Obsessive Compulsive Disorder (OCD)

Signs that people need to seek medical care are when the thoughts or rituals associated with OCD affect their quality of life.

• Obsessive compulsive disorder (OCD) is characterized by the sufferer experiencing either obsessions or compulsions that occur repeatedly and persistently and interfere with their daily life.
• Obsessions are recurrent thoughts or worries that intrude on the person's normal thinking and that the sufferer knows are excessive or unwarranted.
• Compulsions are repetitive behaviors, loosely defined as habits that the sufferer feels compelled to perform and has difficulty resisting that are either done in response to obsessions or follow rigid rules. Individuals with compulsions may even have anxiety to the point of having panic attacks if not allowed to engage in their compulsive behaviors.
• A small percentage of the general population will likely develop OCD at some time in their life. It tends to run in families and to occur more often in women than men.
• Some studies, however, indicate that OCD may be more prevalent in boys than girls.
• There are many famous, accomplished people who suffer from OCD.
• There are thought to be several types of OCD:
  • washing/cleaning and checking compulsions,
  • symmetry, ordering, and arranging compulsions,
  • hoarding obsessions,
  • excessive sexual or religious thoughts,
  • obsessions in the absence of compulsions,
  • compulsions without obsessions.
• Girls and women are more likely to have obsessions rather than compulsive behavior or a combination of the two types of symptoms as compared to OCD in males, who are more likely to suffer from isolated compulsions.
• The period soon after giving birth (postpartum) carries a higher risk of developing OCD for women.
• Women who already suffer from an avoidant or obsessive-compulsive personality disorder (OCPD) are at even higher risk of developing postpartum obsessive-compulsive disorder. Men may also develop postpartum OCD soon after their partners deliver.

A majority of OCD sufferers also have another mental-health condition. Obsessive compulsive personality disorder is a separate disorder from OCD. It is a pervasive pattern of perfectionism, control, and having things in order that results in sacrificing flexibility and efficiency. OCPD begins by early adulthood and is characterized by a combination of a number of the following symptoms:

• a preoccupation with details, rules, order or schedules; perfectionism that interferes with getting things done; excessive commitment to work and productivity;
• inflexibility about morals, ethics, or values;
• an inability to discard worthless objects, even when they have no sentimental value;
• difficulty delegating tasks to others unless done exactly to the OCPD sufferer's specifications;
• a tendency to hoard money, rigidity, and stubbornness.

Although OCD and OCPD have some symptoms in common, they are clearly separate disorders. Most people who suffer from OCD do not have OCPD and visa versa. However, when individuals with OCD do suffer from a personality disorder, OCPD or schizotypal personality disorders seem to be two of the most common. Schizotypal personality disorder is a pervasive pattern of social and interpersonal problems that is characterized by marked uneasiness with, and inability to engage in, close relationships, as well as distorted ways of thinking and perceiving things and displaying behavioral eccentricities that begin by early adulthood.

Many individuals who have OCD tend to experience dissociation. Dissociation is an unexpected partial or complete interruption of an individual's conscious actions that the sufferer cannot easily explain or recall. It separates a person from their thoughts, recollections, emotions, actions, or sense of self. As dissociation is often associated with a history of being abused, individuals may be more likely to have that history as well.

As it is common for people with OCD to also suffer from social phobia, professionals who treat these disorders often use treatments that address both disorders. Although individuals who suffer from compulsive gambling may have some symptoms of OCD, it is not common for people with compulsive gambling to have full-blown OCD or obsessive compulsive personality disorder. Trichotillomania (TTM) is repeated pulling of one's hair from the head or anywhere on the body to reduce anxiety, resulting in decreased emotional tension combined with hair loss. It is thought to have many features in common with OCD. These two disorders often co-occur. While individuals with OCD often also have eating disorders, which condition occurs first seems to vary.

Obsessive compulsive symptoms can occur as part of autism spectrum disorders, often causing significant distress to those individuals. When full-blown OCD occurs in individuals with Asperger's disorder and other autism spectrum disorders, it seems to be more difficult to treat.

Although OCD has been found to be associated with certain infections, injuries, and brain problems in some people, it is much more commonly thought to be the result of the complex relationship between genetic or biological vulnerability and life stress.

