Difference between revisions of "Obsessive compulsive disorder" - New World Encyclopedia

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'''Obsessive-compulsive disorder''' (OCD) is a [[psychiatric]] [[anxiety disorder]] that causes people to have unwanted thoughts (obsessions) and to repeat certain behaviors. While all of us have routines in our life that we accomplish over and over in the case of OCD the subject's obsessive, [[distress]]ing, [[intrusive thoughts]] and related compulsions (tasks or "[[ritual]]s") interfere with having a balanced or healthy lifestyle.
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'''Obsessive-compulsive disorder''' (OCD) is a neurobiobehavioral [[mental disorder]] characterized by distressful, time-consuming thoughts (obsessions) followed by repeated behaviors (compulsions) undertaken in the (often sub-conscious) "belief" that they will lessen the stress and anxiety of the sufferer. While all of us have routines in our life that we undertake repeatedly, in the case of OCD the subject's obsessive, and intrusive thoughts and their accompanying related "tasks" or "rituals" interfere with the afflicted person being able to maintain a balanced or healthy lifestyle.
  
OCD is distinguished from other types of [[anxiety]], including the routine [[tension]] and [[Stress (medicine)|stress]] that appear throughout life. However, a person who shows signs of [[fixation]] or displays traits such as [[Perfectionism (psychology)|perfectionism]], does not necessarily have OCD, a specific and well-defined condition.
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OCD is distinguished from other types of [[anxiety]], including the routine [[tension]] and [[stress]] that appear throughout life by its excessiveness. However, a person who shows signs of [[fixation]] or displays traits such as [[Perfectionism (psychology)|perfectionism]], does not necessarily have OCD, a specific and well-defined condition.
As with other disorders there may be varying degrees of intensity and a proper diagnosis is warranted in order to match appropriate treatment to the sufferer.
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As with other disorders there may be varying degrees of intensity and a proper [[diagnosis]] is warranted in order to match appropriate treatment to the person. While the cause of OCD is unknown, some studies suggest the possibility of brain [[lesions]] while others explore a more [[psychiatry|psychiatric]] analysis such as the impact of major [[clinical depression|depression]], [[organic brain syndrome]] or [[schizophrenia]].
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{{toc}}
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Although there is no known cure recent developments in [[brain]] research, [[drug|medication]]s, and [[behavior therapy]] have all resulted in Obsessive Compulsive Disorder becoming a treatable condition.
  
To be diagnosed with OCD, one must have either obsessions or compulsions alone, or obsessions and compulsions, according to the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV-TR]] diagnostic criteria. The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000) describes these obsessions and compulsions:<ref name="Quick">''Quick Reference to the Diagnostic Criteria from DSM-IV-TR''. Arlington, VA: American Psychiatric Association, 2000.</ref>
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==Diagnosing and defining OCD==
==Recognizing obsessive and compulsive thinking and actions==
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OCD has been defined as follows: "The essential features of OCD are recurrent obsessions or compulsions that are severe enough to be time consuming (that is they take more than one hour a day) or cause marked distress or significant impairment. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable" (American Psychiatric Association [APA] 2000 456-457).<ref name=loving>Karen Landsman, Kathleen M. Rupertus, and Cherry Pedrick, ''Loving Someone with OCD'' (New Harbinger Publications, 2005, ISBN 978-1572243293).</ref>
Obsessions are defined as recurrent and persistent thoughts, [[impulse (psychology)|impulse]]s, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. These thoughts, impulses, or images are not simply excessive worries about real-life problems and the person attempts to ignore,suppress or neutralize them with some other thought or action. In most cases, the sufferer of OCD recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality. In cases where the sufferer does not recognize that his thoughts are extreme an analysis of [[psychosis]] or "break with reality" needs to be evaluated.
 
