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Obsessive-Compulsive Disorder – FAQ

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an anxiety disorder manifested by either obsessions and/or compulsions that cause significant distress or dysfunction in social or personal areas.

Obsessions are thoughts and are defined as “recurrent, persistent ideas, images, or impulses that are a significant source of distress or interfere with social or role functioning.”

Compulsions are behaviors or mental acts that are “repetitive, purposeful, and intentional and performed in response to an obsession or according to certain rules or in a stereotypical fashion.” The thoughts or behaviors cause distress, are resisted at least initially, do not form part of a psychosis, and are recognized as senseless.

Anxiety is a central feature of OCD, and the repetitive behaviors or mental acts are often a means to neutralize the distress associated with obsessions.

FEATURES OF OBSESSIVE-COMPULSIVE DISORDER

Either obsessions or compulsions

Obsessions

Recurrent and persistent ideas, thoughts, impulses, or images that are experienced as intrusive and senseless and cause marked anxiety or distress.

Thoughts, impulses are not simply excessive worries about problems.

Person attempts to ignore or suppress such thoughts or to neutralize them.

Person recognizes that the obsessions are the product of his or her own mind.

Compulsions

Repetitive behaviors or mental acts performed in response to an obsession or rigidly applied rules.

Behaviors are designed to neutralize or prevent distress or some dreaded event or situation, but are excessive or not realistically connected with what they are meant to neutralize.

When do everyday habits cross the line to become OCD or require treatment?

Habits, idiosyncrasies, and compulsiveness are common human behaviors. Thoughts or behaviors become maladaptive or may require treatment when they are sufficiently distressing or so time-consuming that they interfere with functioning.

Is OCD a common problem?

Yes. It affects 1–3% of populations in cross-cultural studies. It may begin at any age but most commonly becomes evident in early adulthood. Childhood cases are more common in boys than girls, but overall in adults the disorder is more common in women.

When and how does OCD start?

Obsessive-compulsive behaviors usually have existed for many years before they come to professional attention. Onset of symptoms generally is gradual but occasionally is abrupt. The mean age of onset is approximately 22 years.

What are the common OCD obsessions and behaviors?

Common obsessions include contamination, doubt, aggression, bodily fears, concerns about safety or harm, and need for exactness, completeness or symmetry.

Compulsions frequently include checking, washing, repeating, counting, collecting, and hoarding. Compulsions usually are paired with obsessions. Performance of a compulsion may temporarily relieve some of the anxiety generated by an obsession. For example, after shaking hands or touching doorknobs, a person with contamination obsessions may need to wash the hands repeatedly until he or she feels clean and the anxiety associated with the obsession lessens, at least temporarily.

Such behaviors can be extremely time-consuming, sometimes taking up much of a person’s day, and may have a severe, deleterious impact on functioning of the individual and family.

What are the causes of OCD?

Some forms of OCD have a familial predisposition. There may be role of environmental influences in the development and expression of OCD. Neuro-imaging studies implicate basal ganglia structures hyperactivity in the pathophysiology of OCD. Abnormalities in Serotonin is considered to be the most researched etiologic factor.

What disorders possibly are related to OCD?

  • Trichotillomania (compulsive or repetitive hair pulling)
  • Body dysmorphic disorder (obsession with an imagined or exaggerated defect in appearance)
  • Tourette’s syndrome (motor and vocal tics)

When do you suspect a person having OCD and related disorders?

Screening Questions for Obsessive-Compulsive and Related Disorders

Do you have thoughts, ideas, or mental images that come into your mind that you cannot seem to get rid of?

Are these thoughts troubling to you in some way—do they make you anxious or upset?

Are there any behaviors or habits that you do over and over that seem excessive or unusual?

Is your life negatively affected by an inflexible need to do things “just right” or in a ritualized, repetitive way?

Do you find that you tend to collect things excessively or have trouble throwing things out so that your home becomes cluttered?

Do you find yourself touching, rubbing, or picking at parts of your body repeatedly?

Do you ever pull out your hair?

Are there any aspects of your appearance that you find yourself troubled by or preoccupied with?

Have others commented on behaviors or actions you perform that seem unusual or excessive to them or to yourself?

What are effective treatments for OCD?

There are two primary modes of treatment for OCD: behavioral and pharmacologic.

Behavioral therapy generally is effective for checking and washing rituals. It is symptom-focused and goal-directed and may be accomplished in as few as a dozen sessions, depending on symptom severity. Motivation and compliance are important factors in success.

Primary treatment for compulsive rituals consists of exposure and response prevention. Such techniques involve a graded progressive exposure to the anxiety-inducing stimulus, with prevention of the associated ritualistic response.

A number of medications have demonstrated efficacy in treating OCDs. All are potent serotonin reuptake inhibitors (SRIs) and tri cyclic antidepressants: Fluoxamine, fluoxetine, sertraline, paroxetine and clomipramine. 

How long does OCD last? Is treatment life long?

OCD tends to be a chronic disorder. There may be episodic or continuous forms, and in occasional patients acute episodes do not recur. Duration of active treatment varies. Some patients require only relatively short-term use of mediations (6–12 months), whereas others need medication for an extended period.