Obsessive Compulsive Disorder (OCD) is a neurological anxiety disorder characterized by powerful, unwanted obsessions (intrusive, recurrent thoughts which a person cannot control) and compulsions (repetitive behaviors or mental acts performed to alleviate the anxiety caused by obsessions). The cause of OCD is not known; however, patients exhibit reduced levels of the neurotransmitter serotonin, and increased activity in the orbital cortex and caudate nucleus. OCD can manifest from early childhood through to middle age, and effects women, men and children of every race and socioeconomic group. One in 50 people in the United States suffers from OCD, and twice that number have experienced it at some point in their lives. Although underdiagnosed and undertreated, OCD symptoms can be effectively treated.
While most thoughts and behaviors which become obsessive/compulsive are common to some extent in every-day life, they are considered a disorder when they persist, make no sense, interfere with normal functioning, and cause intense distress and anxiety. Obsessions include thoughts of germs or contamination (from bodily waste; handling money), inadvertently harming someone else (poisoning their food; running over a pedestrian), making a mistake (leaving the iron on and burning down the house), intrusive sexual thoughts or urges (recurrent pornographic images), need for exactness (intense anxiety when things are asymmetrical), and excessive religious or moral doubt (swearing; saying the wrong thing).
Attempting to eliminate obsessive thoughts through actions results in compulsive behavior. These are not "feel good" actions--their entire objective is to relieve the anxiety caused by the obsession. Compulsions include cleaning and washing (washing hands so frequently they become raw; showering several times a day), checking (over and over to see if the iron, stove, or light switches are off), counting (to a certain number or counting objects over and over), collecting/hoarding (mail or old objects until the house is full), and arranging/organizing (perfectly aligning cans on a shelf). Eighty percent of sufferers experience both obsessions and compulsions--20% experience only one or the other.
Childhood-onset OCD tends to run in families. It is more common in monozygotic (identical) twins than dizygotic (fraternal) twins, and is frequently associated with tic disorders (Tourette's Disorder--involuntary motor or vocal behaviors such as facial grimacing or snorting). Adult OCD is often accompanied by depression. While stress itself does not trigger OCD, stressful circumstances--such as the death of a loved one, divorce, or childbirth--can be the trigger. Unfortunately, OCD frequently goes unrecognized. Studies reveal an average of 17 years from onset of the disorder to the beginning of treatment. This can be due to embarrassment felt by many sufferers, who hide their symptoms and, although most sufferers are acutely aware of their problem, some are not. This is called OCD with poor insight. Also, a sufferer will see, on average, three or four doctors before they find one who accurately diagnoses their disorder.
Effective treatment usually combines Cognitive behavioral psychotherapy (CBT), and medication with seratonin reuptake inhibitors (SRI), such as Prozac, Luvox, Paxil, Zoloft, and Anafranil. Cognitive therapy (CT) aims at reducing faulty catastrophic thinking. Behavioral therapy (BT) aims at changing obsessive thoughts by first changing compulsive behavior--for example, the individual afraid of germs must stay in contact with money until the "germ" anxiety diminishes or is extinguished. Then, through response or ritual prevention, the patient will not be permitted to wash their hands. While CBT can be difficult and anxiety-filled, 50 to 80% of patients who continue for 12 to 20 sessions report reduction in OCD symptoms, and many stay well for years.
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