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Obsessive- Compulsive Disorder  (OCD)  

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Obsessive-Compulsive Disorder  (OCD)

Obsession Compulsive Disorder (OCD) is an anxiety disorder where a person has recurrent and unwanted thoughts (obsessions) and an urge or compulsion to do something to relieve the discomfort caused by their obsessions. The obsessive thoughts may range from the idea of losing control, to themes surrounding religion, safety or cleanliness. Compulsions are associated behaviors which help reduce the anxiety surrounding those obsessions. 

Obsessive-Compulsive Disorder is one of the more difficult to understand of the psychiatric disorders. People who have this condition find themselves repeating certain behaviors and thoughts over and over and over again. They understand that repetition is unnecessary, but are unable to stop them. Common forms of this are checking locks, stoves and lights, washing hands or recurrent intrusive thoughts of hurting oneself or one's children.  They usually experience severe anxiety if they are unable to complete their rituals.  

Signs and Symptoms

Obsessions 

  • Recurrent and persistent thoughts

  • Inability or ignore or resist such thoughts

  • Awareness of thoughts being generated from themselves

  • Thoughts of violence

  • Fear of harming a family member or a friend.

  • Fears of infection (from germs, dirt, etc.).

  • Doubts (is the front door shut, locked; is the iron on).

  • Excessive orderliness or symmetry.

  • Constant brooding (over a word, phrase or unanswerable problem).

Compulsions 

  • Repetitive behaviors and actions in response to the obsessive thoughts

  • Constant checking in response to doubt (locks, doors, windows).

  • Excessive hand washing.

  • Counting over and over to a certain number.

  • Hoarding.

  • Repeated behaviors - such as dressing rituals.  

Adapted from:
Diagnostic and Statistical Manual of Mental Disorders.  Vol. IV  American Psychiatric        Association.  1994

        

Types of Compulsions:

Cleaning Some individuals concerned about contamination will spend hours cleaning their home, showering or bathing, or washing their hands almost constantly.

Checking Individuals worried about harming others may check several, or up to hundreds, of times to make sure stoves are turned off or doors are locked. Checking and cleaning are probably the two most common compulsions.

Repeating Some may wish to ease anxiety by repeating a name or phrase over and over.

Slowness Some individuals take an excessively slow and methodical approach to daily activities. They are overly meticulous and tidy and will spend hours organizing and arranging objects and possessions.

Hoarding Hoarders are unable to throw away useless items, such as old newspapers or magazines, sometimes to the point that they fill rooms or block doorways. This is one of the least common compulsions.

       

Treatments

Behavior Therapy
One of the most effective treatments is a type of behavior therapy known as exposure and response prevention.

During treatment sessions, patients are exposed to the situations that give rise to their anxiety and provoke compulsive behavior or mental rituals. Through this exposure, the patients learn to decrease and then stop the rituals that plague their lives. They find that the anxiety arising from their obsessions lessens without their engaging in ritualistic behavior. For example, therapy for a compulsive cleaner who previously could not handle money without washing her hands might involve counting dollar bills without washing her hands.

This technique works well for patients whose compulsions focus on situations that can be re-created easily. A few engage in compulsive rituals because they fear catastrophic events that can’t be re-created. Therapy for these patients must rely more on imagining exposure to the anxiety-producing situations.

Throughout behavior therapy, the patient follows guidelines or a "contract" on which the psychiatrist and patient agree. For example, the contract may outline whether a patient can perform any part of his or her ritualistic behavior and, if so, for how long and under what circumstances. A compulsive washer may agree to shower for only 10 minutes a day. Compulsive checkers may be permitted to check door locks, gas stoves, or knives only once a day.

Careful studies show that behavior therapy can effectively reduce compulsive behavior and significantly lessen the chances for relapse. But behavior therapy depends on the patient’s willingness to participate and ability to keep his or her part of the treatment contract. Throughout therapy the psychiatrist coaches the patient to fight the compulsion. Often, family members also coach and support their loved ones in sticking with their therapy.

Medication
Various studies indicate that behavior therapy is successful for 50% to 90% of those with OCD. However, some patients will not agree to participate in behavior therapy because it can be difficult. Others also have depression which must be treated simultaneously.

Numerous studies have demonstrated that a class of medications known as serotonin reuptake inhibitors are often effective in the treatment of OCD.

      

References and Links:
The above information has been provided by:

American Psychiatric Association.  Public Information:  Let's Talk Facts            
        Pamphlet Series     
        http://www.psych.org/main.html
Diagnostic and Statistical Manual of Mental Disorders.  Vol. IV  American 
        Psychiatric Association.  1994
National Institute of Mental Health   
        http://www.nimh.nih.gov/about/index.cfm
National Mental Health Association
        http://www.nmha.org/

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