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Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a mental disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that drive them to do something (compulsions).

Often the person carries out the behaviors to get rid of the obsessive thoughts. But this only provides temporary relief. Not doing the obsessive rituals can cause great anxiety and distress.

Alternative Names

Obsessive-compulsive neurosis; OCD

Causes

Doctors do not know the exact cause of OCD. Factors that may play a role include head injury, infections, and abnormal function in certain areas of the brain. Genes (family history) seems to play a strong role.

Most people who develop it show symptoms by age 30.

Symptoms

  • Obsessions or compulsions that are not due to medical illness or drug use
  • Obsessions or compulsions that cause major distress or interfere with everyday life

There are many types of obsessions and compulsions. These can be physically doing things (behaviors) or doing them in the head (mental acts). Examples include:

  • Checking and rechecking actions (such as turning out the lights and locking the door)
  • Excessive counting
  • Excessive fear of germs
  • Repeatedly washing the hands to ward off infection
  • Repeating words silently
  • Praying silently over and over

The person usually recognizes that the behavior is excessive or unreasonable.

Exams and Tests

Your own description of the behavior can help diagnose the disorder. A physical exam can rule out physical causes. A mental health assessment can rule out other mental disorders.

Questionnaires can help diagnose OCD and track the progress of treatment.

Treatment

OCD is treated using a combination of medication and behavioral therapy.

Medicines used include antidepressants, antipsychotics, and mood stabilizers.

Talk therapy (cognitive behavioral therapy; CBT) has been shown to be effective for this disorder. During therapy, the patient is exposed many times to a situation that triggers the obsessive thoughts, and learns to gradually tolerate the anxiety and resist the urge to do the compulsion. Therapy can also be used to reduce stress and anxiety and resolve inner conflicts.

Outlook (Prognosis)

OCD is a long-term (chronic) illness with periods of severe symptoms followed by times of improvement. A completely symptom-free period is unusual. Most people improve with treatment.

Possible Complications

Long-term complications of OCD have to do with the type of obsessions or compulsions. For example, constant handwashing can cause skin breakdown. OCD does not usually progress into another mental health problem.

When to Contact a Medical Professional

Call for an appointment with your health care provider if your symptoms interfere with daily life, work, or relationships.

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, Va: American Psychiatric Publishing. 2013.

Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Elsevier Mosby; 2008:chap 39.

Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007;164:5-53.

Nestadt G, Grados M, Samuels JF. Genetics of obsessive-compulsive disorder. Psychiatr Clin N Am. 2010;33:141-158.

Stein DJ, Denys C, Gloster AT, et al. Obsessive-compulsive disorder: diagnostic and treatment issues. Psychiatr Clin N Am. 2009;32:665-685.

Updated: 3/10/2014

Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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