OCD (Obsessive-Compulsive Disorder)

People with OCD have excessive doubts, worries, or superstitions. While all people experience these problems occasionally, OCD patients’ worries can control their lives. They may cope with common problems by indulging in compulsions that are excessive or do not make logical sense.

Medical researchers have shown that OCD is a brain disorder that is caused by incorrect information processing. People with OCD say their brains become stuck on a certain urge or thought. In the past, OCD was considered untreatable. However, advances in therapy and medication have greatly increased the chance that someone with OCD can be successfully treated.

Possible Causes of OCD

While researchers have not yet identified any gene that causes OCD, there is some evidence that genetics may affect who develops the disorder. Children who have family members with OCD have a greater chance of developing OCD early in life. However, family members do not inherit specific symptoms from each other.

Sometimes OCD symptoms begin in childhood after the child has strep throat. Medical researchers believe that in this case an autoimmune mechanism is to blame. In these cases, treatment with antibiotics may be effective in combatting OCD symptoms.

Researchers know that OCD is triggered by communication problems between the brain’s deeper structures and the front part of the brain. These parts of the brain primarily use serotonin to communicate. This is why increasing the levels of serotonin in the brain can help to alleviate OCD symptoms. However, even though researchers know that low levels of serotonin can cause OCD symptoms, there is no laboratory test to diagnose OCD.

Symptoms

People with OCD symptoms have compulsions or obsessions that cannot be controlled without help.
Experiencing some OCD compulsions or obsessions does not mean someone has the disorder. In order for professionals to make an OCD diagnosis, the compulsions or obsessions must significantly impact the patient’s life.

While most OCD patients have both compulsions and obsessions, some may only have one or the other. Obsessions regularly occur without warning, and people with OCD feel that they cannot control them. Obsessions also trigger feelings of disgust, fear, or doubt. Common OCD obsessions include:

• Fear of contamination from dirt or germs
• Forbidden thoughts
• Excessive doubts about religion
• A compulsion to confess, tell, or ask questions
• Sexual thoughts that intrude on daily life
• A need to have objects organized in a particular manner
• Imagining self-harm or loss of control over aggression

OCD patients use compulsions to relieve the discomfort caused by obsessions. Common OCD compulsions include:

• Praying
• Touching
• Arranging or ordering objects
• Counting
• Checking
• Washing
• Hoarding
• Repeating actions

Treating OCD

When patients are first diagnosed with OCD, they enter the acute treatment stage. During this time, treatment is focused on stopping the current OCD episode. Once treatment is successful, a patient transitions into maintenance treatment. Maintenance treatment focuses on preventing further OCD episodes. Each stage of OCD treatment has the same three major components: therapy, medication, and education.

Therapy

Professionals use cognitive behavioral psychotherapy to treat patients diagnosed with OCD. This type of treatment provides patients with the psychological tools to help them resist the effects of their OCD. Cognitive behavioral therapy relies on three techniques to help treat OCD.

The first technique requires patients to be exposed to objects or situations that trigger their OCD. For example, patients who avoid handling money or door handles due to possible exposure to germs are encouraged to regularly use these objects.

The second technique asks patients to avoid initiating a ritual or other response after being exposed to the triggering object. Patients who touch objects they consider to be contaminated, for example, should avoid ritualistically washing their hands or other damaging behaviors.

The third technique requires patients to logically examine faulty assumptions. Patients who have OCD may believe that their failure to complete rituals has an adverse effect on themselves or people they love. Therapists help them examine this faulty reasoning. When patients are able to identify a logical fallacy, they are more likely to be able to resist completing their ritualistic response to triggering situations.

Medication

Not every OCD patient requires medication. However, many people diagnosed with OCD find taking a selective serotonin reuptake inhibitor (SSRI) can help curb their OCD symptoms. Currently, there are four SSRIs used to treat OCD, including:

• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Sertraline (Zoloft)
• Paroxetine (Paxil)

OCD patients should expect to take medication for three to four weeks before they experience any benefits. With a proper dosage, someone with OCD can expect to receive the maximum benefit from the medication in 10 to 12 weeks.

In some cases where a SRI is not effective, a therapist may prescribe a nonselective serotonin reuptake inhibitor such as clomipramine (Anafranil). Clomipramine affects serotonin, but it also impacts other neurotransmitters in the brain. For this reason, clomipramine is more likely to cause adverse reactions in OCD patients than are the other medications.

Education

Patients diagnosed with OCD should learn as much as they can about this disorder. They can combine learning about the disorder through reading and talking to others with OCD with regular meetings with a clinician. During the first meeting with the clinician, they should develop a treatment plan. OCD patients who are in the acute stage of treatment will likely see their clinician once a week to discuss their response to their medication and therapy.

Family Support for OCD

Family members can help OCD patients manage their disorder by being supportive and calm and by becoming informed about the disorder. They should offer compliments when the OCD patient avoids reacting to his or her compulsions. In some cases, it may be helpful for family members to offer their observations to the patient’s clinician.

Under no circumstances should a family member be critical or offer negative comments about the patient’s disorder. Such feedback is not helpful and is often detrimental to the patient. If family members have previously participated in OCD rituals with the patient, they should not immediately stop. Instead, the family members should discuss this problem with the OCD patient’s therapist.

Living with OCD

Patients who have successfully completed OCD treatment can expect to have monthly check-ins with their clinician for at least six months. They will likely complete at least a year of cognitive behavioral therapy and, if necessary, medication, before discontinuing these types of treatment.

Once patients discontinue cognitive behavioral therapy or medication, relapses are common. For this reason, some professionals recommend that patients continue to use medication if they do not want to continue therapy. Two to four relapses may indicate that the patient needs to take medication permanently. A patient should discuss even a minor relapse with a clinician to avoid further setbacks.

For more on the topic of OCD, we’ve included the following expert consensus documents as reference materials:

• Guidelines for the Treatment of Obsessive-Compulsive Disorder, in HTML
• A Guide for Patients and Families, in HTML

View Resources

• MedlinePlus – informatiom about OCD
• VCOY – general informatiom about OCD
• Wright.edu – OCD by Dan Stein
• MIT – neurobiology of OCD
• Stanford – Pharmacological treatments