An Introduction to Obsessive-Compulsive Disorder

By 20 Jul 2001

Obsessive-compulsive disorder (OCD) is one of the more disabling and widespread, yet least understood, mental disorders. This disorder is characterized by two central features -- obsessions and compulsions. Both the features need to be present and to such a degree that they interfere with your normal daily functioning to be diagnosed with OCD. Many people have traits of compulsiveness and "being compulsive" which should not be confused with OCD.

Obsessions are unwanted ideas or impulses that repeatedly pop up in a person's mind. According to the National Institute of Mental Health (NIMH), "Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common."

Examples of common obsessions include: "My hands may be contaminated -- I must wash them"; "I may have left the gas on in the house"; or "I am going to injure my child." These thoughts are often intrusive, unpleasant and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.

Compulsions, on the other hand, are repetitive behaviors to which people who suffer from OCD resort. The two most common compulsions are washing (hands, usually) and checking (e.g., gas is off on stove). Other common compulsions include counting (often while performing another compulsive action such as hand washing), repeating, hoarding and endlessly rearranging objects in an effort to keep them in precise alignment with each other.

A person who has OCD often believes that these behaviors will keep harm away from them or their loved ones and that if they fail to complete a compulsive behavior, harm is imminent.

Also, according to the NIMH, "Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary."

"OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder or another of the anxiety disorders," states the NIMH. "Co-existing disorders can make OCD more difficult both to diagnose and to treat."

One of the more frustrating aspects of OCD is that people who have it are often very much aware of how ridiculous or silly some of their behaviors may seem. This insight, however, is usually of little help to them in their treatment.

The causes of OCD remain as murky as do the causes for most mental disorders. It is probably a complex combination of genetic, biological, psychological and social factors which go to make up what we label "OCD." There may be a problem with how a person develops their information processing skills. But to a great extent, we simply do not yet know what causes OCD.

However, as with most mental disorders, not knowing the cause does not mean we do not know what works in treatment. And what works in treatment for OCD are certain psychopharmacological agents and behavior or cognitive-behavior psychotherapy. Specifically, according to the NIMH:

"Clinical trials in recent years have shown that drugs that affect the neurotransmitter serotonin can significantly decrease the symptoms of OCD."

"The first of these serotonin reuptake inhibitors (SRIs) specifically approved for the use in the treatment of OCD was the tricyclic antidepressant clomipramine (AnafranilR). It was followed by other SRIs that are called "selective serotonin reuptake inhibitors" (SSRIs). Those that have been approved by the Food and Drug Administration for the treatment of OCD are flouxetine (ProzacR), fluvoxamine (LuvoxR) and paroxetine (PaxilR)."

"Another that has been studied in controlled clinical trials is sertraline(ZoloftR). Large studies have shown that more than three-quarters of patients are helped by these medications at least a little. And in more than half of patients, medications relieve symptoms of OCD by diminishing the frequency and intensity of the obsessions and compulsions. Improvement usually takes at least three weeks or longer.

If a patient does not respond well to one of these medications, or has unacceptable side effects, another SRI may give a better response. For patients who are only partially responsive to these medications, research is being conducted on the use of an SRI as the primary medication and one of a variety of medications as an additional drug (an augmenter)."

"Medications are of help in controlling the symptoms of OCD, but often, if the medication is discontinued, relapse will follow. Indeed, even after symptoms have subsided, most people will need to continue with medication indefinitely, perhaps with a lowered dosage."

Medications are rarely enough to help overcome a serious mental disorder such as OCD. According to the NIMH, "Studies of behavior therapy for OCD have found it to be a successful treatment for the majority of patients who complete it. For the treatment to be successful, it is important that the therapist be fully trained to provide this specific form of therapy. It is also helpful for the patient to be highly motivated and have a positive, determined attitude."

"The positive effects of behavior therapy endure once treatment has ended. A recent compilation of outcome studies indicated that, of more than 300 OCD patients who were treated by exposure and response prevention, an average of 76 percent still showed clinically significant relief from three months to six years after treatment (Foa & Kozak, 1996)."

You should keep in mind that "OCD affects not only the sufferer but the whole family. The family often has a difficult time accepting the fact that the person with OCD cannot stop the distressing behavior. Family members may show their anger and resentment, resulting in an increase in the OCD behavior. Or, to keep the peace, they may assist in the rituals or give constant reassurance."

"Education about OCD is important for the family. Families can learn specific ways to encourage the person with OCD to adhere fully to behavior therapy and/or pharmacotherapy programs. Self-help books are often a good source of information. Some families seek the help of a family therapist who is trained in the field. Also, in the past few years, many families have joined one of the educational support groups that have been organized throughout the country" (NIMH).

OCD can be successfully treated. But it must first be properly recognized and diagnosed by a trained mental health professional, such as a psychologist, psychiatrist or clinical social worker. Treatment should be multi-faceted, addressing not only the biological aspect (through appropriate medication), but also the psychological and social aspects of this disorder (through psychotherapy).

In the hands of skilled professionals, most people with OCD can enjoy relief from their symptoms and the ability to live free of most obsessions and compulsions.

For further information about obsessive-compulsive disorder (which is a type of anxiety disorder), please contact:

Anxiety Disorders Association of America
6000 Executive Blvd., Suite 513
Rockville, MD 20852
Phone: (301) 231-9350

Reprinted with permission.

Last reviewed: By John M. Grohol, Psy.D. on 29 Mar 2015
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