  
'''Compulsions are defined by:'''
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[[Obsessive–compulsive disorder]] (OCD) is classified as "Obsessive-Compulsive and Related Disorders" in the American Psychiatric Association (APA)'s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), although it was previously classified as an [[anxiety disorder]] in the DSM-IV.<ref>[https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t13/ DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison] ''National Library of Medicine'', 2016. Retrieved November 17, 2022.</ref> Similarly, it was classified as an anxiety disorder in the [[World Health Organization]] (WHO)'s International Classification of Diseases (ICD-10), but not in ICD-11.<ref>Anna Marras, Naomi Fineberg, and Stefano Pallanti, [https://pubmed.ncbi.nlm.nih.gov/27401060/ Obsessive compulsive and related disorders: comparing DSM-5 and ICD-11] ''CNS Spectr'' 21(4) (2016):324-333. Retrieved November 17, 2022.</ref>
# Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
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{{readout||right|250px|Most people with OCD are well aware that their obsessions and compulsions are irrational}}
# The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
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Obsessions are defined as recurrent and persistent [[cognition|thought]]s, [[impulse (psychology)|impulse]]s, or [[mental image|image]]s that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. These thoughts, impulses, or images are not simply excessive worries about real-life problems, and the person in an attempt to ignore, suppress or neutralize the thoughts with some other action, perpetuates a cycle of obsessive/compulsive behavior. In most cases, the sufferer of OCD recognizes that the obsessional thoughts are a product of his or her own mind, and are not based in [[reality]]. In cases where the sufferer does not recognize that his thoughts are extreme an analysis of [[psychosis]] or "a break with reality" needs to be evaluated.
  
In addition to these criteria, at some point during the course of the disorder, the sufferer must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning.<ref name="Quick" /> OCD often causes feelings similar to those of [[Depression (mood)|depression]].
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Compulsions are defined by repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors are aimed at preventing or reducing distress or preventing some dreaded event or situation from occurring; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
  
==Causes and related disorders==
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OCD, like some other disorders such as [[anorexia nervosa]] can be difficult to detect or diagnose if the sufferer keeps such thoughts and behaviors to him or herself, due to feelings of either shame and/or denial about their condition.
  
Today the community of scientists studying obsessive-compulsive disorder is split into two factions disagreeing over the illness's cause. One side believes that obsessive-compulsive behavior is a psychological disorder; the other side thinks it has a neurological origin.  
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==Prevalance==
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According to the [[National Institute of Mental Health]] (NIMH) OCD affects both men and women equally and some estimates say that as many as 3.3 million Americans ages 18 to 54, an estimated 2.3 percent of the population, may have OCD at any one time. If children were included in this figure it would increase to seven million. The onset of symptoms usually occurs between the ages of 20 and 30 with 75 percent of patients being diagnosed before the age of 30.<ref name=loving/> Although children may also suffer from OCD, they can go undiagnosed for a long period of time or may appear in conjunction with a constellation of symptoms such as [[Attention-deficit hyperactivity disorder]] (ADHD), [[dyslexia]], or [[clinical depression|depression]].
  
The [[Stanford University School of Medicine]] OCD webpage states, "Although the causes of the disorder still elude us, the recent identification of children with OCD caused by an autoimmune response to [[Group A streptococcal infection]] promises to bring increased understanding of the disorder's pathogenesis."<ref>{{cite web |url=http://ocd.stanford.edu/treatment/history.html |title=History of Treatment of OCD - OCD Research - Stanford University School of Medicine |accessdate=2007-06-28 |format= |work=}}</ref>
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==OCD and children==
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As the understanding of mental illness grows, along with better and more effective treatments, children can be diagnosed earlier, thus preventing future problems. A child [[Psychiatry|psychiatrist]] or other qualified mental health professional usually diagnoses [[anxiety disorder]]s and OCD in children or adolescents following a comprehensive psychiatric evaluation. Parents who note signs of severe anxiety or obsessive or compulsive behaviors in their child or teen can help by seeking an evaluation and early treatment.<ref>[https://www.cdc.gov/childrensmentalhealth/ocd.html Obsessive-Compulsive Disorder in Children] ''Centers for Disease Control and Prevention''. Retrieved November 27, 2022.</ref>
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In order for a diagnosis of OCD to be made, the obsessions and compulsions must be pervasive, severe, and disruptive enough that the child or adolescent's daily routines are adversely affected. The average onset age for OCD in children is around 10.2 years of age. The disorder tends to develop earlier in boys than in girls and most often symptoms occur between ages nine and 13. Nearly half of all adults with OCD have had an onset in childhood, although they may have received help much later.<ref name=loving/>
  
