Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition characterized by recurrent anxiety-provoking thoughts (obsessions) coupled with repetitive behaviors or mental rituals (compulsions) that are designed to reduce anxiety.
OCD can significantly impair the well-being of affected individuals by interfering with work performance, family life, and other social interactions. The majority of people with OCD report having experienced at least moderate distress from their obsessions and compulsions. (Koran L. Quality of life in obsessive-compulsive disorder. Psychiatr Clin North Am. 2000;23[3]:509-17)
Nowadays—perhaps because several celebrities have admitted to suffering from OCD—anyone who is perceived by others to be meticulous or overtly dedicated to a cause is likely to be labeled “obsessive-compulsive.”
In reality, the lifetime prevalence of OCD is less than two percent. Affected persons usually begin to notice symptoms during adolescence; more than 50% of these individuals experience symptoms before their mid-20s. (Kessler R, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62[6]:617-27 [Published correction in Arch Gen Psychiatry. 2005;62(7):209])
Because people who suffer from OCD often realize that their thoughts and behaviors are inappropriate, they hesitate to report their symptoms to others—including their physicians. Therefore, the average time it takes to treat OCD after the onset of symptoms that meet diagnostic criteria is 11 years. (Pinto A, et al. The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. J Clin Psychiatry. 2006;67[5]:703-11)
What are the Diagnostic Criteria for Obsessive-Compulsive Disorder?
- Recurrent obsessions or compulsions
- Obsessions and compulsions are severe enough to be time consuming (more than one hour daily) or to cause marked distress or significant impairment
- At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable
- If another Axis I psychiatric disorder is present (i.e., depression, ADHD, anxiety, bipolar disorder, etc.) the content of the obsessions or compulsions is not restricted to that disorder
- The disturbance is not a result of physiologic effects of a substance or medical condition
(From the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, text revision. American Psychiatric Association, Washington, DC. 2000)
Signs and Symptoms of Obsessive-Compulsive Disorder
OCD is characterized by thoughts and behaviors that tend to dominate the sufferer. Common obsessions (and their accompanying compulsions) include:
- Fear of contamination (repetitive hand washing or laundering of clothes)
- Need for strict order (rearranging objects to achieve symmetry; labeling behavior; counting)
- Violent thoughts or impulses (scrupulous avoidance of individuals [or property] against whom aggressive thoughts are directed)
- Fear of loss (hoarding or excessive purchasing of items; saving trash)
- Entrenched doubts (repeated checking of locks, appliance plugs, alarms, etc.)
- Religious (continual praying; repeatedly seeking counsel about sinning or blasphemous thoughts)
How is Obsessive-Compulsive Disorder Treated?
Treatment for OCD is rarely curative, but appropriate therapies can bring dramatic improvement in symptoms.
Education and ongoing support from family members and physicians are critical components of successful treatment.
Psychological Treatments
- Cognitive behavior therapy: patients confront situations that are known to create distress related to their obsessions, and then refrain from performing their typical compulsive behaviors. This can be achieved via “systematic desensitization,” where the patient first imagines troubling scenarios and eventually progresses to direct confrontation of real-life situations.
- OCD does not respond to psychodynamic psychotherapy or “talk therapy.”
Pharmacotherapy
- OCD responds well to medications that affect serotonin levels in specific areas of the brain. Selective serotonin reuptake inhibitors (SSRIs) have become first-line therapy for this disorder. Fluvoxamine, fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) have all been approved by the U.S. FDA for treating OCD. Citalopram (Celexa) and escitalopram (Lexapro), while not FDA-approved, are also commonly used.
- Up to 70% of affected persons exhibit a reduction of OCD symptoms with SSRI therapy; the doses required are typically higher than those used for other conditions.
- For patients that don’t respond fully to a SSRI after a three-month trial, the addition of an antipsychotic medication (risperidone, quetiapine, olanzapine, etc.) may bring further improvement.
- Combining psychological treatments with pharmacologic therapies may confer added symptom improvement.
Complementary and Alternative Medicine
- Moderate-intensity aerobic exercise and “mindfulness interventions” (e.g., meditation) have shown promise for treating OCD, but data are incomplete.
- St. John’s wort has demonstrated benefit in some studies—and the herb is commonly prescribed in Europe for treating mild to moderate depression—but its place in the treatment of OCD is still uncertain.
(From Fenske J and Schwenk T. Obsessive-compulsive disorder: diagnosis and management. Am Fam Phys. 2009;80[3]:239-45)
Response to any treatment or combination of therapies may take weeks to months (expectations of immediate improvement are unrealistic), but obsessive-compulsive disorder is eminently treatable. This disorder need not become the centerpiece of one’s existence.
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