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Obsessive-Compulsive Disorder

(OCD)
by Amy Scholten, MPH
Definition

Obsessive-compulsive disorder (OCD) is an anxiety disorder. The person suffers from unwanted repetitive thoughts and behaviors. These obsessive thoughts and compulsive behaviors are very difficult to overcome. If severe and untreated, OCD can destroy the ability to function at work, school, or home.

Causes

The cause is unknown. OCD might be due to neurobiological, environmental, genetic, and psychological factors. An imbalance of serotonin (a brain chemical) may play a major role.

OCD is linked to other neurological disorders, including:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

Symptoms

Symptoms:

  • Compulsions—repetitive behaviors or mental acts to reduce the distress associated with obsessions
  • Obsessions—unwanted, repetitive, and intrusive ideas, impulses, or images

People with OCD may know that their thoughts and behaviors do not make sense. And they would like to avoid or stop them. But they are often unable to block their obsessive thoughts or compulsions.

Common obsessions:

  • Excessive need to do things correctly or perfectly
  • Persistent fears that harm may come to self or a loved one
  • Persistent worries about a tragic event
  • Unacceptable religious, violent, or sexual thoughts
  • Unreasonable concern with being contaminated

Common compulsions:

  • Collecting and hoarding useless objects
  • Excessive checking of door locks, stoves, water faucets, light switches, etc.
  • Mentally repeating phrases
  • Repeatedly making lists, counting, arranging, or aligning things
  • Repeatedly washing hands
  • Repeating routine actions a certain number of times until it feels just right
  • Unnecessary rereading and rewriting
Diagnosis

OCD is usually diagnosed through a psychiatric assessment. OCD is diagnosed when obsessions and/or compulsions either:

  • Cause a person significant distress
  • Interfere with a person’s ability to properly perform at work, school, or in relationships
Treatment

Treatment reduces OCD thoughts and behaviors. But treatment does not completely eliminate them. Most commonly, treatment is a combination of medication and cognitive behavioral therapy.

Treatments include:

Medications

Selective serotonin reuptake inhibitors (SSRIs) reduce OCD symptoms by affecting the neurotransmitter serotonin. This function is independent of their antidepressant effects. SSRIs include:

  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Other medications used include clomipramine (Anafranil) and clonazepam (Klonopin) . Clomipramine is a tricyclic antidepressant drug that alters serotonin levels. Clonzepam is a benzodiazepine that relieves anxiety.

Therapy

Behavioral therapy addresses the actions associated with OCD; cognitive behavioral therapy (CBT) addresses both the thought processes and the actions associated with OCD.

Examples of therapies used to treat OCD include:

  • Exposure and response prevention—helps you gradually confront the feared object or obsession without giving in to the compulsive ritual linked to it
    • In patients who are also taking SSRIs, this form of therapy may be more effective than stress management training.
  • Aversion therapy—use of painful stimulus to prevent OCD behavior
  • Flooding—intense exposure to object that causes OCD behavior
  • Implosion therapy—repeated exposure to object that causes fear
  • Thought stopping—patient learns to stop negative thoughts
  • Thought switching—patient learns to replace negative thoughts with positive thoughts
Future Treatment

An implantable brain device has received limited FDA approval to treat severe cases of OCD. Often called a brain pacemaker, the device delivers mild electrical impulses to the brain to interrupt OCD symptoms.

Prevention

There are no guidelines for preventing OCD because the cause is not known. But early intervention may help before it becomes worse.

Last reviewed: September 2011 by Ryan Estevez, MD, PhD, MPH.

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