OCD is an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). People with OCD feel they cannot control these obsessions and compulsions. Repetitive behaviors, such as hand washing, counting, hoarding, touching objects, seeking reassurance, making lists, checking, or cleaning, are often performed in the hopes of reducing anxiety or anxiety-provoking obsessions. However, performing these so-called rituals provides only temporary relief. Left untreated, the obsessions and compulsions can take over a person’s life. OCD is often a chronic, relapsing illness.
The cause of OCD is not known. It is believed to develop from genetic, biologic, environmental, and psychological factors.
OCD may be associated with other disorders, including:
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Tourette syndrome—characterized by multiple motor and vocal tics
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Trichotillomania—the repeated urge to pull out scalp hair, eyelashes, eyebrows, or other body hair
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Body dysmorphic disorder—imaginary or exaggerated defects in appearance
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Eating disorders—such as bulimia nervosa or anorexia nervosa
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Hypochondriasis—morbid concern for one’s own health, including delusions that one is suffering from a disease or diseases for which no physical basis is evident
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Substance abuse
Additional disorders that may accompany OCD include depression, attention-deficit hyperactivity disorder (ADHD), and other anxiety disorders.
According to the Obsessive Compulsive Foundation, 1 in 50 Americans has OCD during the course of a given year. The first symptoms of OCD often begin during childhood, adolescence, or early adulthood.
Screening
The purpose of screening is early diagnosis and treatment. Screening tests are administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
There are no current screening tests or screening guidelines for OCD. There are some research tools that doctors use when studying OCD symptoms. The Yale-Brown Obsessive Compulsive Scale, for people aged 14 years and older, is commonly used. There is also a version of this scale to be used with children. These may be reviewed during a regular physical exam.
Diagnosis
If you have OCD, your obsessive and compulsive behaviors are extreme enough to interfere with your everyday life. This is not the same as the “compulsive” behavior many people normally display, such as high standards of performance, perfectionism, and organization in work and recreational activities. Normal “compulsiveness” often serves a valuable purpose, contributing to a person’s self-esteem and success on the job. OCD, on the other hand, involves obsessions and rituals that are very distressing and interfere with daily functioning.
Diagnosis of OCD is usually based on the following:
Initial Assessment
Your doctor will ask you about your symptoms and medical history. This may be done with a structured interview and/or questionnaire. You may also be given a psychological assessment. OCD may be diagnosed if the specified symptoms consume at least 1 hour each day and/or result in both emotional distress and disturbed functioning, but are not caused by medication, drug abuse, or a medical condition. You usually know that the behaviors are excessive or unreasonable.
When you have OCD, the symptoms are disruptive enough to cause problems at school, work, and/or in family and peer relationships.
Evaluation of Other Mental and Neurologic Disorders
Other psychiatric disorders, such as depression, generalized anxiety disorder, Tourette syndrome (a neurologic disorder), eating disorders (such as anorexia and bulimia), attention-deficit hyperactivity disorder (ADHD), and personality disorders often occur with OCD. You may be tested for these and other psychiatric disorders.
Symptoms
Symptoms of OCD are:
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Obsessions—unwanted, repetitive, and intrusive ideas, impulses, or images
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Compulsions—repetitive behaviors or mental acts usually performed to reduce the anxiety or distress associated with obsessions
If you have OCD, you know that your thoughts and behaviors are nonsensical, and you would like to avoid or stop them.
Common obsessions include:
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Persistent fears that harm may come to yourself or a loved one
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Unreasonable concern about becoming contaminated
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Unreasonable concern about safety
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Unacceptable religious, violent, or sexual thoughts
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Excessive need to do things perfectly
Common compulsions include:
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Excessive checking of door locks, stoves, water faucets, light switches, etc.
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Repeatedly making lists, counting, arranging, or aligning things
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Collecting and hoarding useless objects
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Repeating routine actions a certain number of times until it feels just right
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Unnecessary rereading and rewriting
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Mentally repeating phrases
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Repeated hand washing
Most people with OCD have both obsessions and compulsions, but some only have 1 or the other. The majority of patients with OCD are ashamed of their disorder, and many find it hard to confide in a doctor. However, now that effective treatments are available, more people are talking to their doctor about their symptoms.
Risk Factors
A risk factor is something that increases your likeli-hood of getting a disease or condition.
It is possible to develop OCD with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing OCD. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
Risk factors may include:
Age
OCD tends to develop in late adolescence or early adulthood. However, it can begin as early as preschool age and as late as age 40 years.
Genetic Factors
Research suggests that genes may play a role in the development of OCD in some cases. The condition tends to run in families. A person who has OCD has a 25% chance of having a blood relative who has it.
