What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is an anxiety disorder in which time 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.
Many people have focused thoughts or repeated behaviors. But these do not disrupt daily life and may add structure or make tasks easier. For people with OCD, thoughts are persistent and routines are rigid and not doing them causes great distress. Many people with OCD know or suspect their obsessions are not true; others may think they could be true (known as poor insight). Even if they know their obsessions are not true, people with OCD have a hard time keeping their focus off the obsessions or stopping the compulsions.
A diagnosis of OCD requires the presence of obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social or other important function. About 1.2 percent of Americans have OCD and among adults slightly more women than man are affected. OCD often begins in childhood, adolescence or early adulthood; the average age symptoms appear is 19 years old.
- Obsessions and Compulsions
Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust. Many people with OCD recognize that the thoughts, impulses, or images are a product of their mind and are excessive or unreasonable. Yet these intrusive thoughts cannot be settled by logic or reasoning. Most people with OCD try to ignore or suppress such obsessions or offset them with some other thought or action. Typical obsessions include excessive concerns about contamination or harm, the need for symmetry or exactness, or forbidden sexual or religious thoughts.
Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors are aimed at preventing or reducing distress or a feared situation. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible. Compounding the anguish these rituals cause is the knowledge that the compulsions are irrational. Although the compulsion may bring some relief to the worry, the obsession returns and the cycle repeats over and over.
Some examples of compulsions:
- Cleaning to reduce the fear that germs, dirt, or chemicals will "contaminate" them some spend many hours washing themselves or cleaning their surroundings.
- Repeating to dispel anxiety, some people utter a name or phrase or repeat a behavior several times. They know these repetitions won’t actually guard against injury but fear harm will occur if the repetitions aren’t done.
- Checking to reduce the fear of harming oneself or others by, for example, forgetting to lock the door or turn off the gas stove, some people develop checking rituals. Some people repeatedly retrace driving routes to be sure they haven’t hit anyone.
- Ordering and arranging to reduce discomfort, some like to put objects, such as books in a certain order, or arrange household items “just so,” or in a symmetric fashion.
- Mental compulsions to response to intrusive obsessive thoughts, some people silently pray or say phrases to reduce anxiety or prevent a dreaded future event.
One effective treatment is a type of cognitive-behavioral therapy known as exposure and response prevention. During treatment sessions, patients are exposed to the 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 the 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.
A class of medications known as selective serotonin reuptake inhibitors (SSRIs) is effective in the treatment of OCD. Patients who do not respond to one medication sometimes respond to another. Other psychotropic medications can also be effective. Noticeable benefit usually takes six to twelve weeks to occur.
Patients with OCD who have received appropriate treatment have shown to have increased quality of life and improved functioning. Successful treatment may improve the individual's ability to attend school, work, develop and enjoy relationships and pursue leisure activities.
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.
Other conditions sharing some features of OCD occur more frequently in family members of OCD patients. These include, for example, body dysmorphic disorder (preoccupation with imagined ugliness), hypochondriasis (preoccupation with physical illness), trichotillomania (hair pulling), some eating disorders such as binge eating disorder, and neurologically based disorders such as Tourette’s syndrome.
- Body Dysmorphic Disorder
- Hoarding Disorder
- Hair-Pulling Disorder (Trichotillomania)
- Skin-Picking Disorder (Excoriation)
Physician Review By:
Tristan Gorrindo, M.D.
Ranna Parekh, M.D., M.P.H.