Obsessive Compulsive Disorder

What is OCD?

Obsession Compulsive Disorder (OCD) is an anxiety disorder where a person has recurrent and unwanted ideas or impulses (called obsessions) and an urge or compulsion to do something to relieve the discomfort caused by the obsession. The obsessive thoughts range from the idea of losing control, to themes surrounding religion or keeping things or parts of one's body clean all the time. Compulsions are behaviors which help reduce the anxiety surrounding the obsessions. Most people (90%) who have OCD have both obsessions and compulsions. The thoughts and behaviors a person with OCD has are senseless, repetitive, distressing, and sometimes harmful, but they are also difficult to overcome.

Obsessions are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate, and that cause marked anxiety or distress. The most common obsessions are repeated thoughts about contamination (i.e., becoming contaminated by germs or by shaking hands); repeated doubts (wondering whether one has performed some act, such as leaving the water running or leaving the stove burner on); a need to have things in a particular order; aggressive or horrific impulses (although the person may never act on this) or sexual imagery that is inappropriate or frightening.

Compulsions are repetitive behaviors (hand washing, checking the door locks) or mental acts (praying, counting, repeating words). The goal of compulsions is to prevent or reduce anxiety or distress. The person feels driven to perform the compulsion to reduce the distress caused by the obsessive thought.

OCD is more common than schizophrenia, bipolar disorder, or panic disorder, according to the National Institute of Mental Health. Yet it is still commonly overlooked by both mental health professionals, mental health advocacy groups, and people who themselves have the problem.

Is Obsessive-Compulsive Disorder Inherited?

No specific genes for OCD have yet been identified, but research suggests that genes do play a role in the development of the disorder in some cases. Childhood-onset OCD tends to run in families (sometimes in association with tic disorders). When a parent has OCD, there is a slightly increased risk that a child will develop OCD, although the risk is still low. When OCD runs in families, it is the general nature of OCD that seems to be inherited, not specific symptoms. Thus a child may have checking rituals, while his mother washes compulsively.

What causes Obsessive-Compulsive Disorder?

There is no single, proven cause of OCD.

Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia).

These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are prominently involved in OCD. Drugs that increase the brain concentration of serotonin often help improve OCD symptoms.

Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in those who improve after taking a serotonin medication or receiving cognitive-behavioral psychotherapy.

Although it seems clear that reduced levels of serotonin play a role in OCD, there is no laboratory test for OCD. Rather, the diagnosis is made based on an assessment of the person's symptoms. When OCD starts suddenly in childhood in association with strep throat, an autoimmune mechanism may be involved, and treatment with an antibiotic may prove helpful.

HOW IS OCD TREATED?

The first step in treating OCD is educating the patient and family about OCD and its treatment as a medical illness. During the last 20 years, two effective treatments for OCD have been developed: cognitive-behavioral psychotherapy (CBT) and medication with a serotonin reuptake inhibitor (SRI).

Stages Of Treatment

Acute treatment phase: Treatment is aimed at ending the current episode of OCD.

Maintenance treatment: Treatment is aimed at preventing future episodes of OCD.

Components Of Treatment

Education: This is crucial in helping patients and families learn how best to manage OCD and prevent its complications.

Psychotherapy: Cognitive-behavioral psychotherapy (CBT) is the key element of treatment for most patients with OCD.

Medication: Medication with a serotonin reuptake inhibitor is helpful for many patients.

What Medications Are Used To Treat Obsessive-Compulsive Disorder?

Research clearly shows that the serotonin reuptake inhibitors (SRIs) are uniquely effective treatments for OCD. These medications increase the concentration of serotonin, a chemical messenger in the brain. Five SRIs are currently available by prescription in the United States:

Clomipramine (Anafranil, manufactured by Ciba-Geigy)

Fluoxetine (Prozac, manufactured by Lilly)

Fluvoxamine (Luvox, manufactured by Solvay)

Paroxetine (Paxil, manufactured by Smith-Kline Beecham)

Sertraline (Zoloft, manufactured by Pfizer)

Citalopram (Celexa, marketed by Forest Laboratories, Inc.)

Fluoxetine, fluvoxamine, paroxetine, citalopram, and sertraline are called selective serotonin reuptake inhibitors (SSRIs) because they primarily affect only serotonin. Clomipramine is a nonselective SRI, which means that it affects many other neurotransmitters besides serotonin. This means that clomipramine has a more complicated set of side effects than the SSRIs. For this reason, the SSRIs are usually tried first since they are usually easier for people to tolerate.

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