One study found that children have inherited OCD symptoms in 45% to 60% of cases, while adults have inherited symptoms in 27% to 47% of cases.
Presence of Other Mental or Neurologic Conditions
OCD often occurs in people who have other anxiety disorders, depression, Tourette syndrome, attention-deficit hyperactivity disorder (ADHD), substance abuse, eating disorders, and certain personality disorders.
PANDAS, which refers to Pediatric Autoimmune Neuropsychiatric Disorders associated with Strepto-coccal Infections, is a term that refers to a group of children who have OCD and/or a tic disorder, which gets worse or is related to strep throat. Researchers are studying what causes this. One theory is that antibodies in the body may interact with the brain.
Stress
OCD symptoms often occur during stress from major life changes, such as the loss of a loved one, divorce, relationship difficulties, problems in school, or abuse.
Pregnancy and Postpartum Period
OCD symptoms may worsen during and immediately after pregnancy. In this case, fluctuating hormones can trigger symptoms. Postpartum OCD is characterized by disturbing thoughts and compulsions regarding the baby’s well-being.
Reducing Your Risk
There are currently no guidelines for reducing your risk of OCD because there is not a clear cause. Early diagnosis and treatment can reduce how much the personality traits interfere with your daily life.
Medications
The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Your doctor may give you medicine to help alleviate your unwanted thoughts and repeated actions. These are often referred to as antiobsessional medications. They can also help you feel less anxious and afraid. It may take a few weeks before you start to see an improvement.
Most of the drugs used to treat OCD are antide-pressants. These medications affect brain hormones that are out of balance. If you develop depression in association with OCD or because of the disability produced by OCD, antidepressants can help with this as well.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Common names include:
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Citalopram
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Fluvoxamine
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Paroxetine
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Fluoxetine
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Sertraline
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Escitalopram
SSRIs affect the concentration of the neurotransmitter serotonin, which plays a role in anxiety, depression, and OCD. It appears that for most people, high doses of these drugs are required to produce antiobsessional effects. Improvement is usually seen in 4 to 6 weeks after beginning treatment. SSRIs are not addictive.
Do not take an SSRI if you have taken a mono-amine oxidase inhibitor (MAOI) in the last 2 to 5 weeks.
Possible side effects include:
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Nausea
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Diarrhea
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Insomnia
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Loss of appetite or weight loss
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Weight gain
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Lightheadedness
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Sexual dysfunction (ranging from decreased arousal, to erectile dysfunction, and/or delayed time to orgasm)
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Nervousness
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Risk of severe mood and behavior changes, including suicidal thoughts in some patients (young adults may be at a higher risk for this side effect)
Tricyclic Antidepressants
Common name: Clomipramine
Tricyclic antidepressants regulate the neurotransmitters serotonin and/or noradrenalin in the brain. They have been used effectively for the treatment of OCD. Improvement is usually seen in 2 to 6 weeks after beginning treatment. Tricyclic antidepressants are not addictive.
Possible side effects include:
Atypical Antidepressants
Common names include:
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Trazodone
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Venlafaxine
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Nefazodone
Atypical antidepressants affect the concentration of the neurotransmitter serotonin and can be effective in treating OCD. Improvement is usually seen in 4 to 6 weeks after beginning treatment.
Possible side effects include:
Special Considerations
Consultation with a specially trained mental health professional is recommended if you do not respond to treatment with medicine. A mental health professional can help clarify the diagnosis and determine if another psychiatric disorder is present. They can also make recommendations about psychotherapy and changes in medicine.
If you are taking medicine, follow these general guidelines:
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Take the medicine as directed. Do not change the amount or the schedule.
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Ask what side effects could occur. Report them to your doctor.
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Talk to your doctor before you stop taking any prescription medicine.
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Plan ahead for refills if you need them.
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Do not share your prescription medicine with anyone.
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Medicines can be dangerous when mixed. Talk to your doctor if you are taking more than 1 medicine, including over-the-counter products and supplements.
Other Treatments
Treatment of OCD is tailored to meet your particular needs.
Behavioral Therapy
Behavioral therapy can help you modify and gain control over your behavior. A technique called exposure and response prevention (ERP) is especially helpful in treating symptoms of OCD. With this approach, you are deliberately and voluntarily exposed to feared objects or ideas, either directly or by imagination. Then, with your permission, you are discour-aged or prevented from carrying out your typical compulsive behavior.
For example, if you are a compulsive hand washer, you may be asked to touch an object that you believe to be contaminated and then denied the ability to wash for several hours. If the treatment works, you will gradually experience less anxiety from your obsessive thoughts and you will be able to refrain from compulsive behaviors for progressively longer periods of time.
