(OCD) A neurotic disorder (see NEUROSIS) characterized by OBSESSION, often associated with compulsive ritual acts. Sufferers experience repeated thoughts which intrude on their consciousness unbidden. The thoughts are often unpleasant, and though recognized as foolish or pointless, the subject feels compelled to act them out. The content of obsessional thoughts varies widely, ranging across sexual or violent impulses, fears of contamination and pathological doubting to more vague, meaningless preoccupations. Compulsions are repeated actions based on the obsessional thoughts, which suffers again try, but are unable, to resist. Compulsions may take the form of counting rituals, checking rituals, cleaning rituals (such as repeated handwashing) and obsessional slowness. The carrying out of compulsive acts is not in itself pleasurable. Rather, such acts are frustrating and may prove highly time-consuming and disabling. Sufferers prevented from pursuing rituals may become extremely anxious, though any relief from ANXIETY by engaging in a compulsive act is short-lived.
The condition usually begins in early adulthood, and most surveys indicate that women are slightly more likely to be affected than men.
OCD tends to be a chronic, continuous, condition. It is likely that many sufferers do not come to medical attention, and estimates of prevalence vary widely. Contemporary surveys suggest that the disorder may be more common than previously thought, with a lifetime prevalence of between 2 and 3%. The aetiology of the condition is unknown. FUNCTIONAL NEUROIMAGING studies implicate fronto-striatal abnormalities, and successful treatment with ANTIDEPRESSANT drugs—particularly serotonin selective reuptake inhibitors (SSRI)—suggests SEROTONERGIC dysfunction may play a role. Treatment is usually a combination of pharmacological and psychological therapies. SSRI antidepressants, and the TRICYCLIC clomipramine are frequently used. Exposure therapy (response prevention) with relaxation training, and COGNITIVE THERAPY have been employed with success. Though estimates of outcome vary, approximately 50% of sufferers appear to respond well to treatment. Severely disabling, chronic and intractable OCD is one of the few indications for PSYCHOSURGERY. There are recognized associations with DEPRESSION and TOURETTE’S SYNDROME.
IAN C.REID
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