Obsessive-Compulsive Disorder (OCD)

On occasion, many of us may worry about whether or not we left the stove on before leaving the house or if we locked our doors. This worry may prompt us to return home to make sure that everything is all right. While this type of worry and behavior is normal, some people experience extreme anxiety about these issues. Often the anxiety is so intense that it impacts a person’s ability to live a normal life. To reduce the anxiety, the person may engage in repetitive actions and may experience an increase in anxiety if these actions are not performed. When this occurs, the person may be diagnosed with obsessive-compulsive disorder or OCD.

Obsessive-compulsive disorder is an anxiety disorder. People who develop this disorder have uncontrollable thoughts and fears (obsessions). These obsessions cause repetitive behaviors (compulsions) that the person uses in an effort to stop the obsessions. People with this disorder may realize that their obsessions are unreasonable, and they may try to stop their compulsive behavior. Stopping the compulsive behavior increases anxiety and distress, driving the person to resume performing the behavior.

The causes of OCD are not clearly understood. Most people who have the disorder develop it before the age of 30. OCD has been linked to head injuries and certain types of infections. There is no evidence that people with OCD have any brain abnormalities. In some patients, OCD may be linked to Tourette syndrome.

Three theories have been developed to explain the cause of OCD. These include:

• Biological causes—OCD may be caused by genetic abnormalities. People with OCD often have a close relative that has the disorder.
• Environmental causes—OCD may develop as a result of behaviors that have been learned over time.
• Insufficient levels of serotonin—OCD may occur if levels of serotonin in your brain decrease. Serotonin is a chemical that can help you regulate emotions.

The symptoms of obsessive-compulsive disorder can be broken into two areas: obsessions and compulsions. Most people with OCD have symptoms from both areas. Some people with the disorder have only obsessive or compulsive symptoms.

Although obsessive and compulsive symptoms are different for each person, there are some common obsessive thoughts. Examples of obsessive thoughts include:

• a fear of germs, illness, or disease
• a fear of hurting oneself or others
• violent thoughts of a sexual nature
• a fear that you will lose things that are important to you
• a focus on preciseness and order
• a focus on superstitions
• strict devotion to religious beliefs

Compulsions are behaviors and while behavior will vary for each person with OCD, there are some common compulsions. These include:

• checking and rechecking tasks that have already been completed
• continually calling friends and family to see if they are safe
• counting or repeating words
• excessive cleaning or washing
• ordering things
• excessive praying
• accumulating trash that has no value or worth

If you have symptoms of obsessive-compulsive disorder, your doctor may perform some tests to rule out other health conditions. He or she will complete a physical exam and will order blood work. Your doctor may also recommend a psychological evaluation. During your psychological evaluation a doctor will talk to you about your symptoms. He or she may also ask you to complete tests such as the Yale-Brown Obsessive Compulsive Scale (YBOCS). These tests can help diagnose OCD.

If you are diagnosed with OCD, your doctor may offer several treatment options.

Drugs and Medication

Typically, your doctor will prescribe medications to help reduce obsessive thoughts and compulsive behaviors. Medications known as selective serotonin reuptake inhibitors or SSRIs are often the first medications prescribed for this disorder. Examples of SSRIs include:

• citalopram (Celexa)
• fluoxetine (Prozac)
• fluvoxamine (Luvox)
• paroxetine (Paxil)
• sertraline (Zoloft)

If these medications are not effective, your doctor may try other medications, including tricyclic antidepressants.

Therapy

Your doctor may also recommend therapy to help you learn to cope with your symptoms. Cognitive behavioral therapy (CBT) has been shown to reduce obsessions and compulsions in patients with OCD. When combined with medication, CBT can enhance treatment success.

If you are diagnosed with OCD, treatment will be helpful in reducing your symptoms. OCD is a long-term or chronic illness. Most people with this condition experience periods of active symptoms. These periods are followed by improvement and a reduction in symptoms. OCD is recurrent and for many patients, the symptoms do not completely disappear even with treatment.