Obsessive-compulsive disorder (OCD) is a type of mental illness that causes repeated unwanted thoughts. To get rid of the thoughts, a person with OCD may also do the same tasks over and over. For example, you may fear that everything you touch has germs on it. So to ease that fear, you wash your hands over and over again.
Experts don't know the exact cause of obsessive-compulsive disorder. Research suggests that there may be a problem with the way one part of the brain sends information to another part. Not having enough of a brain chemical called serotonin may help cause the problem.
Some experts believe that a problem related to streptococcal infections, such as strep throat and scarlet fever, can suddenly bring on the disorder or make its symptoms worse in some children.
Symptoms of obsessive-compulsive disorder tend to come and go over time and range from mild to severe. Anxiety is the most common symptom. For example, you may have an overall sense that something terrible will happen if you don't do a certain task, such as check again and again to see if the stove is on. If you fail to check, you may suddenly feel tense or anxious or have a nagging sense that you left something undone.
Symptoms of the disorder include:
The obsessions or compulsions usually take up a lot of time-more than 1 hour a day. They greatly interfere with your normal routine at work or school, and they affect social activities and relationships.
Sometimes people may understand that their obsessions and compulsions aren't real. But at other times they may not be sure, or they may believe strongly in their fears.
Your doctor can check for obsessive-compulsive disorder by asking about your symptoms and your past health. He or she may also do a physical examination. It's important to talk to your doctor if you think you have OCD. Many people with the disorder go without treatment, because they are afraid or embarrassed to talk to a doctor.
Treatment includes medicines and counselling. Using both tends to works best.
Antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs) are most commonly used. Examples of these medicines include Prozac and Zoloft. You may begin to feel better in about 1 to 3 weeks after you start taking medicine. But it can take as long as 12 weeks to see more improvement. If you have concerns about your medicine, or if you do not start to feel better by 3 weeks, talk to your doctor. He or she may increase the dose or change to a different medicine.
Counselling for the disorder includes a type of cognitive-behavioural therapy called exposure and response prevention. This therapy slowly increases your contact with the thing that causes worries or false beliefs. With the help of a counsellor, this therapy can reduce your symptoms over time.
Other cognitive therapy may also help change the false beliefs that lead to OCD behaviours.
Treatment can make your symptoms less severe. But you may still have some mild symptoms after you begin treatment.
Learning about obsessive-compulsive disorder (OCD):
Living with obsessive-compulsive disorder:
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Researchers have yet to pinpoint the exact cause of obsessive-compulsive disorder (OCD), but brain abnormalities, genetic (family) influences, and environmental factors are being studied. Brain scans of people with OCD have shown that they have different patterns of brain activity than people without OCD and that abnormal functioning of circuitry within a certain part of the brain (striatum) may cause the disorder. Abnormalities in other parts of the brain and an imbalance of brain chemicals, especially serotonin, may also contribute to OCD.
Obsessive-compulsive disorder (OCD) is a chronic or long-term illness. Without treatment, symptoms typically come and go over time and may significantly interfere with your ability to work and have a family. Treatment can reduce the severity of the illness. And although some symptoms may linger after treatment, you should be able to have an active social life, raise a family, and work.
Anxiety is the most prominent symptom of OCD. For example, you may have an overall sense that something terrible will happen if you don't follow through with a particular ritual, such as repeatedly checking to see whether the stove is on. If you don't perform the ritual, you may have immediate anxiety or a nagging sense of incompleteness.
Symptoms of OCD vary with each person and include the following:
It is common for children with OCD to need to repeat actions until they feel "just right," such as going back and forth through a door, going up and down stairs, touching things with their right hand and then their left (symmetrical touch), or rereading or rewriting school assignments. Children with OCD may not want to go to school or may be afraid to leave someone they trust.
You may experience suicidal feelings if you have depression along with OCD. Warning signs of suicide include talking about death or giving away possessions.
With obsessive-compulsive disorder (OCD), you develop disturbing, obsessive thoughts that cause fear or anxiety. In order to rid yourself of these thoughts and relieve the fear, you perform rituals, such as repeated handwashing or checking that something has been done. Unfortunately, the relief is only temporary. The thoughts return and you repeat the rituals.
The rituals or behaviours become time-consuming and have a significant impact on your daily life. If your particular fear involves unfamiliar situations, it is possible for you to become so obsessed by the fears that you stop going outside of your home. Quality of life can be substantially lowered by OCD since it can greatly affect your ability to work and have relationships.
Many people are too embarrassed by their symptoms to seek treatment, and they go for years before seeing a doctor. Symptoms of OCD can be reduced with treatment.
OCD can have a negative effect on those who care about you. Family members can become angry and frustrated at the strain the rituals or behaviours put on them. Talk to your doctor about ways your family members can help with OCD.
If you have a parent or sibling with obsessive-compulsive disorder (OCD), your chance of developing OCD is increased.footnote 1
Your risk for developing OCD is greatest from childhood to middle adulthood. The average age of diagnosis is 19.footnote 1
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While your family doctor or general practitioner can diagnose, treat, and monitor obsessive-compulsive disorder (OCD), you may need to partner with a health professional who has had specific training in OCD management. For example, you may be referred to a psychiatrist.
Other health professionals who can provide ongoing counselling and support for OCD but cannot prescribe medicines include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
A diagnosis of obsessive-compulsive disorder (OCD) is based on your symptoms, medical history, and a physical examination. Your doctor may also want a mental health assessment, which is an evaluation of your emotional functioning and your ability to think, reason, and remember (cognitive functioning). A mental health assessment may include an examination of your nervous system, written or verbal tests, and laboratory tests (such as blood and urine tests) as well as a review of your appearance, mood, behaviour, thinking, reasoning, memory, and ability to express yourself.
Many people with OCD live with the condition for years before being diagnosed. Or they go without treatment because they are afraid or embarrassed to talk about their symptoms. Ask yourself these questions:
If your doctor suspects that you have OCD, he or she will look for a full range of symptoms that will confirm the diagnosis, including:
For a diagnosis of OCD, the obsessions or compulsions must be time-consuming (more than 1 hour a day) or greatly interfere with your normal routine at work or school and affect social activities and relationships.
Early detection and proper treatment is very important in improving the course of OCD. This disorder is often a long-lasting (chronic) condition that will need to be monitored throughout your life.
The earlier you seek treatment for obsessive-compulsive disorder (OCD), the better. Early treatment of OCD can reduce symptoms and reduce the disruption the illness can create in your life. Unfortunately, most people see several health professionals and spend years seeking treatment for OCD before they are correctly diagnosed. Their diagnoses are complicated by their being embarrassed or secretive about their symptoms and by other conditions they may have along with OCD, such as depression.
Treatment includes a combination of professional counselling and medicines.
Depending on the severity of your symptoms, your doctor may prescribe only counselling or counselling and an antidepressant, such as fluoxetine (for example, Prozac), fluvoxamine (Luvox), or sertraline (Zoloft).
A type of cognitive-behavioural therapy called exposure and response prevention is considered the most effective type of counselling for OCD. With exposure and response prevention therapy, you repeatedly expose yourself to an obsession, such as something you fear is contaminated, and deny yourself the ritual compulsive act, which in this case would be washing your hands. This therapy is done with a therapist or on your own with direction from your therapist.
In the beginning of exposure and response prevention therapy, your therapist may ask you to write a list of your obsessions, rituals (compulsions), and things that you avoid and then have you rank the amount of anxiety each of the obsessions causes from highest to lowest. You might begin exposing yourself to an obsession that causes a moderate amount of anxiety and then work your way up the list to the obsession that causes the most anxiety.
Therapists often combine exposure and response prevention therapy with cognitive-behavioural therapy to help overcome the faulty beliefs (such as fear of contamination) that lead to OCD behaviours.
Your doctor may first prescribe an antidepressant called a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine (for example, Prozac), or a tricyclic antidepressant, such as clomipramine. You may start to feel better within 1 to 3 weeks after you start taking an SSRI. But it can take as many as 12 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor. Your doctor may increase the dosage of your medicine or change to another SSRI if the first medicine prescribed doesn't help.
Ongoing treatment for OCD includes monitoring the dosage and effectiveness of your medicines. Your doctor may want you to stay on one medicine for at least 10 to 12 weeks before trying a different antidepressant. Although antidepressants are considered the most effective medicine for OCD, researchers are studying whether other medicines can be combined with antidepressants for better results.
If you are in counselling, your doctor will monitor your progress and, if necessary, modify the amount or type of counselling you're receiving. Between 13 and 20 sessions may be needed to relieve symptoms. Your doctor may also advise family members to participate in therapy with you or on their own.
Deep brain stimulation, which uses surgically implanted electrodes in the brain, and magnetic stimulation of parts of the brain may be tried in rare cases of OCD when other treatment has not been successful.
Consistency is important for both counselling and medicines. People who don't take their medicines regularly or stop altogether often have their symptoms return (relapse). With therapy, it is important to work with your doctor to find out when, or if, you should stop.
If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.
You cannot prevent obsessive-compulsive disorder (OCD) from starting. But the best way to prevent a relapse of OCD symptoms is by staying with your therapy and taking any medicines exactly as they have been prescribed.
Taking care of yourself every day is important in dealing with obsessive-compulsive disorder (OCD). This includes taking your medicines as directed every day and doing the homework your therapist gives you to do at home, such as self-directed exposure and response prevention exercises. With exposure and response prevention therapy, you repeatedly expose yourself to an obsession, such as something you fear is contaminated, and deny yourself the ritual compulsive act, which in this case would be washing your hands.
It's also important to involve family members and loved ones in your treatment, especially if your doctor suggested that you participate in therapy together. Keeping lines of communication open may help you deal with relationships that have become strained during your illness.
Reducing overall stress in your life, although not proven treatment for OCD symptoms, may help you cope. Tips to relieve stress and anxiety include:
Eating a healthy, balanced diet and avoiding certain foods or drinks may also help you reduce stress.
After you are diagnosed with obsessive-compulsive disorder (OCD), your doctor will likely prescribe antidepressants known as selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (for example, Prozac). Antidepressants are thought to help balance neurotransmitters (such as serotonin) in your brain.
In some cases it takes time to adjust the dosage or find the right medicine that will work for you. You may start to feel better within 1 to 3 weeks after you start taking an SSRI. But it can take as many as 12 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor. Your doctor may increase the dosage of your medicine, change to another SSRI, or use another medicine known as clomipramine if the medicine first prescribed doesn't help. Clomipramine, a tricyclic antidepressant, has been used for years to treat OCD, but it may have more side effects than SSRIs.
Your doctor may prescribe other medicines if you have other conditions along with OCD.
Antidepressants (SSRIs) such as fluoxetine (for example, Prozac), fluvoxamine (Luvox), and sertraline (Zoloft) are commonly prescribed to treat OCD. These medicines are taken as tablets or capsules. The medicine venlafaxine can also help symptoms of OCD. The tricyclic antidepressant clomipramine (Anafranil) is sometimes used as well.
Antidepressants are used to relieve the obsessive thoughts and subsequent compulsive behaviours in those who have OCD. By increasing the level of serotonin in the brain, antidepressants help to regulate the communication between different parts of the brain.
Other medicines (such as antipsychotics) are sometimes used to treat OCD.
A person with OCD may also have other anxiety disorders that complicate treatment and require using other medicines.
For children and adolescents with OCD, treatment combining cognitive-behavioural therapy with antidepressants (SSRIs), such as sertraline, works better than only taking medicine. Cognitive-behavioural therapy alone also works well, but it works better if it is combined with medicine.
National Institute of Mental Health (2012). Obsessive Compulsive Disorder Among Adults. Available online: http://www.nimh.nih.gov/statistics/1OCD_ADULT.shtml.
Other Works Consulted
American Psychiatric Association (2007). Practice Guideline for the Treatment of Patients With Obsessive-Compulsive Disorder. Arlington, VA: American Psychiatric Association. Available online: http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm.
Eisendrath SJ, Lichtmacher JE (2012). Psychiatric disorders. In SJ McPhee, MA Papadakis, eds., 2012 Current Medical Diagnosis and Treatment, 51st ed., pp. 1010-1064. New York: McGraw-Hill.
Reus VI (2015). Mental disorders. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 19th ed., vol. 2, pp. 2708-2723. New York: McGraw-Hill Education.
Swinson RP (2014). Psychiatric disorders: Obsessive-compulsive disorder. In J Gray, ed., Therapeutic Choices. Ottawa: Canadian Pharmacists Association. https://www.e-therapeutics.ca/tc.showChapter.action?documentId=c0131. Accessed July 28, 2014.
ByHealthwise StaffPrimary Medical ReviewerPatrice Burgess, MD - Family MedicineBrian D. O'Brien, MD - Internal MedicineAdam Husney, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineKathleen Romito, MD - Family MedicineSpecialist Medical ReviewerLisa S. Weinstock, MD - PsychiatryChristine R. Maldonado, PhD - Behavioral Health
Current as ofMay 3, 2017
Current as of: May 3, 2017
Patrice Burgess, MD - Family Medicine
& Brian D. O'Brien, MD - Internal Medicine & Adam Husney, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & Lisa S. Weinstock, MD - Psychiatry & Christine R. Maldonado, PhD - Behavioral Health
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