Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. People with anxiety disorders cannot stop worrying. In OCD, people have intense, repetitive thoughts, images, or impulses that are frightening, absurd, or unusual. These are called obsessions. Typical obsessions include fears of dirt, germs, contamination, and violent or aggressive impulses. People with obsessive-compulsive disorder may have an intense preoccupation with order and symmetry, or be unable to throw anything away. To reduce the anxiety caused by their irrational thoughts, people with OCD perform ritualized actions, known as compulsions, that also are usually bizarre and irrational. Examples are repeated hand-washing, constant counting or arranging of items, and checking over and over again to make sure an appliance is turned off. As the person performs these acts, he may feel temporarily better, but there is no long-lasting sense of satisfaction or completion after the act is performed. Often, a person with obsessive-compulsive disorder believes that something terrible will happen if the ritual isn't performed.
OCD is often described as the "disease of doubt," because a person who has it usually knows the obsessive thoughts and compulsions are irrational but, on another level, fears they may be true. Because the symptoms are upsetting and embarrassing, people with the condition often hide their fears and rituals but cannot avoid acting on them.
Most people with OCD have both obsessions and compulsions, but a few have just one or the other. Some people are barely bothered by the condition, while others find the obsessions and compulsions to be profoundly traumatic and spend much time each day in compulsive actions.
While no one knows for sure, research suggests that the tendency to develop obsessive-compulsive disorder is inherited. If one person in a family has obsessive-compulsive disorder, there is a 25% chance that another immediate family member has the condition. Stress and psychological factors may worsen symptoms, which usually begin during adolescence or early adulthood.
There are several theories behind the cause of OCD. Some experts believe that OCD is related to a chemical imbalance within the brain that causes a communication problem between the front part of the brain (frontal lobe) and deeper parts of the brain responsible for the repetitive behavior. Research has shown that a particular part of the brain is overactive in OCD patients. This overactivity may cause brain cells to get "stuck," much as a jammed transmission in a car damages the gears. This could lead to the development of rigid thinking and repetitive movements. Drugs that boost the levels of serotonin, a natural brain chemical linked to emotion and many different anxiety disorders can reduce OCD symptoms. This suggests that OCD may be related to levels of serotonin in the brain.
Out of shame, people with obsessive-compulsive often avoid seeking treatment. Because they are so good at hiding their problem, many people with OCD don't get the help they need until the behaviors are deeply ingrained habits and hard to change. More than a decade can pass between the onset of symptoms and proper diagnosis and treatment.
Obsessive-compulsive disorder can be effectively treated with a combination of cognitive-behavioral therapy and medication that regulates the brain's serotonin levels. Cognitive-behavioral therapy teaches patients how to confront their fears and obsessive thoughts by waiting out the urge to perform the calming rituals. Eventually their anxiety decreases, and they learn to focus their attention elsewhere. Drugs that are approved to treat obsessive-compulsive disorder include fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). Drugs should be taken for at least 12 weeks before deciding whether or not they are effective.
Without treatment, obsessive-compulsive disorder can last for decades, fluctuating from mild to severe and worsening with age. Treatment with drugs and behavioral therapy is completely successful for some patients. Unfortunately, not all patients have such a good response, and hospitalization may be required in some cases.
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