Q and A: Obsessive-Compulsive Disorder
People with obsessive-compulsive disorder (OCD) have recurrent, unwanted thoughts
(obsessions) and repetitive behaviors (compulsions), which they feel they can't control.
Rituals such as handwashing, counting, checking, or cleaning are often done in hope
of preventing obsessive thoughts or making them go away. But, these rituals provide
only temporary emotional relief. Not doing them greatly increases anxiety. Left untreated,
obsessions and the need to do 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?
About 2.2 million American adults may be affected by OCD during their lives. This
is split between men and women. People 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.
What are obsessions?
Obsessions include:
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Recurrent and persistent, intrusive, inappropriate thoughts that cause stress or anxiety.
This leads to efforts to dismiss those thoughts.
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Thoughts that are not simply excessive worries about real-life problems
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Recognition that the thoughts are a product of their own mind
What are compulsions?
Compulsions include:
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Repetitive behaviors (for example, handwashing) or mental behaviors (for example,
counting and repeating words or phrases)
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Behaviors that are aimed at preventing distress. These are not realistically connected
with what they are intended to lessen the effect of. These behaviors usually come
before an almost uncontrollable drive to do them.
Other qualifiers
Other reasons that a person would be considered to have OCD:
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The person recognizes the obsessions or compulsions are excessive and unreasonable.
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The obsessions or compulsions cause marked distress, are time-consuming, and interfere
with the person’s life.
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The obsession or compulsion is not a specific symptom of some other mental disorder.
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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 in the brain and nervous
system. 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. A genetic link is currently
being studied as a possible cause of OCD.
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 people with OCD, both behavioral therapy
and medicines produce changes in 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 a tricyclic
antidepressant, SSRIs (selective serotonin reuptake inhibitors), and other antidepressants.
There are many options. If one doesn't work well, talk with your healthcare provider
about trying another.
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. They are then taught ways to avoid doing the compulsive rituals
and to deal with the anxiety. Cognitive psychotherapy also can be effective.
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 harder 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's important that the person with OCD have an initial evaluation
by a psychiatrist or other mental health specialist to make sure of a correct diagnosis.