==Psychological explanations==
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==Possible causes of OCD==
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===The brain===
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Research into OCD focuses on the [[brain]] structure, circuitry, and neurochemical factors that may distinguish people with OCD from the general population. The area of the brain in question is the [[basal ganglia]] located in the center of the brain, where information that has entered from the outside world is sorted and unnecessary information is discarded. These areas also control impulsiveness. People with OCD can become overwhelmed with intrusive thoughts that they cannot easily disregard.
  
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The [[orbital cortex]] located in the front of the brain and above the eyes is where we interpret information coming in from the senses and to which we apply moral and emotional judgment. Overstimulation in this area of the brain seems to keep people with OCD "on alert," causing an extra sense of unease.
  
== Cognitive-Behavioral Model ==
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The [[cingulate gyrus]] is also located in the center of the brain and alerts us to danger. This part of the brain also helps us to shift from one thought to another and it's possible that this area is what gives trouble to the OCD person who becomes a slave to his repeated behaviors. Through [[Positron emission tomography|PET]] scan studies Dr. Jeffrey Schwartz and Dr. Lewis Baxter demonstrated that there was an increased energy use in this area of the brain with people who had OCD. Their studies and subsequent treatment breakthroughs with medication and cognitive [[behavioral therapy]] actually proved to decrease the overactivity in this area. This new research combined with technological advancements, such as [[brain imaging]], prove a positive link between the disorder and the brain circuitry and demonstrates that people with OCD have slightly more hyperactivity in their brains that can be controlled successfully.
  
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===Chemical imbalance===
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The neurochemical imbalance that appears to be associated with OCD involves [[serotonin]], an important [[neurotransmitter]]. A neurotransmitter is a chemical messenger that enables communication between [[nerve]] [[cell]]s. Serotonin controls many [[biology|biological]] processes including [[sleep]], [[mood]], [[aggression]], [[appetite]] and even [[pain]]. Medications that increase the amount of serotonin for OCD sufferers appear to make a marked difference in their quality of life. Serotonin imbalance has been implicated in other afflictions, as well, such as [[self mutilation]], [[eating disorder]]s, and depression.
  
This model suggests that the behaviour is carried out to remove anxiety-provoking intrusive thoughts. Unfortunately this only brings about temporary relief as the thought re-emerges.  
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===Strep connection===
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Some cases of OCD in children have been associated with [[streptococcal]] [[infection]]s (called PANDAS or [[pediatric autoimmune neuropsychiatric disorder]]). Other [[Autoimmune Diseases|autoimmune]] diseases have also been associated with OCD symptoms such as [[lupus]], [[Sydenham's chorea]], and [[rhuematic fever]]. These are more rare and OCD generally occurs without such a precipitating or traumatic event.
  
Each time the behaviour occurs it is <b>negatively reinforced</b> (see [[Reinforcement]]) by the relief from anxiety, thereby explaining why the dysfunctional activity increases and <b>generalises</b> (extends to other, related stimuli) over a period of time.
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===Genetic basis===
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Although the presence of a [[gene]]tic link has not yet been definitely established it appears that either differences in specific genes or possibly several combinations of genes predispose a person to OCD. There appears to be more of a genetic link in childhood-onset OCD (Geller 1998), and there are findings of higher rates of OCD when [[Tourette's syndrome]] and/or tics is experienced by related family members (Alsobrok and Pauls 1998).<ref name=loving/>
  
For example, after touching a door-knob a person might have the thought that they may develop a disease as a result of contamination. They then experience  anxiety, which is relieved when they wash their hands. This might be followed by the thought "but did I wash them properly?" causing an increase in anxiety once more, the hand-washing once again rewarded by the removal of anxiety (albeit briefly) and the cycle being repeated when thoughts of contamination re-occur. The distressing thoughts might then spread to fear of contamination from e.g. a chair (someone might have touched the chair after touching the door handle).
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==OCD symptoms==
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The typical OCD sufferer performs tasks (or [[compulsion]]s) to seek relief from [[obsession-related anxiety]]. While obsessions are persistent ''thoughts'' compulsions are repetitive behaviors that are performed in response to them. To others, these tasks may appear odd and unnecessary, but for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and the build up of [[stress]]. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, or repeatedly washing hands at regular intervals throughout the day.  
  
