Obsessive-Compulsive Disorder

Obsessions or compulsions, or more commonly both, are the hallmark of obsessive-compulsive disorder (OCD). Obsessions are recurrent and persistent ideas, thoughts, impulses, or images that are intrusive and inappropriate and cause marked anxiety or distress. Common obsessions include fears of harming other persons or sinning against God. Compulsions are repetitive, purposeful, and intentional behaviors or mental acts performed in response to obsessions or according to certain rules that must be applied rigidly. They are meant to neutralize or reduce discomfort or to prevent a dreaded event or situation, even though the sufferer generally knows the irrationality of these acts. Obsessions create anxiety, which is relieved by compulsive rituals such as checking, washing, counting, confessing, hoarding, and rearranging objects with symmetry and precision. These symptoms can cause functional disability as severe as psychosis and can make it virtually impossible to function at work or at home.

To receive a diagnosis of OCD, a person must have either obsessions or compulsions that cause marked distress, consume more than one hour daily, or significantly interfere with the person's normal routine, occupational functioning, or usual social activities and relationships. The person must recognize that the obsessions and compulsions are unreasonable. Many psychiatrically normal individuals—particularly children—have occasional obsessional thoughts or repetitive behaviors, but they tend not to cause distress or disability. Many people double-check locks or avoid stepping on cracks. These rituals are viewed as acceptable and desirable and are easily adapted to changing circumstances. To the obsessive-compulsive person, however, rituals are a distressing and unavoidable way of life. Data indicate that as many as 2–3 percent of the general population meet criteria for OCD at some point during their lives. Men and women are equally likely to develop OCD, although men have an earlier onset.

Recent developments in the treatment of OCD have improved outcomes and instilled a greater sense of optimism. The mainstays of treatment are pharmacotherapy and cognitive-behavior therapy. Behavior therapies, which tend to be more successful for ritualizers, emphasize exposure paired with response prevention. Proponents of behavior therapies state that 60–70 percent of the patients who persevere with the treatment improve markedly. New generations of drugs work well at relieving both obsessions and compulsions in nearly 75 percent of patients. Treatment is long term because patients tend to relapse when the drug is discontinued, often within weeks. Patients who complete a course of behavior therapy are less likely to relapse.