Examples of compulsions include counting, repeating words or actions (for example, checking locks or hand washing), arranging things according to rigid rules, and praying. These behaviors are done for the purpose of preventing or decreasing anxiety or preventing an unrealistic dreaded event. An example of an unrealistic dreaded event is becoming ill if hands are washed less than once every half hour. The symptoms of OCD either significantly interfere with the sufferer's daily routine or functioning (for example, causing insomnia or difficulty concentrating at work), cause significant stress, or take up a lot of time.

In contrast to symptoms of OCD in adults, those in children may include a lack of insight that their obsessions or compulsions are a problem. Symptoms in children may also include

• tantrums when the child's ability to engage in compulsions is prevented.

Symptoms of OCD in teenagers often involve physical (somatic) complaints. While the severity of OCD symptoms can change in their level severity, the kind of symptoms tends to change little in adults compared to children and teens.

Signs that people need to seek medical care are when the thoughts or rituals associated with OCD affect their quality of life. People who have questions about a particular treatment should contact a qualified health-care professional, local medical or mental-health society, or university medical school for additional information.

Because the specific cause of the obsessive-compulsive disorder is unknown, there is no established treatment to cure OCD.

Treatment is aimed at minimizing or relieving symptoms, and some proposed treatments are unproven and may be harmful. Always ask your doctor about any new treatment, including any herbal supplements.

Many health-care professionals may help diagnose OCD: licensed mental-health therapists, family physicians, or other primary-care providers, specialists whom you see for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers. There is no specific test for OCD. Therefore, its diagnosis may be based on the following:

• Certain signs and symptoms must be present, as previously described.
• The professional may use a standardized questionnaire or self-test to help assess your history and current risk of anxiety, depression, and suicide attempts.
• A physical examination and laboratory tests are often done to rule out medical conditions that may cause or worsen anxiety. Examples of such tests include a complete blood count, blood chemistries, thyroid function tests, and liver function tests.
• Your doctor may perform the following imaging studies: an X-ray, scan, or other radiologic study if something that is found on physical exam or in blood tests indicates the need for an imaging study.

Always talk to your doctor about any treatment decisions for OCD. You and your healthcare professional together will develop a treatment program individually tailored to your needs. The treatment program should be based on your overall medical and emotional condition, as well as your current symptoms, and should be modified over time as your symptoms change. This requires regular follow-up visits to your healthcare professional to monitor changes in your condition. Currently, most practitioners use a combination of the therapies discussed below.

Psychological treatments for OCD include cognitive-behavioral therapy, which helps the person counteract negative thoughts that lead to compulsions, as well as exposure and response-prevention therapies.

Behavior modification therapy focuses on helping the OCD sufferer avoid and eventually extinguish the urges to engage in compulsive behaviors while remaining free of anxiety. Examples of behavior therapies include response prevention, which involves delaying and eventually avoiding engaging in compulsions, and exposure, which allows the person with OCD to practice response prevention by repeatedly putting the person in a situation that may lend itself to engaging in compulsions.

Children and adolescents tend to respond very well to exposure-based cognitive behavioral therapy, whether it is provided on an individual basis with the family involved in treatment or care that is provided through group therapy.

• The selective serotonin reuptake inhibitor (SSRI) group of medications is usually considered to be the most desirable treatment for OCD. This is also true for OCD symptoms that occur in the context of autism spectrum disorders. Examples of SSRI medications include sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). The possible side effects of this group of medications can vary greatly from person to person and depend on which medication is being used. Common side effects of SSRIs include dry mouth, sexual dysfunction, nausea, tremors, trouble sleeping, blurred vision, constipation or soft stools, and dizziness. For this group of medications, missing one or more doses may result in sufferers experiencing achiness, tiredness, or stomach upset.
• Tricyclic antidepressants (TCAs) have also effectively treated OCD. Examples of TCAs are clomipramine (Anafranil), amitriptyline (Elavil), and imipramine (Tofranil). Many TCAs are less well tolerated than SSRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance-abuse disorders. Examples of benzodiazepines include clonazepam (Klonopin), lorazepam (Ativan), and alprazolam (Xanax). In very rare cases, some people have been thought to become more acutely anxious or depressed once on any antianxiety/antidepressant medication, even trying to or completing suicide or homicide. Although debate continues about whether the medication or the illness itself is the cause of this rare complication, it is thought to be more likely to occur in children and teens.

