Obsessive-Compulsive Disorder (OCD)

What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder. People who have OCD are often or always troubled by ideas or images that stick in their mind. These thoughts, called obsessions, cause you to feel anxious and force you to behave in ways that make no sense. You may feel that you must do certain things over and over (rituals) to reduce your anxiety. These acts are called compulsions.

OCD affects between 1% and 2.5% of people in this country. Men with OCD usually begin having symptoms from 6 to 15 years of age, women in their early 20s.

What is the cause?

The cause of OCD is unknown. It tends to run in families. Some studies show that parts of the brain work differently in people with OCD. Some forms of OCD may be related to strep infections. OCD often occurs along with mood disorders such as other anxiety disorders, depression, and bipolar disorder.

What are the symptoms?

If you have OCD, you are usually aware that your obsessions or compulsions are keeping you from living fully and well. You may see your behavior as foolish or pointless, but it is very hard for you to change it.

Your obsessions often concern doubts about matters of safety (like whether you shut off the stove). Sometimes, however, your thoughts have to do with a fear that something awful will happen or that you will do something terrible (like kill loved ones for no reason).

If you have OCD, you may spend hours each day performing compulsive acts. The behavior may seriously disrupt your everyday life.

Some of the typical compulsions or rituals of OCD include:

• Cleaning: Fearing germs, you may shower several times a day or wash your hands until the skin is cracked and painful.
• Repeating: To reduce anxiety, you may repeat a name or phrase many times.
• Completing: You may do things in an exact order and repeat each step until things are done perfectly.
• Checking: If you fear harming yourself or others by forgetting to lock the door or unplug the toaster, you will check over and over again to see that it is done.
• Hoarding: You may collect useless items that you repeatedly count and stack.

People with OCD often have depression or the symptoms of depression. These include:

• guilt
• low self-esteem
• anxiety
• fatigue
• inability to make decisions

OCD symptoms often create problems in relationships and daily living. In extreme cases, you may become totally disabled. You may be unable to leave home because you spend your days doing rituals or having obsessive thoughts.

How is it diagnosed?

There is no lab test for OCD. Your healthcare provider will make the diagnosis by talking with you and someone close to you about your symptoms. He or she will ask very specific questions about the type of obsessions or compulsions you have.

You may have OCD if your obsessions or compulsions:

• cause you marked distress
• take more than an hour of your time a day
• get in the way of your normal routine, work, social activities, or relationships

Your healthcare provider may ask such questions as:

• Do you have troubling thoughts you cannot ignore or get rid of no matter how hard you try?
• Do you keep things very clean or wash your hands a lot more than other people you know?
• Do you check things over and over, even though you know that the oven has been turned off or that the front door is locked?

Your healthcare provider will check to make sure that a medicine or drug is not adding to your symptoms. Also, because fears (phobias) and depression can occur along with OCD, it is important for your healthcare provider to be able to tell which is which.

How is it treated?

Several types of medicines can help treat OCD. Your healthcare provider will work with you to carefully select the best one for you.

Behavior therapy is helpful in treating OCD. The type of behavior therapy most often used to treat OCD is called exposure and response prevention. It consists of having you confront your fears head-on by gradually increasing your exposure to them. With help from your therapist, you learn to overcome your anxiety.

If, for example, you wash your hands all the time because you fear being dirty, your healthcare provider may stand at the sink with you and prevent you from washing your hands until the anxiety goes away. This process also involves learning ways to relax, such as breathing exercises.

How long will the effects last?

Symptoms of OCD can be effectively managed with treatment. Without treatment, the disorder may last a lifetime, becoming less severe from time to time, but rarely going away completely. In some people, OCD occurs in episodes, with years free of symptoms before a relapse. Advances in therapy and new medicines are helping many people with OCD live productive lives.

How can I take care of myself?

Include your family in your therapy. You and your family may benefit from reading books and viewing videos on OCD, and from joining support groups.

Follow your provider's instructions for taking medicine and don't miss your therapy sessions.

Know that you are not alone. There are millions of people affected by OCD, and there are national groups devoted to helping people with this disorder. Remember that over 90% of people with OCD can manage this disorder with proper treatment.

When should I call the healthcare provider?

Call your healthcare provider if you feel that any of your ideas or actions are slipping out of your control.

Where can I get more information?

For more information, contact:

• The Obsessive-Compulsive Foundation, Inc.
  Phone: 1-203-878-5669
  Web site: http://www.ocfoundation.org.
• National Alliance for the Mentally Ill (NAMI)
  Phone: 1-800-950-NAMI
  Web site: http://www.nami.org
• Mental Health America
  Phone: 1-800-969-6642
  Web site: http://www.mentalhealthamerica.net