Definition

Obsessive-Compulsive Disorder (OCD) is classed as an Anxiety Disorder in the DSM-IV. Individuals suffering from OCD are hampered by persistent obsessions and/or compulsions that are significantly distressing and difficult to avoid. These dysfunctional preoccupations can also take up a considerable amount of a person's time and significantly interfere with the person's normal functioning (e.g., work performance and interpersonal relationships). For these reasons, it is not uncommon for individuals to also contend with depression and anxiety.

Obsessions are essentially ideas, thoughts, impulses, or images that are intrusive, repetitive and often disturbing. They tend to be experienced as uncontrollable and are often associated with a fear of losing control. They are also rarely acted upon and individuals typically try to suppress or neutralize them with other thoughts or actions.

Compulsions are repetitive, stereotyped and intentional acts that are performed in response to an obsession or according to certain rules. They are frequently excessive and unrealistic and are designed to neutralize or prevent either discomfort or some feared event or situation.

Research is indicating that OCD is equally common amongst males and females, and less common among African-Americans. In addition, according to the latest Report of the Surgeon General on Mental Health, the one year prevalence rate for OCD in the general population has been estimated at 2.4%.

Symptoms

OCD symptoms may be conceptualized in terms of the two categories outlined above. It should be noted however, that OCD affects individuals in many different ways; symptoms may be different for different people and they may also vary in intensity. In general, symptoms are unwanted and distressing, time-consuming, and significantly interfere with a person's normal functioning.

Common obsessions can include: themes of aggression or violence (e.g., killing a loved one), dirt or contamination (e.g., becoming infected through touching things), sex, religion, and doubt (e.g., suffering a nagging uncertainty that one may have done something to hurt another).

Common compulsions can include: cleaning (e.g., hand-washing), checking (e.g., repeatedly making sure that all appliances are safely turned off), touching, and repeating words silently.

Cause(s)

The exact cause of Obsessive-Compulsive Disorder is presently unknown. Research has considered biological, psychodynamic and cognitive-behavioral explanations; however, current clinical research tends to focus on biological and cognitive-behavioral explanations.

Biological investigations of OCD are considering whether certain neurochemical defects in the brain give rise to such behaviors and whether the manifestation of the disorder is rooted in a genetic predisposition; for example, studies have found that a high proportion of the families of individuals with OCD have reported suffering from psychological disorders.

Cognitive-Behavioral explanations of OCD have assumed that a nonspecific, genetic predisposition to experience anxiety and an overcontrolling early home environment may be largely responsible for the manifestation of the disorder. According to this rationale, an overcontrolling home environment may contribute to the formation of rigid standards of personal conduct and a vulnerability to self-criticism. Individuals that come from such a background may consequently be more likely to find seemingly mundane thoughts and images as intolerable. Stressful events and situations may then exacerbate these sensitivities to the point where they give rise to obsessions and compulsive behaviors.

Course

The age of onset is generally in adolescence or early adulthood; however, it may also begin in childhood. It seems to occur earlier in males (peak ages between 13-15 years) than in females (peak ages between 20-24 years). In addition, its onset is usually gradual, but it may persist off-and-on for years.

With this disorder, it is also not uncommon for individuals to suffer for years without treatment. If left unchecked, OCD may significantly impair normal, adaptive functioning and may contribute to such things as job loss and the disruption of marital and other interpersonal relationships.

Treatment

Traditionally, OCD was one of the most notoriously difficult disorders to treat. Most psychotherapeutic approaches (i.e., "talking" therapies) have proved ineffective in eliminating OCD symptoms. Today, however, a combination of medication and cognitive-behavioral treatment has greatly improved the prognosis of the disorder.

Medications that have an effect on the neurotransmitter serotonin have been quite effective in reducing OCD symptoms. Common medications that are prescribed for the disorder include: Luvox (Fluvoxamine), Prozac (Fluoxetine), Anafranil (Clomipramine), Zoloft (Sertraline), Paxil (Paroxetine).

Cognitive-behavioral techniques that have proved particularly effective with the disorder include exposure and response prevention. Exposure requires the individual to confront the source(s) of his/her anxiety and distress through either imaginative exercises or direct encounters, or a combination of both. The basic rationale behind this technique is that multiple exposures to the source(s) of discomfort will reduce an individual's feelings of anxiety. Response Prevention is the other component of treatment and it is concerned with breaking the habit of engaging in compulsive behaviors following exposure to anxiety producing stimuli.

Dealing with Relapse

During a period of stability and wellness, individuals should devise a relapse management plan with their mental health professional and family members or friends that will outline what steps may need to be taken should a relapse occur. The plan will need to identify symptoms that may constitute warning signs and, if they are evident, an agreement should be made by the individual and members of his or her immediate support network to contact the family physician, counselor, or other mental health professional. In addition, methods to reduce stress and stimulation should be established with a counselor so that they can be put into effect pending any relapse.

Emergencies

In the case of an emergency, individuals should call their physician, therapist, or the emergency ward of their local hospital. Additional assistance may also be obtained by clicking on the Further Information and Support link below.

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