OBSESSIVE COMPULSIVE DISORDER

General Information

DEFINITION--A disorder characterized by recurrent, intrusive thoughts (obsessions) and repetitive, ritualistic behaviors (compulsions). The disorder usually begins in adolescence and waxes and wanes throughout life, never going completely away and sometimes becoming more severe. New cases after age 50 are rare.

BODY PARTS INVOLVED--Nervous system.

SEX OR AGE MOST AFFECTED--Both sexes; adolescents and young adults; rarely starts after age 50.

SIGNS & SYMPTOMS

Obsessions and/or compulsions that consume more than an hour a day and cause significant distress or impairment. Obsessions (thoughts) are recurrent and attempts to ignore or resist them are unsuccessful. Obsessions include:

Thoughts of violence; fear of harming a family member or a friend. Fears of infection (from germs, dirt, etc.). Doubts (is the front door shut, locked; is the iron on). Excessive order-liness or symmetry. Constant brooding (over a word, phrase or unanswerable problem).

• Compulsions (actions) are repetitive, purposeful behaviors in response to the thoughts (obsessions) in an attempt to neutralize the thought.

Compulsions include:

Checking in response to doubt (locks, doors, windows). Excessive hand washing. Counting over and over to a certain number. Hoarding. Repeaters - such as dressing rituals.

CAUSES

• Exact cause is unknown. It may be connected to an imbalance in a brain chemical called serotonin. Serotonin is involved in sending impulses from one nerve cell to the next and in regulating repetitive behavior.
• Certain forms of brain damage (e.g., encephalitis) can result in obsessions.

RISK INCREASES WITH

• People who suffer from phobias and panic attacks or major depression.
• Schizophrenia; organic brain syndrome.
• Family history of the disorder.

HOW TO PREVENT--No specific prevention methods known.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• There are no medical tests to diagnose the disorder. Often the patient's description of the behavior offers the best clues to diagnosis.

APPROPRIATE HEALTH CARE

• Treatment is aimed at reducing anxiety, resolving inner conflicts, relieving depression, learning ways of dealing with stress, building self-esteem and understanding the behavior.
• Behavioral therapy (usually a process known as "exposure and response prevention") is used in treatment and is often combined with medications to achieve satisfactory results.
• Group therapy (sometimes). Family therapy is important to help educate relatives.

POSSIBLE COMPLICATIONS

• Incapacity to develop and maintain normal work and personal relationships.
• Depression; psychosis.
• Anxiety and panic-like episodes.
• Housebound lifestyles; indecisiveness.

PROBABLE OUTCOME--Effective and specific therapy is now available, and though it may not lead to a total cure, it can reduce disabling symptoms considerably.

How To Treat

GENERAL MEASURES--

• This is a complex disorder that usually requires professional help.
• See Resources for Additional Information.

MEDICATION--

• Antidepressant, such as clomipramine or fluoxetine, may be prescribed. Complete benefits may not be seen for 10-12 weeks. About 10% of patients are unable to tolerate the side effects of the drugs, but an adverse response to one does not mean there will be problems with the other.
• Antianxiety or tranquilizer drugs may be prescribed.

ACTIVITY--No restrictions.

DIET--With use of some medications, a tyramine free diet may be necessary to prevent precipitation of hypertensive crisis. The doctor will advise you if this is necessary.

Call Your Doctor If

• You have symptoms of obsessive compulsive disorder.
• Symptoms continue or worsen after an adequate treatment time has elapsed.
• New, unexplained symptoms appear. Drugs used in treatment may produce side effects.