People with
obsessive-compulsive disorder (OCD) suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions) that they feel they cannot control. Rituals such as handwashing, counting, checking something, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases
anxiety.
If left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a chronic, relapsing illness.
The cause or causes of OCD are not known.
However, there is growing evidence that the condition represents abnormal functioning of brain circuitry, probably involving a part of the brain called the striatum. OCD is not caused by family problems or by attitudes learned in childhood, such as an inordinate emphasis on cleanliness or a belief that certain thoughts are dangerous or unacceptable.
Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioral therapy and medication produce changes in the striatum. This is graphic evidence that both psychotherapy and medication affect the brain.
People with OCD may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. They may be obsessed with germs or dirt, and wash their hands over and over. They may be filled with doubt and feel the need to check things repeatedly.
Treatment Options for OCD
OCD treatments combine medications and behavioral therapy (a specific type of psychotherapy). Several medications have been proven effective in helping people with OCD, including:
If one drug is not effective, others should be tried. A number of other medications are currently being studied.
A type of behavioral therapy known as "exposure and response prevention" is useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts, and then is taught techniques to avoid performing the compulsive rituals and to deal with the
anxiety.
OCD is sometimes accompanied by:
When a person also has other disorders, OCD is often more difficult to diagnose and treat.
Symptoms of OCD can also coexist with, and may even be part of, a spectrum of other brain disorders, such as Tourette's syndrome. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD.
About 2.3 percent of the U.S. population ages 18 to 54 (approximately 3.3 million Americans) has OCD in a given year. It affects men and women equally.
OCD typically begins during adolescence or early childhood; at least one-third of the cases of adult OCD began in childhood.
OCD cost the United States $8.4 billion in 1990 in social and economic losses, nearly 6 percent of the total mental health bill of $148 billion for that year.