==Biological explanations==
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'''Obsessions''' and their related '''compulsions''' may include but are not limited to the following:
There are many different theories about the cause of obsessive-compulsive disorder. The majority of researchers believe that there is some type of abnormality in the [[neurotransmitter]] [[serotonin]], among other possible psychological or biological abnormalities; however, it is possible that this activity is the brain's ''response'' to OCD, and not its cause. Serotonin is thought to have a role in regulating anxiety, though it is also thought to be involved in such processes as [[sleep]] and [[memory]] function. This neurotransmitter travels from one [[nerve cell]] to the next via [[synapse]]s. In order to send chemical messages, serotonin must bind to the [[receptor (biochemistry)|receptor]] sites located on the neighboring nerve cell. It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential. This suggestion is supported by the fact that many OCD patients benefit from the use of [[selective serotonin reuptake inhibitors]] (SSRIs) &mdash; a class of [[antidepressant]] medications that allow for more serotonin to be readily available to other nerve cells.<ref name="bbc">BBC Science and Nature: Human Body and Mind. Causes of OCD. <http://www.bbc.co.uk/science/humanbody/mind/articles/disorders/causesofocd.shtml>. Accessed April 15, 2006.</ref> For more about this class of drugs, see the [[OCD#Treatment|section about potential treatments]] for OCD.
 
  
Recent research has revealed a possible [[genetic mutation]] that could be the cause of OCD. Researchers funded by the [[National Institutes of Health]] have found a [[mutation]] in the human serotonin transporter gene, [[hSERT]], in unrelated families with OCD. Moreover, in his study of identical twins, Rasmussen (1994) produced data that supported the idea that there is a "heritable factor for neurotic anxiety".<ref>Rasmussen, S.A. "Genetic Studies of Obsessive Compulsive Disorder" in ''Current Insights in Obsessive Compulsive Disorder'', eds. E. Hollander; J. Zohar; D. Marazziti & B. Oliver. Chichester, England: John Wiley & Sons, 1994, pp. 105-114. </ref> In addition, he noted that environmental factors also play a role in how these anxiety symptoms are expressed. However, various studies on this topic are still being conducted and the presence of a genetic link is not yet definitely established.
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*Fear of [[dirt]] or [[germ]]s/repetitive washing and cleaning
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*Fear of disorder/arranging things in a certain way, over concern with [[symmetry]] (balance) and exactness
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*Worry that a task has been done poorly, even when the person knows this is not true/checking it over and over
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*Irrational fear of harm coming to them or a loved one/checking locks, household appliances, or on the safety of others, etc.
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*Fear of thinking [[evil]] or sinful thoughts/developing [[Superstition|superstitious]] [[ritual]]s
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*Recall and review of distressing situations/ thinking about certain sounds, images, words or numbers repeatedly
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[[File:OCD handwash.jpg|thumb|300px|Frequent and excessive hand washing occurs in some people with OCD]]
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There are many other possible symptoms, and it is not necessary to display those described in the list above to be considered as suffering from OCD.  
  
Another possible genetic cause of OCD was discovered in August 2007 by scientists at [[Duke University Medical Center]] in North Carolina. They genetically engineered mice that lacked a [[gene]] called [[SAPAP3]]. This [[protein]] is highly expressed in the [[striatum]], an area of the [[brain]] linked to planning and the initiation of appropriate actions. The mice spent three times as much time grooming themselves as ordinary mice, to the point that their fur fell off.<ref>[http://www.newscientist.com/channel/life/genetics/mg19526183.400-missing-gene-creates-obsessivecompulsive-mouse-.html Missing gene creates obsessive-compulsive mouse], ''[[New Scientist]]'', August 2007</ref>
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Often the person with OCD will truly be uncertain whether the fears that cause him or her to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do [[Exposure and response prevention|ERP therapy]] on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually [[delusion]]al, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not. Since [[fear]] and [[doubt]] can feed the cycle of obsessive compulsive behavior the person will often seek continual reassurance.
  
