Obsessive-Compulsive Disorder (OCD) is characterized by intrusive obsessive thoughts that result in compulsive ritualistic behaviors and routines. While it’s possible to have only obsessive symptoms or only compulsive symptoms, they usually occur in conjunction. People suffering from OCD experience uncontrollable, distressing thoughts or fears about certain things (such as dirt, germs, or order) which then lead to compulsive behaviors performed as an attempt to alleviate worry or anxiety. Just being a “neat freak” or afraid of germs doesn’t necessarily constitute OCD – OCD is diagnosed by obsessions and compulsions which significantly interfere with daily life.
Symptoms
Symptoms of OCD can be divided into obsessions and compulsions. Obsessions are described as being “ego-dystonic”, which means that even though the person who experiences them recognizes them as their own thoughts, they feel the obsessions are outside of their control.
Obsessions that are symptomatic of OCD include:
- Severe anxiety and obsessive thoughts regarding contamination and germs
- Worrying about having done something bad by accident (e.g., accidentally running someone over with a car)
- Worrying about having forgotten something important (e.g., forgetting to lock a door)
- Needing to have things in a particular order (e.g., having things arranged symmetrically)
- Fear of social embarrassment that triggers compulsions
- Repeated thoughts or images
- Inability to control intrusive thoughts
In diagnosed OCD, sufferers will usually spend at least an hour a day dealing with intrusive thoughts or compulsions.
Compulsions are repetitive physical or mental actions that a person engages in to reduce anxiety. Often, the compulsion is designed to counteract or undo an obsession. Compulsions that are symptomatic of OCD include:
- Excessive checking (e.g., checking repeatedly to make sure doors are locked or to make sure some type of mistake wasn’t made)
- Excessive counting
- Repetitive praying
Symptoms of OCD may increase or decrease in severity during one’s lifespan, and are often the most intense when a person is under stress.
Causes
On average, one-third of adults who will be afflicted by the condition shows signs of OCD as children and are later diagnosed around age 19. Over 3 million Americans suffer from OCD each year, and OCD does not seem to affect one gender more than another. Research has yet to provide evidence-based, direct causes of OCD. However, the following factors are noted as possible contributors to the disorder:
- Family history of OCD
- Abnormal levels of serotonin in the brain
- Experiencing a highly stressful or traumatic event
- Depression
In order to qualify for a diagnosis of Obsessive-Compulsive Disorder, someone must have either obsessions or compulsions (or both) and these must interfere with their daily functioning. The person must also recognize, to some degree, that the obsessions and/or compulsions are excessive or unreasonable.
Treatment
OCD is treated with both therapy and medications. Many professionals recommend a synthesis of the two, and emphasize that medication alone may not be effective for treating the cause of the affliction. Supplementing these methods with alternative treatments like meditation, mindfulness training, or yoga may facilitate recovery.
Therapy
Psychotherapy is commonly used to help with OCD. Psychotherapy methods, like Cognitive Behavioral Therapy (CBT), involve helping the individual see the connection between their thoughts, feelings, and behaviors. Once this connection is understood, therapists will work with patients using a variety of techniques to change the thoughts, feelings, and behaviors that underlie and perpetuate the OCD.
One psychotherapeutic approach, exposure therapy, is frequently used by experts when treating OCD. In exposure therapy, patients are asked to confront the triggers of their convulsions in order to help desensitize them. For example, a person who compulsively cleans may be asked to stand in a filthy room and resist the urge to tidy up.
Medications
Anti-anxiety medications and antidepressants are most commonly prescribed for OCD. All of the following types of medications can help reduce anxiety but do so in different ways and with different side effects and risks.
- Selective Serotonin Reuptake Inhibitors (SSRIs): A frequently used anti-depressant medication for GAD, SSRIs include fluoxetime (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and fluvoxamine (Luvox).
- Benzodiazepines: A frequently used sedative and anti-anxiety medication for GAD, benzodiazepines include diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax).
- Others: There are several other medications that are sometimes prescribed for anxiety and are not SSRIs or benzodiazepines. These include gabapentin (Neurontin), quetiapine (Seroquel), and hydroxyzine (Atarax).
Consult your doctor if you believe you have any of the symptoms related to this disorder and discuss the benefits and risks of any medication or therapy.
Brian P. Brennan, M.D., is an assistant professor of psychiatry at Harvard Medical School and is currently the Director of Medical Research at the Obsessive-Compulsive Disorder Institute at McLean Hospital and the Associate Director of Translational Neuroscience Research in the Biological Psychiatry Laboratory at McLean Hospital. He received his medical degree from the Raymond and Ruth Perelman School of Medicine (formerly known as the University of Pennsylvania School of Medicine) and completed residency training in the combined Massachusetts General Hospital/McLean Hospital Psychiatry Residency Training Program.
The overarching theme of Dr. Brennan’s research is the investigation of novel biological targets for the development of improved pharmacologic therapies for mood and anxiety disorders. Specifically, Dr. Brennan focuses on the use of neuroimaging as a means to better understand the mechanism of action of both standard and novel treatments for mood and anxiety disorders and to identify neurochemical and functional mediators of treatment response.
Dr. Brennan’s clinical and research work has led to grant funding from the National Institute of Mental Health, NARSAD, the Sidney R. Baer, Jr. Foundation, and the Stanley Medical Research Institute and receipt of the Outstanding Professional of the Year Award from the Boston Chapter of the Depression and Bipolar Disorder Support Alliance.
