Obsessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD) by definition is: a type of anxiety disorder is a potentially disabling illness that traps people in endless cycles of repetitive thoughts and behaviors. People with OCD are plagued by recurring and distressing thoughts, fears, or images (obsessions) that they cannot control. The anxiety (nervousness) produced by these thoughts leads to an urgent need to perform certain rituals or routines (compulsions). The compulsive rituals are performed in an attempt to prevent the obsessive thoughts or make them go away. Although the ritual may make the anxiety go away temporarily, the person must perform the ritual again when the obsessive thoughts return. This OCD cycle can progress to the point of taking up hours of the person's day and significantly interfering with normal activities. People with OCD may be aware that their obsessions and compulsions are senseless or unrealistic, but they cannot stop themselves.
“Getting dressed in the morning was tough, because I had a routine, and if I didn’t follow the routine, I’d get anxious and would have to get dressed again. I always worried that if I didn’t do something; my parents were going to die. I’d have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me.”
Symptoms of OCD can include any or all of the following: Fear of dirt or contamination by germs, fear of causing harm to another, fear of making a mistake, fear of being embarrassed or behaving in a socially unacceptable manner, fear of thinking evil or sinful thoughts, need for order, symmetry, or exactness, excessive doubt and the need for constant reassurance. Compulsions can include: Repeatedly bathing, showering, or washing hands, refusing to shake hands or touch doorknobs, repeatedly checking things, such as locks or stoves, constant counting, mentally or aloud, while performing routine tasks, constantly arranging things in a certain way, eating foods in a specific order, being stuck on words, images or thoughts, usually disturbing, that won't go away and can interfere with sleep, repeating specific words, phrases, or prayers, needing to perform tasks a certain number of times, collecting or hoarding items with no apparent value, and many more. Some people will do only one or many of these.
Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.
What Causes OCD?
Although the exact cause of OCD is not fully understood, studies have shown that a combination of biological and environmental factors may be involved.
Biological Factors: The brain is a very complex structure. It contains billions of nerve cells — called neurons — that must communicate and work together for the body to function normally. The neurons communicate via electrical signals. Special chemicals, called neurotransmitters, help move these electrical messages from neuron to neuron. Research has found a link between low levels of one neurotransmitter — called serotonin — and the development of OCD. In addition, there is evidence that a serotonin imbalance may be passed on from parents to children. This means the tendency to develop OCD may be inherited.
In addition, certain areas of the brain appear to be affected by the serotonin imbalance that leads to OCD. This problem seems to involve the pathways of the brain that link the area of the brain that deals with judgment and planning, and the area of the brain that filters messages involving body movements.
Studies also have found a link between a certain type of infection caused by the Streptococcus bacteria and OCD. This infection, if recurrent and untreated, may lead to the development of OCD and other disorders in children.
Environmental Factors: There are environmental stressors that can trigger OCD in people with a tendency toward developing the condition. Certain environmental factors may also cause a worsening of symptoms. These factors include:
Changes in living situation
Death of a loved one
Work- or school-related changes or problems
How Common Is OCD?
OCD afflicts about 3.3 million adults and about 1 million children and adolescents in the U.S. The disorder usually first appears in childhood, adolescence, or early adulthood. It occurs about equally in men and women and affects people of all races and socioeconomic backgrounds.
How Is OCD Diagnosed?
There is no laboratory test to diagnose OCD. The doctor bases his or her diagnosis on an assessment of the patient's symptoms, including how much time the person spends performing his or her ritual behaviors.
How Is OCD Treated?
OCD will not go away by itself, so it is important to seek treatment. The most effective approach to treating OCD combines medications with cognitive-behavior therapy.
Cognitive behavior therapy: The goal of cognitive behavior therapy is to teach people with OCD to confront their fears and reduce anxiety without performing the ritual behaviors (called exposure therapy or exposure and response prevention therapy). Therapy also focuses on reducing the exaggerated or catastrophic thinking that often occurs in people with OCD.
Medication therapy: Tricyclic antidepressants, such as Anafranil, and selective serotonin reuptake inhibitor (SSRI) antidepressants, such as Paxil, Prozac and Zoloft may be helpful in treating OCD. In severe cases of OCD and in people who do not respond to medical and behavioral therapy, electroconvulsive therapy (ECT) or psychosurgery may be used to treat OCD. During ECT, electrodes are attached to the patient's head, and a series of electric shocks are delivered to the brain, which induce seizures. The seizures cause the release of neurotransmitters in the brain.
What Is the Outlook for People With OCD?
In most cases, OCD can be successfully treated with medication, cognitive-behavior therapy, or both. With ongoing treatment, most people can achieve long-term relief from symptoms and return to normal or near-normal functioning.
Can OCD Be Prevented?
OCD cannot be prevented. However, early diagnosis and treatment can help reduce the time a person spends suffering from the condition.