As about half of people who receive an adequate trial of SSRI medication fail to experience an adequate decrease in OCD symptoms, the use of other medications and psychotherapies is important. For people who do not respond robustly to the combination of psychotherapy and one medication, some OCD sufferers may improve with the addition of one of the following medications:

• Antipsychotic medications, like olanzapine (Zyprexa), risperidone (Risperdal), or quetiapine (Seroquel): Except in individuals who also suffer from bipolar (manic depressive) disorder, it is unclear how frequently these medications are beneficial in this way.
• Anticonvulsant medications like divalproex sodium (Depakote) or carbamazepine (Tegretol) that have been used to treat bipolar disorder may also be of use in people who simultaneously suffer from both bipolar disorder and OCD.

While certain subtypes of OCD may tend to respond more or less robustly to psychotherapy versus medication, there is enough variability in how individuals respond to treatment that either antipsychotic or antiseizure medication treatment is often considered in each person with OCD.

• In treating postpartum OCD, time is of the essence during this critical time of maternal-infant bonding. Therefore, sometimes faster-acting medications like tramadol (Ultram) are used to treat this disorder. Tramadol is a pain reliever that increases the activity of serotonin, epinephrine, norepinephrine, and opiates that naturally occur in the brain and work rapidly. This is in contrast to medications like SSRIs, which can take weeks to work.

As many people with OCD also experience dissociation, and dissociation is sometimes treated using hypnosis, that intervention is being explored as a treatment for OCD sufferers. For individuals with OCD that also have trichotillomania, it may be that specifically targeting the sufferer's tendency toward perfectionism is a particularly helpful therapeutic technique.

Given that many more people with OCD are seeking behavior therapy than there are enough trained mental health professionals to provide it, an alternative that has been developed to therapist-guided behavior therapy is computer-guided treatment. While it is thought to be somewhat less effective than care that is directly provided by a therapist, it can be helpful when clinician-guided therapy is not available.

A newer psychological intervention for OCD is mindfulness therapy. It involves teaching OCD sufferers about meditative breathing, getting more in touch with how their body responds to stress, as well as being more mindful of how to manage their OCD symptoms on a daily basis.

Regular follow-up is necessary for your health-care professional to monitor your treatment program. Because the treatment program should be based on your overall medical and emotional conditions, as well as current symptoms, it should be modified over time. Visit your health-care professional regularly.

As with most physical and mental health conditions, symptoms of the obsessive-compulsive disorder tend to be worsened by stress, too little or too much exercise, or by a lack of sleep. Avoid these triggers.

Psychological interventions tend to be quite effective in significantly reducing symptoms but usually do not result in a complete relief of symptoms. When people who receive psychological treatment individually are compared to those who engage in group psychotherapy, OCD sufferers who receive individual therapy tend to improve more robustly. Even those who respond well to medication treatment tend to have an even better prognosis when behavior treatment is added.

Individuals with OCD may try to hide these behaviors because they worry about possible societal stigma. If left untreated, OCD can interfere with an adult's ability to work and a child's ability to attend school or play. For all age groups, this disorder can prevent sufferers from socializing and functioning as a part of a family. For women who experience postpartum OCD, potential complications include them and their babies failing to bond and develop a healthy relationship with each other if the OCD is not effectively treated.

Many support groups are available for people with obsessive-compulsive disorder, but not everyone with OCD will find a support group useful. Groups can add more stress for some people rather than relieving it. When considering joining a support group, think about the following:

• A useful group involves both newcomers and people who have had OCD for a longer time.
• You should feel comfortable with the people in the group.
• Group leaders should make shy members feel welcome and prevent others from dominating discussions. Discussions should provide you with useful information.
• Established groups are often more useful because the history of the group may indicate that it is stable and meets the needs of its members.
• Groups that promise immediate cures and solutions are probably unrealistic.
• Some group discussions are merely complaint sessions and do not offer helpful information or constructive discussions.
• Avoid any group that encourages you to stop the multimodality therapy prescribed by your healthcare professional.
• Groups should not require you to reveal personal or sensitive information.
• Groups should not charge high fees or require you to buy products.
• Groups usually discourage members from having personal relationships outside the group, since that might undermine the work that occurs in the group.