What is obsessive-compulsive disorder?
Obsessive-compulsive disorder (OCD), one of the anxiety disorders, 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; not performing the rituals increases the anxiety.
Although the ritual might 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 might be aware that their obsessions and compulsions are senseless or unrealistic, but they cannot stop themselves.
What are the symptoms of obsessive-compulsive disorder?
The symptoms of OCD, which are the obsessions and compulsions, might vary.
Common obsessions include:
- 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/the need for constant reassurance
Common compulsions 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
- Repeating specific words, phrases or prayers
- Needing to perform tasks a certain number of times
- Collecting or hoarding items with no apparent value
What causes obsessive-compulsive disorder?
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 might be passed on from parents to children. This means the tendency to develop OCD might be inherited, but the children might not necessarily develop the disorder.
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, might lead to the development of OCD and other disorders in children. This condition—known as pediatric autoimmune neuropsychiatric disorder associated with strep, or PANDAS — might respond to treatment with antibiotics.
Environmental factors
There are environmental stressors that can trigger OCD in people with a tendency toward developing the disorder. Certain environmental factors also might cause a worsening of symptoms. These factors include:
- Abuse
- Changes in living situation
- Illness
- Death of a loved one
- Work- or school-related changes or problems
- Relationship concerns
How common is obsessive-compulsive disorder?
OCD afflicts about 3.3 million adults, and about 1 million children and adolescents in the United States. 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 obsessive-compulsive disorder diagnosed?
There is no laboratory test for 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. The doctor makes the diagnosis based on information outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). DSM-IV, compiled by the American Psychiatric Association, is the standard reference manual for the diagnosis of recognized mental illnesses in the United States.
How is obsessive-compulsive disorder treated?
OCD will not go away by itself, so it is important to seek treatment. The person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses.
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. It also focuses on reducing the exaggerated or catastrophic thinking that often occurs in people with OCD
Medication therapy
A group of drugs called selective serotonin reuptake inhibitors (SSRIs) work by increasing and sustaining the levels of serotonin in the brain, thus improving the movement of electrical signals from neuron to neuron. The SSRIs approved in the United States for the treatment of OCD include fluoxetine (Prozac), fluvoxamine (Luvox), Paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa). Another antidepressant medication, clomipramine (Anafranil), also is approved for treating OCD.
In severe cases of OCD and in people who do not respond to treatment, electroconvulsive therapy (ECT) or surgery might 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.
A surgical procedure called bilateral cingulotomy interrupts the pathway of the brain involved in the development of OCD. With the pathway disrupted, OCD symptoms should stop. This procedure also might be done using stereotactic radiosurgery, also called a Gamma Knife. The Gamma Knife is a non-surgical machine that emits hundreds of powerful, highly focused gamma radiation beams aimed at the area of the brain where the problem is located.
What is the outlook for people with obsessive-compulsive disorder?
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. Unfortunately, many people are unaware of the disorder or too embarrassed by their behaviors to seek treatment.
Can obsessive-compulsive disorder be prevented?
OCD cannot be prevented. However, early diagnosis and treatment can help reduce the time a person spends battling this disorder.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/1/2005…#9490
