Obsessive Compulsive Disorder

Some people are organized, some follow a strict routine or schedule each day, but when this obsession with rituals interferes with everyday activities, it becomes something more than just a habit. Obsessive-compulsive disorder, or OCD compels you to use rituals or habits to relieve anxiety caused by obsessions. For those suffering from OCD, obsessions are a constant, persistent, and intrusive worry or annoyance. Both the obsessions and the responses or rituals (called compulsions) can be very disruptive to your life. OCD is not merely the preference to have things “just so” – it is a compulsive drive to control life.

Obsessive-compulsive disorder (OCD) is a recognized medical condition that can affect anyone at any age. OCD is a type of anxiety disorder, distinct from other types of anxiety disorder such as panic disorder or generalized anxiety disorder. The difference between being “uptight” and having OCD is that a person with OCD is driven to engage in repetitive or compulsive behaviors even though he or she may know that the obsessions are unreasonable or that the compulsions are damaging. In OCD, the compulsions are not merely unusual or even excessive: they are disruptive and upsetting, resulting in increased anxiety that creates a cycle, which worsens the condition.

Diagnosis of OCD is based on identification of both obsessive and compulsive symptoms. In general, people with OCD have the following characteristics.

Obsessive Symptoms

You may experience frequent and repetitive thoughts or images that are upsetting. These recurring thoughts or fears often follow a common theme, such as violence, sexuality, or contamination. Common examples include:

• fear of contamination (germs), dirt, or intruders
• thoughts or images of violence
• thoughts of harming loved ones
• sexual thoughts and images
• fear of conflict with religious beliefs
• impulses to act violently or inappropriately

Compulsive Symptoms

You frequently engage in repetitive or ritualistic behaviors with notable frequency. These compulsive behaviors are not “random,” and are meant to reduce the anxiety created by the obsessions, but they only result in very short-lived relief from the anxiety. Compulsions never create long-term well-being, and often enhance anxiety as you recognize their pointlessness. Common examples include:

• Frequent hand-washing or cleaning
• Insistence on specific or symmetrical arrangements of items
• Frequent counting
• Constant checking of door locks or stove settings
• Hoarding of unneeded items

Research into the causes of OCD is ongoing. However, scientists now understand that OCD is caused, at least in part, by imbalances in particular brain-signaling systems. For this reason, antidepressants are particularly effective (specifically SSRI drugs).

According to the Centers for Disease Control and Prevention, anxiety disorders (including OCD and other anxiety disorders) are the most common mental disorders in the general population. Among anxiety disorders, OCD is one of the less common, affecting about 1 percent of the population over a one-year period. Lifetime prevalence (extent of the population experiencing any anxiety disorder) is 15 percent at any given time, 10 percent of the population is suffering from an anxiety disorder. OCD specifically affects about 1% of adults. It can occur at any age, but is often diagnosed by age 19

Obsessive-compulsive disorder (OCD) does not get better by itself, and severe cases can be disabling. Left untreated, the compulsions can substantially reduce quality of life for you and your loved ones and exert a significant burden on you and those around you. 

Various treatments are available for OCD, and many are effective. Treatment can be difficult because the disease does not go away, so treatment usually continues for life. For most, a combination of medications and counseling (psychotherapy) is proven effective. Some more mild cases are managed well with counseling alone.

Therapy

Some new methods in psychotherapy are being used successfully to treat OCD and other anxiety disorders. One is called Cognitive-Behavioral Therapy, or CBT. In CBT, the patient learns to alter thinking patterns that create fear, and to alter behavioral patterns in response to fear triggers. 

Medications

There are two main medications used to treat OCD: anti-anxiety drugs and antidepressants. Anti-anxiety drugs can be effective against OCD. However, antidepressants are usually more effective, and are usually tried first.

Antidepressants often work by increasing the levels of serotonin; for example, selective serotonin reuptake inhibitors (SSRIs) can be very effective in depression. A similar drug, Venlafaxine (also known as Effexor), is often helpful in OCD.

Selective Serotonin Reuptake Inhibitors (SSRI): This class of medication produces the antidepressant effect by increasing serotonin levels in the brain.  It has gained enormous popularity due to limited side effects as compared to the previous generation of antidepressant (Tricyclic antidepressants). SSRI medications are also safer with regard to drug overdose, particularly with suicidal patients.

• SSRI Medications: Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), and Escitalopram (Lexapro).
• Common Side Effects: nausea, diarrhea, jitteriness, restlessness, headache, insomnia, decreased sexual desire, and delayed orgasm.

The brain systems that control fear and worry are similar to – and overlap with – systems involved in mood. OCD almost certainly involves changes in this chemistry and function of the brain, but scientists know relatively little about how and why these alterations occur. However, there are a few known factors that may predispose some to OCD including:

• Significant life events: people who tend to react strongly to stressful events may be at risk for obsessive symptoms.
• Genetic factors: OCD is somewhat more common in people whose biological family members have OCD. This is true of other anxiety disorders.
• Other Mental Disorders: OCD, like other anxiety disorders, can occur in combination with other mental disorders.

There is currently no test to diagnose OCD. However, routine lab tests are performed to exclude diseases that cause anxiety-like symptoms. Psychotherapy can distinguish OCD from other similar disorders (such as generalized anxiety disorder and schizophrenia).

There is no sure way to prevent OCD, because researchers have been unable to pinpoint why some people get it and some don’t. However, taking steps to control stress, maintaining a good support system, and keeping chronic medical illness in control can help manage anxiety. In addition, treatment at the earliest sign of a problem can help prevent OCD from worsening.