Technological advancements have allowed for the possibility of [[brain imaging]]. Using tools like [[positron emission tomography]] (PET scans), it has been shown that those with OCD tend to have brain activity that differs from those who do not have this disorder.<ref>Tennen, M. 2005, June. "Causes of OCD Remain a Mystery." <http://www.healthatoz.com/ healthatoz/Atoz/dc/cen/ment/obcd/alert07172003.jsp>. Accessed April 14, 2006.</ref> This suggests that brain functioning in those with OCD may be impaired in some way. A popular explanation for OCD is that offered in the book ''Brain Lock'' by Jeffrey Schwartz, which suggests that OCD is caused by the part of the brain that is responsible for translating complex intentions (e.g., "I will pick up this cup") into fundamental actions (e.g., "move arm forward, rotate hand 15 degrees, etc.") failing to correctly communicate the chemical message that an action has been completed. This is perceived as a feeling of doubt and incompleteness, which then leads the individual to attempt to consciously deconstruct their own prior behavior &mdash; a process which induces anxiety in most people, even those without OCD.
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OCD is different from behaviors such as [[addiction]] to [[gambling]] or [[overeating]]. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is, likewise, not to be confused with [[Obsessive Compulsive Personality Disorder]] which is a separate [[syndrome]].
  
It has been theorized that a miscommunication between the [[orbitofrontal cortex]], the [[caudate nucleus]], and the [[thalamus]] may be a factor in the explanation of OCD. The orbitofrontal cortex (OFC) is the first part of the brain to notice whether or not something is wrong. When the OFC notices that something is wrong, it sends an initial "worry signal" to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to interpret the worrying event. The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in [[compulsive behaviors]] in an attempt to relieve this apprehension.<ref name="bbc" /> This overactivity of the OFC is shown to be attenuated in patients who have successfully responded to [[SSRI]] medication. The increased stimulation of the [[serotonin]] receptors [[5-HT2A receptor|5-HT2A]] and [[serotonin receptor|5-HT2C]] in the OFC is believed to cause this inhibition. <ref>[http://neuro.psychiatryonline.org/cgi/content/full/14/1/88 Obsessive-Compulsive Disorder Associated With a Left Orbitofrontal Infarct - K<FONT SIZE=-1>IM</FONT> and L<FONT SIZE=-1>EE</FONT> 14 (1): 88 - J Neuropsychiatry Clin Neurosci<!-- Bot generated title —>]</ref>
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OCD is placed in the anxiety class of [[mental illness]], but like many [[chronic stress disorders]] it can lead to [[clinical depression]] over time if the patient is not able to find the necessary supports and strategies for coping. OCD's effects on day-to-day life, particularly its substantial consumption of time, can produce difficulties with work, finances, and relationships.
  
Some research has discovered an association between a type of size abnormality in different [[brain structures]] and the predisposition to develop OCD. Through the use of [[magnetic resonance imaging]] (MRI), researchers at [[Cambridge's Brain Mapping Unit]] were able to discover distinctive patterns in the brain structure of individuals with OCD and their close family members. <ref>[http://www.admin.cam.ac.uk/news/dp/2007112601 Brain pattern associated with genetic risk of Obsessive Compulsive Disorder<!-- Bot generated title —>]</ref> This is the first instance in which it has been demonstrated that those with a familial risk of developing OCD have anatomical differences when compared with ordinary individuals. The discovery of these structural differences in the area of the brain associated with stopping [[motor response]] may ultimately aid researchers who seek to determine which genes contribute to the development of OCD.
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==Treatment==
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For years, people with OCD suffered in secret and even when their behaviors were brought into the open adequate treatment was unavailable. Today, with improvements in neuropsychiatric research OCD is quite treatable and those who suffer from it can live productive and normal lives.
  
