Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder is characterized by recurring, persistent, unwanted, anxiety-provoking, intrusive ideas, images, or urges (obsessions). Also, some people feel driven to repeatedly perform certain rituals (compulsions)—particular actions or mental acts—to try to lessen or prevent the anxiety caused by the obsessions.
Obsessive-compulsive disorder (OCD) is slightly more common among women than men and affects about 1 to 2% of the population. Children are also affected (see Obsessive-Compulsive Disorder (OCD) and Related Disorders in Children and Adolescents). Up to 30% of people with OCD have had or have a tic disorder (see Tourette Syndrome and Other Tic Disorders in Children and Adolescents).
OCD differs from psychotic disorders, in which people lose contact with reality. OCD also differs from obsessive-compulsive personality disorder (see Obsessive-Compulsive Personality Disorder (OCPD)), although people with these disorders may have some of the same characteristics, such as being orderly or reliable or being a perfectionist.
People with OCD have obsessions—thoughts, images, or urges that occur over and over even though people do not want them to. These obsessions intrude even when people are thinking about and doing other things. Also, obsessions usually cause great distress or anxiety. The obsessions usually involve thoughts of harm, risk, or danger.
Common obsessions include the following:
Because the obsessions are not pleasurable, people try to ignore and/or control them.
Compulsions (also called rituals) are one way people respond to their obsessions. For example, they may feel driven to do something—repetitive, purposeful, and intentional—to try to prevent or relieve the anxiety caused by their obsessions.
Common compulsions include the following:
Most rituals, such as excessive handwashing or repeated checking to make sure a door has been locked, can be observed. Other rituals, such as repetitive counting or quietly mumbling statements intended to diminish danger, cannot be observed.
Rituals may have to be done in a precise way according to rigid rules. The rituals may or may not be logically connected to the obsession. When compulsions are logically connected to the obsession (for example, showering to avoid being dirty or checking the stove to prevent fire), they are clearly excessive. For example, people may shower for hours each day or always check the stove 30 times before they leave the house. All obsessions and rituals are time-consuming. People may spend hours each day on them. They may cause so much distress or interfere with functioning so much that people are incapacitated.
Most people with OCD are somewhat aware that their obsessive thoughts do not reflect actual risks and that their compulsive behaviors are excessive. However, some people are convinced that their obsessions are well-founded and that their compulsions are reasonable.
Some people with OCD are aware that their compulsive behaviors are excessive. Thus, they may perform their rituals secretly, even though the rituals may occupy several hours each day. As a result, their relationships may deteriorate, and they may do less well in school or at work.
About one third of people with OCD are depressed at the time the disorder is diagnosed. Altogether, about 40% become depressed at some point.
Exposure therapy and ritual prevention therapy are often effective in treating OCD. Exposure therapy involves gradually and repeatedly exposing people to whatever (situations or people) triggers obsessions, rituals, or discomfort but not letting them perform the compulsive ritual. Discomfort or anxiety gradually diminishes during repeated exposure as people learn that rituals are unnecessary for decreasing discomfort. The improvement usually persists for years, perhaps because people who have mastered this approach are able to continue to practice it after formal treatment has ended.
Selective serotonin reuptake inhibitors (such as fluoxetine), a type of antidepressant, and clomipramine, a tricyclic antidepressant, are effective. Many experts believe that a combination of exposure and ritual prevention therapy and drug therapy is the best treatment.
Psychodynamic psychotherapy (which emphasizes the identification of unconscious patterns in current thoughts, feelings, and behaviors) and psychoanalysis have generally not been effective for people with OCD.