also have other physical or emotional illnesses?
OCD sometimes is accompanied by depression, eating disorders, substance abuse, attention
deficit hyperactivity disorder, or other anxiety disorders. When a person also has
other disorders, OCD often is more difficult to diagnose and treat. Symptoms of OCD
also can coexist and may even be part of a spectrum of neurologic disorders, such
as Tourette's syndrome. Appropriate diagnosis and treatment of other disorders is
important to successful treatment of OCD. It is important that the OCD sufferer have
an initial evaluation by a psychiatrist or other mental health specialist to make
sure of a correct diagnosis.