==Obsessive behavior==
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What seems to be most effective is a combination of [[cognitive behavioral therapy]] (CBT), and [[Psychiatric medication|medications]], with medication being the first line of treatment until symptoms are under control, and a patient is feeling motivated to change the behavioral patterns that contribute to OCD. While medications provide immediate relief for OCD, behavioral therapy is long lasting and will teach strategies that can be implemented for a lifetime.
 
 
Community studies have placed the prevalence between one and three percent, although the prevalence of clinically recognized OCD is much lower, suggesting that many individuals with the disorder are unaccounted for clinically.<ref>{{cite journal |author=Fireman B, Koran LM, Leventhal JL, Jacobson A |title=The prevalence of clinically recognized obsessive-compulsive disorder in a large health maintenance organization |journal=The American journal of psychiatry |volume=158 |issue=11 |pages=1904-10 |year=2001 |pmid=11691699 |doi= | doi = 10.1176/appi.ajp.158.11.1904 <!--Retrieved from CrossRef by DOI bot—>}}</ref> The fact that many individuals do not seek treatment may be due in part to [[social stigma|stigma]] associated with OCD. Another reason for not seeking treatment is because many sufferers of OCD do not realize that what they are suffering from is OCD, mainly because the typical depiction of the disorder in the media and elsewhere only covers a few of the many symptoms of OCD.
 
 
 
The typical OCD sufferer performs tasks (or [[wikt:compulsion|compulsion]]s) to seek relief from [[obsession-related anxiety]]. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to the build up of [[stress]]. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, or repeatedly washing hands at regular intervals throughout the day. Physical symptoms may include those brought on from anxeties and unwanted thoughts, as well as [[tics]] or [[Parkinson's disease]]-like symptoms: rigidity, tremor, jerking arm movements, or involuntary movements of the limbs.
 
 
 
Obsessions may include but are not limited to the following:
 
*Fear of dirt or germs
 
*Concern with order, symmetry (balance) and exactness
 
*Worry that a task has been done poorly, even when the person knows this is not true
 
*Fear of thinking evil or sinful thoughts
 
*Thinking about certain sounds, images, words or numbers all the time
 
*Need for constant reassurance
 
**Strange and chronic worries about certain events such as sleeping, eating, leaving home without certain items
 
*Fear of hurting a family member or friend
 
 
 
There are many other possible symptoms, and it is not necessary to display those described in the list above to be considered as suffering from OCD. Formal diagnosis should be performed by a [[mental health professional]] (a [[psychologist]], a [[psychiatrist]], a [[psychoanalyst]], etc). As most people feel some of the symptoms some of the time, since there is a range of normal behavior versus neurotic behavior it is the relative degree of excess or inability to live life normally that contributes to a diagnoses of OCD.
 
 
 
OCD sufferers are aware that such thoughts and behavior are not [[rationality|rational]],<ref>{{cite book |title=Introduction to Clinical Psychiatry |last=Elkin |first=G. David |year=1999 |publisher=McGraw-Hill Professional |isbn=0838543332 }}</ref> but feel bound to comply with them to fend off feelings of panic or dread.
 
 
 
In an attempt to relate further the immense distress that those afflicted with this condition must bear, Barlow and Durand (2006) use the following example.<ref name="Barlow">Barlow, D. H. and V. M. Durand. ''Essentials of Abnormal Psychology''. California: Thomson Wadsworth, 2006.</ref> They implore readers not to think of pink elephants. Their point lies in the assumption that most people will immediately create an image of a pink elephant in their minds, even though told not to do so. The more one attempts to stop thinking of these colorful animals, the more one will continue to generate these mental images. This phenomenon is termed the "Thought Avoidance Paradox," and it plagues those with OCD on a daily basis, for no matter how hard one tries to get these disturbing images and thoughts out of one's mind, feelings of distress and anxiety inevitably prevail. Although everyone may experience unpleasant thoughts at one time or another, these are usually warranted concerns that are short-lived and fade after an adequate time period has lapsed. However, this is not the case for OCD sufferers.<ref>Carter, K. "Obsessive-Compulsive Disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. 14 Feb. 2006.</ref>
 
 
 
OCD is often confused with the separate condition [[obsessive-compulsive personality disorder]]. The two are not the same condition, however. OCD is ''ego dystonic'', meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ''ego syntonic''—marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD, by contrast, are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with [[anxiety]]; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions.<ref>Carter, K. "Obsessive-Compulsive Personality Disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. 11 April 2006.</ref> This is a significant difference between these disorders.
 
