Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts and/or repetitive behavior that interfere with daily functioning. The obsessive thoughts and repetitive [Page 556]behaviors in OCD are found in often overweight or obese individuals whose obsessive thoughts compel them to overeat or binge. Both OCD and obesity may be treated by increasing serotonin levels in the brain.

Symptoms

The obsessions experienced in OCD are intrusive, negative thoughts that have no basis in reality and only serve to create anxiety. The obsessions are out of character for the individual even though the individual recognizes the obsessions as self-generated, coming from his or her own mind. Common obsessions include contamination, harming oneself or others, the need for symmetry, behaving unacceptably, making a mistake, and sexual or religious obsessions.

To relieve the anxiety caused by the obsessions, the individual performs compulsions, or repetitive behaviors, also called rituals. Rituals are not useful tasks and the preoccupation with performing the rituals interferes with daily life. Rituals can be physical behaviors such as washing, hoarding, checking, asking for reassurance, arranging, or organizing. A common example of a physical ritual is washing the hands until they are raw. Rituals can also be mental behaviors such as counting, repeating words in the mind, and attempting to neutralize the obsessive thoughts. A common example of a mental ritual is counting the number of steps between places. Performing the ritual only temporarily relieves the anxiety caused by the obsession, forcing the individual to perform the ritual multiple times a day or whenever anxiety from the obsessions becomes too much to handle.

Clinical Diagnosis

OCD can develop at any time during the life span. In children, the symptoms are noticeable around age 6 or 7. Most cases of OCD develop by the age of 21. Women are only slightly more likely to develop OCD than men. Many individuals with OCD do not receive treatment because of the shame and humiliation of admitting they have a problem.

OCD is diagnosed using the following criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV):

• Having either obsessions or compulsions. Obsessions are defined as (1) recurrent and persistent thoughts that are intrusive and induce anxiety; (2) not excessive worries about real-life problems; (3) attempts are made to ignore or suppress the thoughts; and (4) the thoughts are recognized as a product of the person's own mind. Compulsions are defined as (1) repetitive behaviors or mental acts that the person feels driven to perform, and (2) aimed at reducing anxiety or preventing an event even though the thoughts and events are not connected in a realistic way.
• Recognizing that the obsessions or compulsions are unreasonable.
• Obsessions or compulsions are time consuming or interfere with normal functioning.
• If another disorder is present, the obsessions or compulsions are not restricted to it (e.g., preoccupation with food when the individual has an eating disorder).
• The obsessions or compulsions are not drug induced or caused by a medical condition.

Causes

The cause of OCD is not known; however, there are genetic, biological, and psychological factors linked to its development. Genetics may play a role in OCD. Prader-Willi syndrome, a genetic disorder involving chromosome 15, is characterized by food preoccupations, rituals, and compulsiveness, with the majority of affected individuals suffering from obesity by adolescence or early adulthood.

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