Obsessive-Compulsive Disorder

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from The National Institute of Mental Health (NIMH) (see below). Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

Overview

Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviours (compulsions) that he or she feels the urge to repeat over and over.

Signs and Symptoms

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety.

Common symptoms include:

• Fear of germs or contamination
• Unwanted forbidden or taboo thoughts involving sex, religion, and harm
• Aggressive thoughts towards others or self
• Having things symmetrical or in a perfect order

Compulsions are repetitive behaviours that a person with OCD feels the urge to do in response to an obsessive thought.

Common compulsions include:

• Excessive cleaning and/or handwashing
• Ordering and arranging things in a particular, precise way
• Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
• Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes.

But a person with OCD generally:

• Can't control his or her thoughts or behaviours, even when those thoughts or behaviours are recognized as excessive
• Spends at least 1 hour a day on these thoughts or behaviours
• Doesn't get pleasure when performing the behaviours or rituals, but may feel brief relief from the anxiety the thoughts cause
• Experiences significant problems in their daily life due to these thoughts or behaviours

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn't make sense, some adults and most children may not realize that their behaviour is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

If you think you have OCD, talk to your doctor about your symptoms. If left untreated, OCD can interfere in all aspects of life.

Risk Factors

OCD is a common disorder that affects adults, adolescents, and children all over the world. Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen.

The causes of OCD are unknown, but risk factors include:

Genetics: Twin and family studies have shown that people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. The risk is higher if the first-degree relative developed OCD as a child or teen. Ongoing research continues to explore the connection between genetics and OCD and may help improve OCD diagnosis and treatment.

Brain Structure and Functioning: Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear. Research is still underway. Understanding the causes will help determine specific, personalized treatments to treat OCD.

Environment: People who have experienced abuse (physical or sexual) in childhood or other trauma are at an increased risk for developing OCD.

Streptococcal infection: In some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

Treatments and Therapies

OCD is typically treated with medication, psychotherapy or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.

Sometimes people with OCD also have other mental disorders, such as anxiety, depression, and body dysmorphic disorder, a disorder in which someone mistakenly believes that a part of their body is abnormal. It is important to consider these other disorders when making decisions about treatment.

Medication

Serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms. Examples of medications that have been proven effective in both adults and children with OCD include clomipramine, which is a member of an older class of “tricyclic” antidepressants, and several newer “selective serotonin reuptake inhibitors” (SSRIs), including:

• fluoxetine
• fluvoxamine
• sertraline

SRIs often require higher daily doses in the treatment of OCD than of depression and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.

If symptoms do not improve with these types of medications, research shows that some patients may respond well to an antipsychotic medication (such as risperidone). Although research shows that an antipsychotic medication may be helpful in managing symptoms for people who have both OCD and a tic disorder, research on the effectiveness of antipsychotics to treat OCD is mixed.

If you are prescribed a medication, be sure you:

• Talk with your doctor or a pharmacist to make sure you understand the risks and benefits of the medications you're taking.
• Do not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to "rebound" or worsening of OCD symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
• Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication.

Other medications have been used to treat OCD, but more research is needed to show the benefit for these options. For basic information about these medications, see website recommendations below.

Psychotherapy

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behaviour therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP) is effective in reducing compulsive behaviours in OCD, even in people who did not respond well to SRI medication. For many patients EX/RP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms.

About the source

The National Institute of Mental Health (NIMH) is the lead federal agency for research on mental disorders. NIMH is one of the 27 Institutes and Centres that make up the National Institutes of Health (NIH), the largest biomedical research agency in the world. NIH is part of the U.S. Department of Health and Human Services (HHS).

Recommended websites

For further reading go to:

• Obsessive-Compulsive Disorder at Cleveland clinic
• An OCD self-screening test
• Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

_______________________________________________________________________________________________________________________

Are you a healthcare practitioner who enjoys patient education, interaction and communication?

If so, we invite you to criticise, contribute to or help improve our content. We find that many practicing doctors who regularly communicate with patients develop novel and often highly effective ways to convey complex medical information in a simplified, accurate and compassionate manner.

MedSquirrel is a shared knowledge, collective intelligence digital platform developed to share medical expertise between doctors and patients. We support collaboration, as opposed to competition, between all members of the healthcare profession and are striving towards the provision of peer reviewed, accurate and simplified medical information to patients. Please share your unique communication style, experience and insights with a wider audience of patients, as well as your colleagues, by contributing to our digital platform.

Your contribution will be credited to you and your name, practice and field of interest will be made visible to the world. (Contact us via the orange feed-back button on the right).