Obsessive-Compulsive
Disorder (OCD)
Obsessive-Compulsive Disorder, is a type of anxiety
disorder. A person who has OCD has recurring or repeated obsessions and/or
compulsions. Obsessions are thoughts, ideas, or images that persist in
the mind. Compulsions are mental acts or behaviours that are carried out
repeatedly. These obsessions and compulsions are severe enough to be time-consuming.
They may also cause a fair amount of distress or impairment. The impairment
can interfere with everyday activities.
The exact cause of OCD is not known. Recent studies have shown
abnormal patterns of brain activity in people with OCD. The abnormalities
occur in a part of the brain called the striatum. Obsessive-compulsive
behaviours may be an attempt by the person to reduce anxiety. People who
have OCD usually know that their behaviour and thoughts are inappropriate.
This recognition is distressing to them.
People with OCD may have a wide variety of obsessions and compulsions.
Here are some common examples:
- attempts, usually unsuccessful,
to stop or ignore thoughts and behaviours
- excessive cleaning, usually due to a fear of
germs
- excessive hand-washing
- following an arbitrary set of rules for behaviour
- hoarding useless or unnecessary items
- performance of a ritualistic sequence of behaviours
- repetition of activities or words
- repetition of a behaviour until it is done perfectly
It generally begins in childhood or adolescence. OCD tends to run
in families. The sense of helplessness and the impairment with OCD may
lead to depression. OCD is often seen together with other psychiatric
disorders, such as the following:
- alcohol abuse
- attention deficit disorders
- depression
- drug abuse or addiction
- eating disorders, such as anorexia or bulimia
- other anxiety disorders
Diagnosis
of OCD begins with a medical history and physical examination. There are
no specific tests for OCD. The doctor will ask about any obsession or
compulsive behaviour. OCD is diagnosed if the behaviours take up more
than an hour of the day or if they cause real distress.
The
Yale-Brown Obsessive Compulsive Scale (YBOCS) is sometimes used to measure
the severity of the symptoms. Anxiety scales can also be used. These scales
are designed to track response to treatment.
OCD
is considered a chronic disorder. The course of the disorder is variable.
Symptoms may come and go, ease over time, or grow progressively worse.
Treatment should help the person learn to recognise symptoms before they
become severe. If symptoms worsen, the individual may need to resume therapy
or medications.
Exposure
and response prevention therapy is very useful for treating OCD. In this
approach, a person is exposed to whatever triggers the obsessive thoughts.
The individual is then taught techniques to avoid performing the compulsive
rituals. He or she is also taught to deal with the anxiety.
Cognitive-behavioural
therapy is also used to treat OCD. The doctor helps the person change
his or her attitudes and beliefs. The individual learns to react differently
to obsessions or compulsions.
Relaxation
techniques may also be helpful. They help the person to control the body's
reactions to anxiety.
Following
is a list of some of the more common antidepressant medications used to
treat OCD:
- clomipramine
- fluoxetine
- fluvoxamine
- paroxetine
- sertraline
Medications may take 6-8 weeks to show any improvement in OCD. If
one medication is not effective, others can be tried. The aim of treatment
is to manage the condition but to cure it. Most people with OCD continue
to experience some symptoms for their entire life but learn to cope with
it better.
Neurosurgery
may be performed for severe cases of OCD. It is done only if all other
treatment has failed and the person is severely disabled. This is no longer
performed in Australia.