Obsessive-compulsive disorder (OCD) is a type of
disorder. Anxiety disorder is the experience of prolonged, excessive
worry about circumstances in one's life. OCD is characterized by
distressing repetitive thoughts, impulses, or images that are intense,
frightening, absurd, or unusual. These thoughts are followed by
ritualized actions that are usually bizarre and irrational. These ritual
actions, known as compulsions, help reduce anxiety caused by the
individual's obsessive thoughts. Often described as the
"disease of doubt," the sufferer usually knows the obsessive
thoughts and compulsions are irrational but, on another level, fears they
may be true.
Most people with obsessive-compulsive disorder have both obsessions and
compulsions, but occasionally a person will have just one or the other.
The degree to which this condition can interfere with daily living also
varies. Some people are barely bothered, while others find the obsessions
and compulsions to be profoundly traumatic and spend much time each day in
compulsive actions. Because the symptoms are so distressing, sufferers
often hide heir fears and rituals but cannot avoid acting on them. OCD
sufferers are often unable to decide if their fears are realistic and need
to be acted upon.
Obsessions are intrusive, irrational thoughts that keep popping up in a
person's mind, such as the urgency to wash one's hands
again. Typical obsessions include fears of dirt, germs, contamination, and
violent or aggressive impulses. Other obsessions include feeling
responsible or others'
or an irrational
of hitting a pedestrian with a car. Additional obsessions can involve
excessive religious feelings or intrusive sexual thoughts. The patient may
need to confess frequently to a religious counselor or may fear
the strong sexual thoughts in a hostile way. People with
obsessive-compulsive disorder may have an intense preoccupation with order
and symmetry or may be unable to throw anything out.
Compulsions usually involve repetitive rituals such as excessive washing
(especially hand washing or bathing), cleaning, checking and touching,
counting, arranging, and/or hoarding. As the person performs these acts,
he may feel temporarily better, but there is no long-lasting sense of
satisfaction or completion after the act is performed. Often, a person
with obsessive-compulsive disorder believes that if the ritual is not
performed, something dreadful will happen. While these compulsions may
temporarily ease stress, short-term comfort is purchased at a heavy
price—time spent repeating compulsive actions and a long-term
interference with life.
The difference between OCD and other compulsive behavior is that while
people who have problems with gambling, overeating, or with substance
abuse may appear to be compulsive, these activities also provide pleasure
to some degree. The compulsions of OCD, on the other hand, are never
OCD may be related to some other conditions, such as the continual urge to
pull out body hair (
); fear of having a serious disease (hypochondriasis); or preoccupation
with imagined defects in personal appearance disorder (body dysmorphia).
Some people with OCD also have
, a condition featuring
and unwanted vocalizations (such as swearing). OCD is often linked with
depression and other anxiety disorders.
Almost one out of every 40 people suffers from obsessive-compulsive
disorder at some time in their lives. The condition is two to three times
more common than either
or manic depression and strikes men and women of every ethnic group, age,
and social level.
If one person in a
has obsessive-compulsive disorder, there is a 25 percent chance that
another immediate family member has the condition. It also appears that
stress and psychological factors may worsen symptoms, which usually begin
or early adulthood.
Causes and symptoms
Research suggests that the tendency to develop obsessive-compulsive
disorder is inherited. There are several theories behind the cause of OCD.
OCD may be related to a chemical imbalance within the brain that causes a
communication problem between the front part of the brain (frontal lobe)
and deeper parts of the brain responsible for the repetitive behavior. The
orbital cortex located on the underside of the brain's frontal lobe
is overactive in OCD patients. This may be one reason for the feeling of
alarm that pushes the patient into compulsive, repetitive actions. It is
possible that people with OCD experience overactivity deep within the
brain that causes the cells to get "stuck," much like a
jammed transmission in a car damages the gears. This could lead to the
development of rigid thinking and repetitive movements common to the
disorder. The fact that drugs which boost the levels of serotonin, a brain
messenger substance linked to emotion and many different anxiety
disorders, in the brain can reduce OCD symptoms may indicate that to some
degree OCD is related to levels of serotonin in the brain.
There may also be a link between childhood episodes of
and the development of OCD. In some vulnerable children, strep antibodies
attack a certain part of the brain. Antibodies are cells that the body
produces to fight specific diseases. That attack results in
PET scans of a brain showing active areas in obsessive-compulsive
disorder; positive correlations (activity increases as symptoms get
stronger), top row; negative correlation (activity decreases as
symptoms strengthen), bottom.
(Wellcome Department of Cognitive Neurology/SPL/Photo Researchers,
the development of excessive washing or germ
. A phobia is a strong but irrational fear. In this instance the phobia is
fear of disease germs present on commonly handled objects. These symptoms
would normally disappear over time, but some children who have repeated
infections may develop full-blown OCD. Treatment with
, immunoglobulin, or blood cleansing procedures can decrease the
circulating anti-strep antibodies in the blood, thus lessening the OCD
symptoms in some of these children.
