Obsessive-compulsive disorder

Definition

Obsessive-compulsive disorder is an anxiety disorder characterized by recurrent thoughts, feelings, ideas or sensations (obsessions) or behaviors that makes a person feel driven to perform (compulsions). A person may have both obsessions and compulsions. 

An example of obsessive-compulsive disorder is excessive, repeated handwashing to ward off infection.

Causes, incidence, and risk factors

Obsessive-compulsive disorder (OCD) was previously believed to be rare. However, recent data shows that about 7 million Americans have the condition.

OCD usually is noticed between the ages of 20 and 30. The majority of those who will develop it show symptoms by age 30.

There are several psychological theories about the cause of OCD, but none have been confirmed. Some reports have linked OCD to head injury and infections. Several studies have shown that there are brain abnormalities in patients with OCD, but more research is needed.

About 20% of those with OCD have motor tics, suggesting the condition may be related to Tourette syndrome.   However, this link is not clear.

Symptoms

• Obsessions or compulsions that cause significant distress or interfere with everyday life
• Obsessions or compulsions are not due to medical illness or drug use

The person usually recognizes that the behavior is excessive or unreasonable.

Signs and tests

The person's own description of the behavior usually leads to diagnosis of the disorder. A physical exam is performed to rule out physical causes, and a psychiatric evaluation is given to rule out other psychiatric disorders. Questionnaires, such as the Yale-Brown Obsessive Compulsive Scale, can help diagnosis OCD and track the progress of treatment.

Treatment

OCD is treated using medications and psychotherapy.

The first medication considered is usually a type of antidepressant called a selective serotonin reuptake inhibitors (SSRI). These drugs include fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).

If an SSRI does not work, an older antidepressant called clomipramine may be prescribed. Clomipramine is the oldest medication treatment for OCD. It works better than SSRI antidepressants in treating the condition, but it has unpleasant side effects, including sleepiness, difficulty starting urination, dry mouth, and a drop in blood pressure when rising from a seated position.

In some cases, an SSRI and clomipramine may be combined. Other medications such as benzodiazepines may offer some relief from anxiety, but they are generally used only with the more reliable treatments.

Psychotherapy is used to reduce anxiety, resolve inner conflicts, and provide effective ways of reducing stress.

Behavioral therapies may include:

• Exposure/response prevention: The person is repeatedly exposed to a situation that triggers anxiety symptoms, and learns to resist the urge to perform the compulsion.
• Thought-stopping: The person learns to stop unwanted thoughts and focus attention on relieving anxiety.

Expectations (prognosis)

OCD is a chronic (long-term) illness with periods of severe symptoms followed by times of improvement. However, a completely symptom-free period is generally unusual. With treatment, most patients have considerable improvement.

Complications

The most likely long-term consequences of OCD are related to the nature of the obsessions or compulsions. For example, constant handwashing can cause skin breakdown. However, OCD does not ordinarily progress into another disease.

Calling your health care provider

Call for an appointment with your health care provider if symptoms interfere with daily life, work, or relationships.

Prevention

There is no known prevention for this disorder.

References

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:167-170.

Rakel RE. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders; 2005:1348-1350.

Illustrations

Obsessive-compulsive disorder

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