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Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a brain disorder, and more specifically, an anxiety disorder. OCD is manifested in a variety of forms, but is most commonly characterized by a subject's obsessive drive to perform a particular task or set of tasks, compulsions commonly termed rituals.

OCD should be distinguished from non-organic conditions that may mimic its symptoms, such as caffeinism.

OCD should also be distinguished from the similarly named but notably different obsessive-compulsive personality disorder, which psychiatric guidelines define as a personality characteristic rather than an anxiety disorder.

The phrase "obsessive-compulsive" has worked its way into the wider American lexicon, and is often used in an offhanded sense to describe someone who is meticulous or absorbed in a cause. Such casual references obviously should not be conflated with clinical diagnoses of obsessive-compulsive disorder. It is also important to distinguish OCD from other types of anxiety, including the routine tension and stress that appear throughout life. A person who shows signs of infatuation or fixation with a subject, or displays traits such as perfectionism, is not necessarily stricken with OCD, a specific and well-defined disorder.

Symptoms and prevalence

Modern research has revealed that OCD is much more common than previously thought. An estimated two to three percent of the population of the United States is thought to have OCD or display OCD-like symptoms. Because of the condition's personal nature, and the lingering stigma that surrounds it, there may be many unaccounted OCD sufferers, and the above percentages could be even higher.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsessions. To others, these tasks may appear simple and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways for fear of dire consequences and to stop the stress build up. Examples of these tasks: repeatedly checking that one's parked car has been locked before leaving it; turning lights on and off a set number of times before exiting a room; repeatedly washing hands at regular intervals throughout the day.

OCD rituals are often bound up with intricate detail -- detail that may seem arbitrary to outsiders. A smoker with OCD, for instance, may argue with herself that quitting cigarettes is possible only on the 13th or 27th of a month, and only when she has possession of four cigarettes at noon.

Most with OCD are aware that such thoughts and behavior are not rational, but feel bound to comply with them to fend off fears of panic or dread. Because sufferers are consciously aware of this irrationality but feel helpless to push it away, OCD is often regarded as one of the most vexing and frustrating of the major anxiety disorders.

Other people with OCD are not aware of anything abnormal with them; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. This form of OCD resembles delusional disorder. Eventually their obsessions will become so severe they need help to overcome what began as an irritating, time wasting problem.

Obsessions are thoughts and ideas that the sufferer cannot stop thinking about. Common OCD obsessions include fears of acquiring disease, getting hurt or causing harm to someone. Obsessions are typically automatic, frequent, distressing, and difficult to control or put an end to by themselves. A sufferer will almost always obsess over something which he or she is most afraid of. People with OCD who obsess over hurting themselves or others are actually less likely to do so than the average person.

Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. For an OCD sufferer who obsesses about germs or contamination, for example, these compulsions often involve repeated cleansing or meticulous avoidance of trash and mess. Most of the time the actions become so regular that it is not a noticeable problem. Common compulsions include excessive washing and cleaning; checking; hoarding; repetitive actions such as touching, counting, arranging and ordering; and other ritualistic behaviors that the person feels will lessen the chances of provoking an obsession. Compulsions can be observable -- washing, for instance -- but they can also be mental rituals such as repeating words or phrases, or counting.

Not all OCD sufferers engage in compulsive behavior. Recent years have seen increased diagnoses of Pure Obsessional OCD, or "Pure O." This form of OCD is manifested entirely within the mind, and involves obsessive ruminations triggered by certain thoughts. These mental "snags" can be debilitating, often tying up a sufferer for hours at a time. At this writing (2004), Pure O is considered the trickiest form of OCD to treat, though headway continues to be made by specialists such as Dr. Steven Phillipson.

OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no tangible pleasure in doing so.

OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life -- particularly its substantial consumption of time -- can produce difficulties with work, finances and relationships.

Causes and related disorders

Recent research has revealed a possible genetic mutation that could be the cause of OCD. Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD.

Violence is rare among OCD sufferers, but the disorder is often debilitating to the quality of life. Also, the psychological self-awareness of the irrationality of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. To avoid perceived obsession triggers, they also often avoid certain situations or places altogether.

Some people with OCD also suffer from conditions such as Tourette syndrome, attention deficit disorder, trichotillomania and hypochondria. Other minor side problems that come along with these disorders are scratching, picking, and nail biting.

Some cases are thought to be caused at least in part by childhood streptococcal infections and are termed PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcus). The streptococcal antibodies become involved in an autoimmune process.

Treatment

OCD can be treated with behavioral therapy (BT) or cognitive behavior therapy (CBT) and with a variety of medications. According to the Expert Consensus Guidelines for the Treatment of Obsessive-Compulsive Disorder (Journal of Clinical Psychiatry, 1995, Vol. 54, supplement 4), the treatment of choice for most OCD is behavior therapy or cognitive behavior therapy. Medications can help make the treatment go faster and easier, but most experts regard BT/CBT as clearly the best choice. Medications generally do not produce as much symptom control as BT/CBT, and symptoms invariably return if the medication is ever stopped.

The specific technique used in BT/CBT is called Exposure and Ritual Prevention (also known as Exposure and Response Prevention) or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school). That is the "exposure." The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the (formerly) anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all -- again, without performing the ritual behavior of washing or checking.

Medication treatments include selective serotonin reuptake inhibitors such as paroxetine (Paxil, Aropax), sertraline (Zoloft), fluoxetine (Prozac), and fluvoxamine (Luvox) as well as the tricyclic antidepressants, and in particular clomipramine (Anafranil). Some medications like Gabapentin have also been found to be useful in the treatment of OCD. Symptoms tend to return, however, once the drugs are discontinued.

Recent research has found increasing evidence that opioids may significantly reduce OCD symptoms, though the addictive property of these drugs likely stands as an obstacle to their sanctioned approval for OCD treatment. Anecdotal reports suggest that some OCD sufferers have successfully self-medicated with opioids such as Ultram and Vicodin, though the off-label use of such painkillers is not encouraged, again because of their addictive qualities.

Hallucinogens, such as psilocybin (an active ingredient in "magic mushrooms") and LSD, have also shown promise -- reducing symptoms for up to several months after ingestion in some people. The US FDA has approved a study to determine their effectiveness that is being conducted at the University of Arizona.


The information above is not intended for and should not be used as a substitute for the diagnosis and/or treatment by a licensed, qualified, health-care professional. This article is licensed under the GNU Free Documentation License. It incorporates material originating from the Wikipedia article "Obsessive-compulsive disorder".

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