Obsessive-Compulsive Disorder (OCD)

Age: late adolescence, early adulthoodFamily members with a history of OCDOther anxiety disordersDepressionTourette syndromePersonality disorderAttention deficit disorder Symptoms Symptoms of OCD: Obsessionsunwanted, repetitive, and intrusive ideas, impulses, or imagesCompulsionsrepetitive behaviors or mental acts usually performed to reduce the distress associated with obsessionsAlthough people with OCD know that their thoughts and behaviors are nonsensical and would like to avoid or stop them, they are frequently unable to block their obsessive thoughts or avoid acting on their compulsions. Common obsessions include: Persistent fears that harm may come to self or a loved oneUnreasonable concern with being contaminatedUnacceptable religious, violent, or sexual thoughtsExcessive need to do things correctly or perfectly Common compulsions include: Excessive checking of door locks, stoves, water faucets, light switches, etc.Repeatedly making lists, counting, arranging, or aligning thingsCollecting and hoarding useless objectsRepeating routine actions a certain number of times until it feels just rightUnnecessary rereading and rewritingMentally repeating phrasesRepeatedly washing hands DiagnosisOCD is usually diagnosed through a psychiatric assessment. OCD is often diagnosed when obsessions and/or compulsions cause a person significant distress or interfere with the persons ability to properly perform at work, school, or in relationships.

TreatmentTreatment reduces OCD thoughts and behaviors, but does not completely eliminate them.Treatments include: MedicationsSelective serotonin reuptake inhibitors (SSRIs) reduce OCD symptoms by affecting the neurotransmitter serotonin. This function is independent of their antidepressant effects. Common SSRIs include: Fluoxetine (Prozac)Fluvoxamine (Luvox)Paroxetine (Paxil)Sertraline (Zoloft)Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when theres an increase or decrease in the dose. The medications of concern, mostly SSRIs (selective serotonin re-uptake inhibitors), are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.

Another medication often used is clomipramine (Anafranil). This is a tricyclic antidepressant drug that alters serotonin levels. Behavior Therapy (Exposure and Response Prevention)This helps you gradually confront the feared object or obsession without succumbing to the compulsive ritual associated with it. PreventionThere are no guidelines for preventing OCD because the cause is un known. However, early intervention may provide help before the disorder becomes severely disruptive. RESOURCES: Anxiety Disorders Association of Americahttp://www.adaa.org/ National Institute of Mental HealthNational Institutes of Healthhttp://www.nimh.nih.gov/ Obsessive-Compulsive Foundationhttp://ocfoundation.org/ CANADIAN RESOURCES: Canadian Mental Health Associationhttp://www.cmha.ca/ Canadian Psychological Associationhttp://www.cpa.ca/ References: Fauci AS, Braunwald E, Isselbacher KJ, et al. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: The McGraw-Hill Companies; 2000. Obsessive-compulsive disorder (OCD). National Institute of Mental Health, National Institutes of Health website. Available at: http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml. Accessed June 8, 2008.

Last reviewed December 2007 by Theodor B. Rais, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.