People with obsessive-compulsive disorder feel ashamed of their problem
and often try to hide their symptoms. They avoid seeking treatment.
Because they can be very good at keeping their problem from friends and
family, many sufferers do not get the help they need until the behaviors
are deeply ingrained habits and hard to change. As a result, the condition
is often misdiagnosed or underdiagnosed. All too often, it can take more
than a decade between the onset of symptoms and proper diagnosis and
OCD appears to be related to a disruption in serotonin levels, there is no
blood test for the condition. Instead, doctors diagnose OCD after
evaluating a person's symptoms and history.
Obsessive-compulsive disorder can be effectively treated by a combination
of cognitive-behavioral therapy and medication that regulates the
brain's serotonin levels. Drugs that are approved to treat
obsessive-compulsive disorder include fluoxetine (Prozac), fluvoxamine
(Luvox), paroxetine (Paxil), and sertraline (Zoloft), all selective
serotonin reuptake inhibitors (SSRIs) that
affect the level of serotonin in the brain. Older drugs include the
antidepressant clomipramine (Anafranil), a widely studied drug in the
treatment of OCD, but one that carries a greater risk of side effects.
Drugs should be taken for at least 12 weeks before a person decides
whether they are effective.
Cognitive-behavioral therapy (CBT) teaches patients how to confront their
fears and obsessive thoughts by making the effort to endure or wait out
the activities that usually cause anxiety without compulsively performing
the calming rituals. Eventually their anxiety decreases. People who are
able to alter their thought patterns in this way can lessen their
preoccupation with the compulsive rituals. At the same time, the patient
is encouraged to refocus attention elsewhere, such as on a hobby.
In a few very severe cases in which patients have not responded to
medication or behavioral therapy, brain surgery may be tried as a way of
relieving the unwanted symptoms. Surgery can help up to one third of
patients with the most severe form of OCD. The most common operation
involves removing a section of the brain called the cingulate cortex. The
serious side effects of this surgery for some patients are seizures,
personality changes, and less ability to plan.
Obsessive-compulsive disorder is a chronic disease that, if untreated, can
last for decades, fluctuating from mild to severe and worsening with age.
When treated by a combination of drugs and behavioral therapy, some
patients go into complete remission. Unfortunately, not all patients have
such a good response. About 20 percent of people cannot find relief with
either drugs or behavioral therapy.
may be required in some cases.
Despite the crippling nature of the symptoms, many successful doctors,
lawyers, business people, performers, and entertainers function well in
society despite their condition. Nevertheless, the emotional and financial
cost of obsessive-compulsive disorder can be quite high.
—A mental disorder characterized by prolonged, excessive worry
about circumstances in one's life. Anxiety disorders include
agoraphobia and other phobias, obsessive-compulsive disorder,
post-traumatic stress disorder, and panic disorder.
—A type of psychotherapy in which people learn to recognize and
change negative and self-defeating patterns of thinking and behavior.
—A repetitive or ritualistic behavior that a person performs to
reduce anxiety. Compulsions often develop as a way of controlling or
"undoing" obsessive thoughts.
—A persistent image, idea, or desire that dominates a
person's thoughts or feelings.
Selective serotonin reuptake inhibitors (SSRIs)
—A class of antidepressants that work by blocking the
reabsorption of serotonin in the brain, thus raising the levels of
serotonin. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and
—A widely distributed neurotransmitter that is found in blood
platelets, the lining of the digestive tract, and the brain, and that
works in combination with norepinephrine. It causes very powerful
contractions of smooth muscle and is associated with mood, attention,
emotions, and sleep. Low levels of serotonin are associated with
Herbert, Fredrick B. "Obsessive-Compulsive Disorder in Children and
Edited by James L. Jacobson et al. Philadelphia: Hanley and Belfus, 2001.
Stafford, Brian, et al. "Anxiety Disorders." In
Nelson Textbook of Pediatrics.
Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.
Barrett, P. "Cognitive-behavioral family treatment of childhood
obsessive-compulsive disorder: a controlled trial."
Journal of the American Academy of Child and Adolescent Psychiatry
43 (January 2004): 46–62.
Storch, E. A. "Behavioral treatment of a child with PANDAS."
Journal of the American Academy of Child and Adolescent Psychiatry
86 (May 2004): 510–1.
Anxiety Disorders Association of America.
11900 Park Lawn Drive, Suite 100, Rockville, MD 20852. Web site:
National Alliance for the Mentally Ill (NAMI).
Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington, VA
22201–3042. Web site: http://www.nami.org.
National Anxiety Foundation.
3135 Custer Dr., Lexington, KY 40517. Web site: