Obsessive-compulsive disorder Health Article

Definition

Obsessive-compulsive disorder (OCD) is currently classified as an anxiety disorder marked by the recurrence of intrusive or disturbing thoughts, impulses, images or ideas (obsessions) accompanied by repeated attempts to suppress these thoughts through the performance of certain irrational and ritualistic behaviors or mental acts (compulsions). The obsessions and compulsions take up large amounts of the patient's time (an hour or longer every day) and usually cause significant emotional distress for the patient and difficulties in his or her relationships with others.

Some researchers have questioned whether OCD really belongs with the other anxiety disorders. They think that it should be grouped with the spectrum of such obsessive-compulsive disorders as Tourette's syndrome, which are known to have biological causes.

OCD should not be confused with obsessive-compulsive personality disordereven though the two disorders have similar names. Obsessive-compulsive personality disorder is not characterized by the presence of obsessions and compulsions; rather, it is a lifelong pattern of insistence on control, orderliness, and perfection that begins no later than the early adult years. It is possible, however, for a person to have both disorders.

Description

Obsessive-compulsive disorder is a mental disorder with two components: obsessions, which consist of thoughts, impulses, or mental images; and compulsions, which are repetitive behaviors that the person feels driven to perform in response to the obsessions. In some cases, the compulsionmay represent a strict rule that the patient must apply rigidly in every situation (tying one's shoes a certain number of times, for example) in order to feel "right." The exact content of obsessions varies from person to person, although certain themes are common. People with OCD experience their disturbing thoughts and images as intrusive and troublesome, but they recognize that their thoughts are products of their own minds. Obsessive thoughts are different from worries about such real-life problems as losing one's job or bad grades in school. In addition, obsessive thoughts are not usually related to any real-life problems.

The most common types of obsessions in persons with OCD in Western countries are:

• fear of contamination (impurity, pollution, badness)
• doubts (worrying about whether one has omitted to do something)
• an intense need to have or put things in a particular order
• aggressive or frightening impulses
• recurrent sexual thoughts or images

It is important to understand that patients diagnosed with OCD do not perform their compulsions for pleasure or satisfaction. A compulsive behavior becomes linked to an obsessional thought because the behavior lowers the level of anxiety produced by the obsession(s).

The most common compulsions in Western countries are:

• washing/cleaning
• counting
• hoarding
• checking
• putting objects in a certain order
• repeated "confessing" or asking others for assurance
• repeated actions
• making lists

Although descriptions of patients with OCD have been reported since the fifteenth century in religious and psychiatric literature, the condition was widely assumed to be rare until very recently. Epidemiological research since 1980 has now identified OCD as the fourth most common psychiatric illness, after phobias, substance use disorders, and major depressive disorders. OCD is presently classified as a form of anxiety disorder, but current studies indicate that it results from a combination of psychological, neurobiological, genetic, and environmental causes.