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What Is Obsessive-Compulsive Disorder?

From hoarding to handwashing to forever checking the stove, obsessive-compulsive disorder (OCD) takes many forms. It is an anxiety disorder that traps people in repetitive thoughts and behavioral rituals that can be completely disabling.

Surveys conducted by the National Institute of Mental Health show that 2 percent of the population suffers from OCD—that's more than those who experience other mental illnesses like schizophrenia, bipolar disorder, and panic disorder. OCD might begin in childhood, but it most often manifests during adolescence or early adulthood. Scientists believe that both a neurobiological predisposition and environmental factors jointly cause the unwanted, intrusive thoughts and the compulsive behavior patterns that appease the unwanted thoughts.

Unless treated, the disorder tends to be chronic—lasting for years, even decades—although the severity of the symptoms may wax and wane over the years. Both pharmacological and behavioral approaches have proven effective as treatments; often a combination of both is most helpful. For more on causes, symptoms and treatments, see our Diagnosis Dictionary.

The Varieties and Symptoms of Obsessions

These uncontrollable thoughts or behaviors can interfere with a person's work, school, and relationships. Though the behaviors may give the person momentary relief from his overall anxiety, he doesn’t derive pleasure from the obsessiveness. People suffering from obsessive-compulsive habits may also contend with motor tics or repetitive movements, such as grimacing and jerking. Research into OCD is ongoing. For example, defects called micro-structural abnormalities have been found in the brain’s white matter of those who suffer OCD, and frontline treatment for this disorder includes exposure and response prevention, as well as plain old empathy and compassion in delivering therapy.

The first symptoms are the obsessions—the unwanted ideas or impulses that occur over and over again and are meant to drive out fears, often of harm or contamination. "This bowl is not clean enough. I must keep washing it." "I may have left the door unlocked." Or "I know I forgot to put a stamp on that letter." The compulsions appear after that—repetitive behaviors such as handwashing, lock-checking, and hoarding. Such behaviors are intended to mitigate fear and reduce the threat of harm. But the effect does not last and the unwanted thoughts soon intrude all over again.

Sufferers may understand the uselessness of their obsessions and compulsions, but that is no protection against them. OCD can become so severe that it keeps people from leaving their homes. The condition strikes males and females in equal proportions.

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What Causes OCD?

Current scientific thinking holds that OCD results from a confluence of factors—a biological predisposition, environmental factors including experiences and attitudes acquired in childhood, and faulty thought patterns.

The fact that many OCD patients respond to SSRI antidepressants suggests the involvement of dysfunction in the serotonin neurotransmitter system. Ongoing research suggests there may be a defect in other chemical messenger systems in the brain.

OCD may coexist with depression, eating disorders, or attention-deficit/hyperactivity disorder, and it may be related to disorders such as Tourette's syndrome, and hypochondria, though the nature of the overlap is the subject of scientific debate.

How to Treat Obsessions and Compulsions

Either psychotherapy or medication, or both, may be prescribed for OCD, and patients may respond better to one form of treatment than to the other.

Studies conducted by the NIMH, however, show that combination drug-psychotherapy is best for young people. The drugs given are typically one of the so-called SSRIs, or selective serotonin reuptake inhibitors. The SSRIs fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil) have been specifically approved for the treatment of OCD. These drugs have been shown to reduce the frequency and severity of obsessions and compulsions in more than half of patients, although discontinuation of drugs often leads to relapse.

Behavioral therapy for OCD tends to produce long-lasting effects. Psychotherapy generally focuses on two aspects of the disorder: unraveling the irrational thoughts involved in the condition and gradually exposing sufferers to the feared object or idea until they are desensitized to it and can tolerate anxiety without engaging in compulsive rituals.

Is OCD on the Rise?

Rates of OCD have not gone up, but public interest in the disease (and its various forms) has. Hoarders and those compelled to engage in rituals to ward off disturbing thoughts have lately appeared as characters on the big and small screens. A slew of real-life sufferers of OCD have written and sought help in the public eye. There is also evidence that subclinical obsessiveness about cleaning and germs could be on the rise.

About a third of adults with OCD developed the disorder as children. The repeated rituals those with OCD engage in, such as constant handwashing or hair-pulling, are meant to allay anxiety, but the relief does not last for long. As with many other mental health conditions in children, the best and most durable treatment is psychotherapy.

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