Alternative Names OCD, obsessive-compulsive neurosis
Definition Obsessive-compulsive disorder, also called OCD, is a type of anxiety disorder. A person who has OCD has recurring or repeated obsessions and/or compulsions. Obsessions are thoughts, ideas, or images that persist in the mind. Compulsions are mental acts or behaviours that are carried out repeatedly. These obsessions and compulsions are severe enough to be time-consuming. They may also cause a fair amount of distress or impairment. The impairment can interfere with everyday activities.
What is going on in the body? The exact cause of OCD is not known. Recent studies have shown abnormal patterns of brain activity in people with OCD. The abnormalities occur in a part of the brain called the striatum. Obsessive-compulsive behaviours may be an attempt by the person to reduce anxiety. People who have OCD usually know that their behaviour and thoughts are inappropriate. This recognition is distressing to them.
What are the signs and symptoms of the condition? People with OCD may have a wide variety of obsessions and compulsions. Here are some common examples:
attempts, usually unsuccessful, to stop or ignore thoughts and behaviours
excessive cleaning, usually due to a fear of germs
excessive hand-washing
following an arbitrary set of rules for behaviour
hoarding useless or unnecessary items
performance of a ritualistic sequence of behaviours
repetition of activities or words
repetition of a behaviour until it is done perfectly
What are the causes and risks of the condition? The exact cause of OCD is not known. It generally begins in childhood or adolescence. OCD tends to run in families. The sense of helplessness and the impairment with OCD may lead to depression. OCD is often seen together with other psychiatric disorders, such as the following:
alcohol abuse
attention deficit disorders
depression
drug abuse or addiction
eating disorders, such as anorexia or bulimia
other anxiety disorders
What can be done to prevent the condition? There is no known way to prevent OCD.
How is the condition diagnosed? Diagnosis of OCD begins with a medical history and physical examination. There are no specific tests for OCD. The doctor will ask about any obsession or compulsive behaviour. OCD is diagnosed if the behaviours take up more than an hour of the day or if they cause real distress.
The Yale-Brown Obsessive Compulsive Scale (YBOCS) is sometimes used to measure the severity of the symptoms. Anxiety scales can also be used. These scales are designed to track response to treatment.
What are the long-term effects of the condition? OCD is considered a chronic disorder. The course of the disorder is variable. Symptoms may come and go, ease over time, or grow progressively worse. Treatment should help the person learn to recognise symptoms before they become severe. If symptoms worsen, the individual may need to resume therapy or medications.
What are the risks to others? OCD is not contagious. It does tend to run in families.
What are the treatments for the condition? Treatment for OCD usually involves both therapy and medication
Exposure and response prevention therapy is very useful for treating OCD. In this approach, a person is exposed to whatever triggers the obsessive thoughts. The individual is then taught techniques to avoid performing the compulsive rituals. He or she is also taught to deal with the anxiety.
Cognitive-behavioural therapy is also used to treat OCD. The doctor helps the person change his or her attitudes and beliefs. The individual learns to react differently to obsessions or compulsions.
Relaxation techniques may also be helpful. They help the person to control the body's reactions to anxiety.
Following is a list of antidepressant medications used to treat OCD:
clomipramine
fluoxetine
fluvoxamine
paroxetine
sertraline
Medications may take weeks to show any improvement in OCD. If one medication is not effective, others can be tried.
Neurosurgery may be performed for severe cases of OCD. It is done only if all other treatment has failed and the person is severely disabled.
What are the side effects of the treatments? Antidepressants may cause mild and usually temporary side effects in some people. Here is a list of the most common side effects:
agitation
constipation
dizziness
drowsiness
dry mouth
nausea
What happens after treatment for the condition? Treatment of OCD is lifelong.
How is the condition monitored? The person with OCD may have regular visits with the doctor. The doctor may order blood tests to monitor the level of medications. Any new or worsening symptoms should be reported to the doctor.
Author: Ann Reyes, Ph.D. Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 19/06/2005 Contributors Potential conflict of interest information for reviewers available on request
