Obsessive-compulsive disorder

Overview
As the name implies, obsessive-compulsive disorder (OCD) is a type of anxiety disorder characterized by obsessions and compulsions. The obsessions provoke anxiety, and the compulsive behaviors are temporary but ineffective attempts to reduce the anxiety. The obsessions or compulsions are recurrent, time-consuming and severe enough to cause marked distress or impairment. Underlying the disorder is some form of pathological doubting that encourages the obsessions and compulsions. At some point, a person who has OCD recognizes that the obsessions or compulsions are excessive or unreasonable. Due to embarrassment, however, people who have OCD rarely reveal their symptoms.
OCD affects both men and women. For males, the condition typically appears between ages 6 and 15. For females, the condition typically appears between ages 20 and 29. The characteristics of OCD are similar for children and adults. Children are usually not aware that the obsessions or compulsions are excessive or unreasonable, however.

According to the National Institute of Mental Health, slightly more than 2 percent of Americans between ages 18 and 54 experience OCD in a given year. According to the American Psychiatric Association, an estimated 2.5 to 3 percent of adults cope with OCD as a chronic condition.

Obsessions
In everyday language, the term obsession is often incorrectly equated with pleasurable fantasies or preoccupations. More accurately, obsessions are persistent, disturbing, intrusive, anxiety-provoking thoughts or images the person believes are illogical and irresistible. Obsessive images are usually violent or disgusting, such as a burning child, rape or repugnant sexual behaviors. People who have OCD consider the obsessions absurd and actively resist them. The obsessive thoughts annoyingly interrupt normal thought, however. Prognosis is not dependent on the content of the obsession.

Compulsions
Compulsions are obsessions expressed in driven, repetitive action. Compulsions are directly linked to the obsession, such as washing your hands to prevent disease. Sometimes they're linked by "magical" thinking, such as superstitions or other irrational thoughts about behavior having magical qualities that protect against danger. For example, "My parents won't die if I wash my hands."

Forms of obsessive-compulsive disorder
Common forms of obsessive-compulsive disorder include:

Washing: A fear of contamination drives you to compulsively clean or engage in excessive hand washing. You may be afraid of becoming contaminated or contaminating others.

Checking: A pathological disbelief drives a need to repeatedly check things. For example, you may doubt that a door is locked, which leads to repeatedly checking that the house or car doors are locked.

Doubting: A fear of terrible things as a result of imperfection. Doubting may paralyze you into inaction, rather than a compulsive behavior. For example, you may continually think, "Did I do this job right?"

Counting or arranging: Obsessions of order and symmetry ruled by "magical" thinking and superstitions fuel a compulsion to arrange or count objects, with asymmetry leading to an imagined catastrophe. For example, you may feel you cannot work unless your pencil is facing north or that everything must be done in pairs or even numbers.

Hoarding: A belief that terrible events will happen if you throw something away. Hoarding is characterized by a catastrophic response to items being thrown away, not simply poor organization skills.

OCD typically appears gradually. However, symptoms may occur suddenly after a severe psychosocial stress factor or event. Milder OCD symptoms are more likely if you do not have compulsions or have a briefer duration of symptoms and a higher level of functioning before being diagnosed with the condition. OCD symptoms tend to wax and wane over time, generally becoming worse under stress.


Causes/associated factors
Some studies indicate that brain circuitry differs for people who have OCD. Other studies suggest a genetic link. OCD occurs at a higher rate among first-degree biological relatives of those who have OCD (such as parents, siblings and children) than among the general population. Among twins, OCD rates are higher for identical twins than fraternal twins. Other studies have shown that having a streptococcal bacterial infection (such as rheumatic fever or strep throat) early in life may lead to the development of obsessions and compulsions. Some cases of OCD have been associated with both this infection and a genetic vulnerability. Preliminary evidence suggests that treatment for the infection improves or cures the OCD.

Characteristics
OCD may cause appetite or sleep disturbances, decreased energy level or physical complaints. Psychologically, you may feel anxious, frustrated, guilty or afraid of catastrophe. Your concentration may become impaired. You may realize that the obsessions are unreasonable, excessive or time-consuming. Common social characteristics include academic, occupational and interpersonal difficulties, as well as substance use or abuse. You may avoid objects or situations that provoke the obsession or compulsion.

Coping strategies
If you suspect you have OCD, it's important to consult a medical doctor to rule out any other medical conditions. Then, consult a mental health professional who has experience diagnosing and treating obsessive-compulsive disorder.
Medications, particularly selective serotonin reuptake inhibitors (SSRIs), are often an effective treatment for OCD. Behavioral therapy, particularly exposure therapy, is also helpful for some people. Through exposure therapy, you would be exposed to the fear-provoking stimuli. Then, the compulsive response to the obsession would be prevented and any catastrophic thoughts identified. Through this exercise, you can watch your anxiety peak and subside. A combination of medication and behavioral therapy is generally considered the best treatment for OCD. Family therapy may be helpful in resolving family problems related to obsessive-compulsive behavior. In addition, learning about symptoms and treatment may be helpful for people who have OCD and their families.

In addition to professional intervention, a variety of self-help strategies may help you cope with OCD. For example, it may be helpful to delay your obsessive thoughts. Postpone obsessing for a short period of time, and then gradually increase the length of time. Rather than suppressing the obsession, the goal is to gain control over the obsession by determining when it will occur. It may also help to focus on an interesting distraction -- such as reading a book, having a conversation, or watching a movie -- to divert your attention from a negative, obsessive thought. Finally, you may want to make a continuous loop tape if your obsessions include negative or frightening themes. Write down the worst case scenario and record it on an audiotape. Then, listen to the tape repeatedly for 30 minutes a day. The goal is to become desensitized to the content on the tape, which, in turn, reduces distress.