What is OCD?

Obsessive-compulsive disorder (or OCD), as categorized by the DSM-IV, is an anxiety disorder. It is characterised by the obsessive need to perform some task. These tasks are often known as rituals. Note that the DSM-IV Axis II Obsessive-compulsive personality disorder is considerably different from Obsessive-compulsive disorder, and is often what people mean when they refer to somebody as "obsessive-compulsive".

Today it is well-accepted that OCD is much more common than was thought previously. Typically 2–3 % of the general population is believed to have OCD or OCD-like symptoms.

In many cases the task that an OCD sufferer does may seem simple to the layperson, but the sufferer feels that they must perform it in some particular way for fear of dire consequences. Examples might include checking that one has locked one's car many times over before leaving it parked, or turning the lights on and off a set number of times every time one leaves a room. Such a person, when addicted to cigarettes, may argue that they can only quit smoking on the 13th or 27th of each month, and only when they possess four cigarettes at noon. Some people who have OCD may be completely aware that such obsessions are not rational, but feel bound to comply with them because otherwise they suffer from panic or irrational dread.

Obsessions are ideas that the person cannot stop thinking about. These are often fears about getting a disease, getting hurt, or causing harm to someone. The main features of obsessions are that they are automatic, frequent, upsetting or distressing, and difficult to control or get rid of. Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. These are often cleansing or avoidance actions. Common compulsions include excessive washing and cleaning, checking, repetitive actions such as touching, counting, arranging and ordering, hoarding, ritualistic behaviours that lessen the chances of provoking an obsession. Compulsions can be observable actions, for example washing, but they can also be mental rituals such as, repeating words or phrases, counting, or saying a prayer.

Causes and related disorders

Recent research has revealed a possible genetic mutation that could be the cause of OCD. Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD.

Violence is rare among OCD sufferers, but the disorder is often debilitating to the quality of life. Also, the psychological self-awareness of the irrationality of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. More often, they avoid certain situations or places altogether.

Some people with OCD also suffer from other conditions such as Tourette syndrome, attention deficit disorder, trichotillomania, hypochondria or Pure Obsessional OCD (rumination).

Treatment

OCD can be treated with a variety of anti-depressants, such as Anafranil, or selective serotonin reuptake inhibitors such as Paxil, Zoloft, Prozac, Luvox, and Anafranil. Some medications like Gabapentin have also been found to be useful in the treatement of OCD. Symptoms tend to return, however, once the drugs are discontinued. There are claims that long-term remission of symptoms has been achieved without medications through cognitive-behavioral therapy making use of the principles of extinction and habituation.

OCD: A Case History