 
 
Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is ''still'' not sure, and it is ''still'' better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.
 
 
 
Some OCD sufferers exhibit what is known as ''overvalued ideas''. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do [[Exposure and response prevention|ERP therapy]] on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually [[delusion]]al, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not.
 
 
 
OCD is different from behaviors such as [[gambling]] addiction and [[overeating]]. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so.
 
 
 
OCD is placed in the anxiety class of [[mental illness]], but like many [[chronic stress disorders]] it can lead to [[clinical depression]] over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life—particularly its substantial consumption of time—can produce difficulties with work, finances and relationships.
 
 
 
There is no known cure for OCD as of yet, but there are a number of successful treatment options available.
 
 
 
===Related disorders===
 
People with OCD may be diagnosed with other conditions, such as [[anorexia nervosa]], [[social anxiety disorder]], [[bulimia nervosa]], [[Tourette syndrome]], [[compulsive skin picking]], [[body dysmorphic disorder]], [[trichotillomania]], and (as already mentioned) [[obsessive-compulsive personality disorder]]. There is some research demonstrating a link between [[drug addiction]] and OCD as well. Many who suffer from OCD suffer also from [[panic attack]]s. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of [[coping]] with the heightened levels of [[anxiety]]), but drug addiction among OCD patients may serve as a type of [[compulsive behavior]] and not just as a coping mechanism. [[Clinical depression|Depression]] is also extremely prevalent among sufferers of OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD (or any other [[anxiety disorder]]) may feel depressed because of an "out of control" type of feeling.<ref>{{cite journal |author=Mineka S, Watson D, Clark LA |title=Comorbidity of anxiety and unipolar mood disorders |journal=Annual review of psychology |volume=49 |issue= |pages=377-412 |year=1998 |pmid=9496627 |doi=10.1146/annurev.psych.49.1.377}}</ref>
 
 
 
Some cases are thought to be caused at least in part by childhood [[streptococcus|streptococcal]] infections and are termed [[PANDAS]] (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The streptococcal [[antibody|antibodies]] become involved in an [[autoimmune]] process. Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be "caught" via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that [[antibiotic]]s may eventually be used to treat or prevent it.<ref>
 
{{Cite web
 
| author = Belkin, L.
 
|title = Can You Catch Obsessive-Compulsive Disorder?
 
|publisher = ''The New York Times Magazine''
 
|url = http://www.nytimes.com/2005/05/22/magazine/22OCD.html?ex=1145419200&en=dac0fb81aa28b46b&ei=5070>
 
|accessdate = 2006-04-12}}</ref>
 
 
 
== Demographics and other statistics ==
 
In a 1980 study of 20,000 adults from [[New Haven]], [[Baltimore]], [[St. Louis]], [[Durham]], and [[Los Angeles]], the lifetime prevalence rate of OCD for both sexes was recorded at 2.5 percent.
 
 
 
Education also appears to be a factor. The lifetime prevalence of OCD is lower for those who have graduated high school than for those who have not (1.9 percent versus 3.4 percent). However, in the case of college education, lifetime prevalence is higher for those who graduate with a degree (3.1 percent) than it is for those who have only some college background (2.4 percent). As far as age is concerned, the onset of OCD usually ranges from the late teenage years until the mid-20s in both sexes, but the age of onset tends to be slightly younger in males than in females.<ref>Antony, M. M.; F. Downie & R. P. Swinson. "Diagnostic Issues and Epidemiology in Obsessive-Compulsive Disorder." in ''Obsessive-Compulsive Disorder: Theory, Research, and Treatment'', eds. M. M. Antony; S. Rachman; M. A. Richter & R. P. Swinson. New York: The Guilford Press, 1998, pp. 3-32. </ref>
 
 
 
[[Violence]] is very rare among OCD sufferers, but the disorder is often debilitating to their [[quality of life]]. Also, the [[psychological self-awareness]] of the [[irrationality]] of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. To avoid perceived obsession triggers, they also often avoid certain situations or places altogether.
 