Behavior therapy has been found to have lasting benefits. The best results occur if the following conditions are met:
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The therapist is well trained in the particular behavior therapy that is used.
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You are highly motivated.
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Your family (if involved) is cooperative.
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You attend sessions regularly.
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You finish homework assignments and complete the course of treatment.
Most psychiatrists and behavior therapists believe that a combination of behavior therapy (consisting of ERP) and medicine is the most effective approach to treating OCD. For example, in a study published in the American Journal of Psychiatry, researchers found that people who took selective serotonin reuptake inhibitors (SSRIs) and participated in ERP had a greater reduction in symptoms, compared to those who took SSRIs and participated in stress management training.
Cognitive Therapy
Cognitive therapy helps you change patterns of thinking that are unproductive and harmful. This kind of therapy helps you examine your feelings and separate realistic from unrealistic thoughts or helpful from unhelpful thoughts. Like behavioral therapy, cognitive therapy helps you gain a better sense of control over your life.
Cognitive-Behavioral Therapy (CBT)
CBT is a combination of cognitive and behavioral therapy. With this type of therapy, you examine your feelings and thought patterns, learn to interpret them in a more realistic way, and apply behavioral strategies.
Examples of therapies used to treat OCD include:
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Exposure and response prevention—involves gradually confronting the feared object or obsession without giving into the compulsive ritual linked to it
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Aversion therapy—involves using a painful stimulus to prevent OCD behavior
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Thought switching—involves learning to replace negative thoughts with positive thoughts
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Flooding—involves being exposed to an object that causes OCD behavior
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Implosion therapy—involves being repeatedly exposed to object that causes fear
Talking to Your Doctor
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with OCD. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
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Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
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Write out your questions ahead of time, so you don’t forget them.
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Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
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Don’t be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
Specific Questions to Ask Your Doctor
About Obsessive-Compulsive Disorder
Describe your obsessive or compulsive behavior to your doctor. Also, tell your doctor if these problems interfere with your daily activities.
In addition, you may want to ask the following questions:
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Could I have a different illness? Can I have a checkup to be sure?
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Have you treated other people with OCD? If not, can you recommend someone who has?
About Treatment Options
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What treatments are available for OCD?
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If I take medicine:
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How long will it take to work?
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What benefits can I expect?
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What side effects should I look for?
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Should I try counseling, as well?
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What type do you recommend?
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Are there any alternative or complementary therapies I should try?
About Counseling
If you decide to try counseling, interview counselors to find one with whom you feel comfortable discussing your problems. Some questions to ask are:
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What is your training and experience in treating OCD?
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What is your basic approach to treatment?
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How long does treatment last?
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What is the length and frequency of treatment sessions?
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What health insurance is accepted?
Resource Guide
Obsessive-Compulsive Foundation
PO Box 961029
Boston, MA 02196
617-973-5801
iocdf.org
This website provides consumer friendly information on OCD. It also offers online screening, a mental health referral list, newsletter, bookstore, message board, book and movie reviews, a list of related websites, and information about support groups for people with OCD.
Anxiety and Depression Association of America
8701 Georgia Avenue, Suite 412
Silver Spring, MD 20910
240-485-1001
adaa.org
This website provides information for the public and doctors on anxiety disorders, finding a therapist, self-help groups, and anxiety screening tools.
American Psychiatric Association
1000 Wilson Boulevard, Suite 1825
Arlington, VA 22209–3901
703-907-7300
www.psychiatry.org
This website provides information for the public and healthcare professionals on psychiatric disorders, as well as access to news releases, books, and journals.
References
Moretti, G., Pasquini, M., et al. “What Every Psychia-trist Should Know About PANDAS: A Review.” Clinical Practice & Epidemiology in Mental Health, vol. 4, 2008, p. 13.
Serretti, A., & Mandelli, L. “Antidepressants and Body Weight: A Comprehensive Review and Meta-analysis.” Journal of Clinical Psychiatry, vol. 71, no. 10, 2010, pp. 1259–72.
Simpson, H.B., Foa, E.B., et al. A Randomized, “Controlled Trial of Cognitive-Behavioral Therapy for Augmenting Pharmacotherapy in Obsessive-Compulsive Disorder.” American Journal of Psychiatry, vol. 165, no. 5, 2008, pp. 621–30.
van Groothest, D.S., Cath, D.C., et al. “Twin Studies on Obsessive-Compulsive Disorder: A Review.” Twin Research and Human Genetics, vol. 8, no. 5, 2005, pp. 450–58.