Obsessive compulsive disorder

Obsessive compulsive disorder 

Overview

Obsessive-compulsive disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts ("obsessions") and/or behaviors ("compulsions") that he or she feels the urge to repeat over and over.

Signs and Symptoms

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

Fear of germs or contamination

Unwanted forbidden or taboo thoughts involving sex, religion, or harm

Aggressive thoughts towards others or self

Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

Excessive cleaning and/or handwashing

Ordering and arranging things in a particular, precise way

Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off

Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive

Spends at least 1 hour a day on these thoughts or behaviors

Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause

Experiences significant problems in their daily life due to these thoughts or behaviors

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

If you think you have OCD, talk to your health care provider about your symptoms. If left untreated, OCD can interfere in all aspects of life.

Causes

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

Biology. OCD may be a result of changes in your body's own natural chemistry or brain functions.

Genetics. OCD may have a genetic component, but specific genes have yet to be identified.

Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or gradually learned over time.

Risk factors

Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:

Family history. Having parents or other family members with the disorder can increase your risk of developing OCD.

Stressful life events. If you've experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.

Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.

Complications

Problems resulting from obsessive-compulsive disorder may include, among others:

Excessive time spent engaging in ritualistic behaviors

Health issues, such as contact dermatitis from frequent hand-washing

Difficulty attending work, school or social activities

Troubled relationships

Overall poor quality of life

Suicidal thoughts and behavior

Diagnosis

Steps to help diagnose obsessive-compulsive disorder may include:

Psychological evaluation. This includes discussing your thoughts, feelings, symptoms and behavior patterns to determine if you have obsessions or compulsive behaviors that interfere with your quality of life. With your permission, this may include talking to your family or friends.

Diagnostic criteria for OCD. Your doctor may use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Physical exam. This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications.

Diagnostic challenges

It's sometimes difficult to diagnose OCD because symptoms can be similar to those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia or other mental health disorders. And it's possible to have both OCD and another mental health disorder. Work with your doctor so that you can get the appropriate diagnosis and treatment.

Treatment

Obsessive-compulsive disorder treatment may not result in a cure, but it can help bring symptoms under control so that they don't rule your daily life. Depending on the severity of OCD, some people may need long-term, ongoing or more intensive treatment.

The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these.

Psychotherapy

Cognitive behavioral therapy (CBT), a type of psychotherapy, is effective for many people with OCD. Exposure and response prevention (ERP), a component of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn ways to resist the urge to do your compulsive rituals. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.

Medications

Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first.

Antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD include:

Clomipramine (Anafranil) for adults and children 10 years and older

Fluoxetine (Prozac) for adults and children 7 years and older

Fluvoxamine for adults and children 8 years and older

Paroxetine (Paxil, Pexeva) for adults only

Sertraline (Zoloft) for adults and children 6 years and older

However, your doctor may prescribe other antidepressants and psychiatric medications.

Medications: What to consider

Here are some issues to discuss with your doctor about medications for OCD:

Choosing a medication. In general, the goal is to effectively control symptoms at the lowest possible dosage. It's not unusual to try several drugs before finding one that works well. Your doctor might recommend more than one medication to effectively manage your symptoms. It can take weeks to months after starting a medication to notice an improvement in symptoms.

Side effects. All psychiatric medications have potential side effects. Talk to your doctor about possible side effects and about any health monitoring needed while taking psychiatric drugs. And let your doctor know if you experience troubling side effects.

Suicide risk. Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. If suicidal thoughts occur, immediately contact your doctor or get emergency help. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Interactions with other substances. When taking an antidepressant, tell your doctor about any other prescription or over-the-counter medications, herbs or other supplements you take. Some antidepressants can make some other medications less effective and cause dangerous reactions when combined with certain medications or herbal supplements.

Stopping antidepressants. Antidepressants aren't considered addictive, but sometimes physical dependence (which is different from addiction) can occur. So stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, sometimes called discontinuation syndrome. Don't stop taking your medication without talking to your doctor, even if you're feeling better — you may have a relapse of OCD symptoms. Work with your doctor to gradually and safely decrease your dose.

Talk to your doctor about the risks and benefits of using specific medications.

Other treatment

Sometimes, psychotherapy and medications aren't effective enough to control OCD symptoms. In treatment-resistant cases, other options may be offered:

Intensive outpatient and residential treatment programs. Comprehensive treatment programs that emphasize ERP therapy principles may be helpful for people with OCD who struggle with being able to function because of the severity of their symptoms. These programs typically last several weeks.

Deep brain stimulation (DBS). DBS is approved by the FDA to treat OCD in adults age 18 years and older who don't respond to traditional treatment approaches. DBS involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that may help regulate abnormal impulses.

Transcranial magnetic stimulation (TMS). The FDA approved a specific device (BrainsWay Deep Transcranial Magnetic Stimulation) to treat OCD in adults ages 22 to 68 years, when traditional treatment approaches have not been effective. TMS is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of OCD. During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet delivers a magnetic pulse that stimulates nerve cells in your brain.

TYPE OF DOCTOR DEPARTMENT : Psychiatry and Psychology SPECIALIST CAN DIAGNOSES THIS DISEASE.