 
 
It has been alleged that sufferers are generally of above-average [[intelligence (trait)|intelligence]], as the very nature of the disorder necessitates complicated thinking patterns.
 
 
 
==Treatment and prognosis==
 
According to the Expert Consensus Guidelines for the Treatment of obsessive-compulsive disorder, [[behavioral therapy]] (BT), [[cognitive therapy]] (CT), [[Psychiatric medication|medications]], or any combination of the three, are first-line treatments for OCD. [[Psychodynamic psychotherapy]] may help in managing some aspects of the disorder, but there are no controlled studies that demonstrate effectiveness of [[psychoanalysis]] or [[dynamic psychotherapy]] in OCD.<ref name="APAguidelines">Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB; American Psychiatric Association. {{PDFlink|"[http://www.psych.org/psych_pract/treatg/pg/OCDPracticeGuidelineFinal05-04-07.pdf Practice guideline for the treatment of patients with obsessive-compulsive disorder]."|1.10&nbsp;[[Mebibyte|MiB]]<!-- application/pdf, 1161779 bytes —>}} Am J Psychiatry 2007; 164(7 Suppl): 5-53. PMID 17849776.</ref>
 
 
 
===Behavioral and family therapy===
 
 
 
The specific technique used in BT/CBT is called [[Exposure and response|exposure and ritual prevention]] (also known as "[[exposure and response prevention]]") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure." The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly [[habituation|habituates]] to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking.
 
 
 
This has been demonstrated to be the most effective treatment for OCD. In the U.K. psycho-surgery cannot be performed unless a course of treatment from a suitably qualified cognitive-behavioural therapist has been carried out.
 
  
 
===Medication===
 
===Medication===
 +
[[Antidepressant]]s called [[serotonin reuptake inhibitors]] (SRIs) and [[selective serotonin reuptake inhibitor]]s (SSRIs) are used to treat OCD. In addition to reducing the obsessive/compulsive urges they can also improve related depression which can work to contribute to a person's sense of well being and motivation towards getting well. Medications found to be effective include: [[clomipramine]] (brand name: Anafranil), [[fluoxetine]] (brand name: Prozac), [[sertraline]] (brand name: Zoloft), [[paroxetine]] (brand name: Paxil) and [[fluvoxamine]] (brand name: Luvox). A newer mediaction that has found success is [[Lexapro]].<ref>[https://www.biopsychiatry.com/inositol.htm Obsessive-Compulsive Disorder] ''National Institute of Mental Health''. Retrieved November 27, 2022.</ref>
 +
Other medications such as [[riluzole]], [[memantine]], [[gabapentin|gabapentin (Neurontin)]], [[lamotrigine|lamotrigine (Lamictal)]], and low doses of the newer [[atypical antipsychotic]]s [[olanzapine|olanzapine (Zyprexa)]], [[quetiapine|quetiapine (Seroquel)]] and [[risperidone|risperidone (Risperdal)]] have also been found to be useful as adjuncts in the treatment of OCD. However, the use of [[antipsychotic]]s in treating OCD must be undertaken carefully.<ref name=loving/>
  
Medications as treatment include [[selective serotonin reuptake inhibitor]]s (SSRIs) such as [[Paxil|paroxetine (Seroxat, Paxil, Xetanor, ParoMerck, Rexetin)]], [[Zoloft|sertraline (Zoloft, Stimuloton)]], [[Prozac|fluoxetine (Prozac, Bioxetin)]], [[escitalopram]] (Lexapro), and [[Luvox|fluvoxamine (Luvox)]] as well as the [[tricyclic antidepressant]]s, in particular [[clomipramine|clomipramine (Anafranil)]]. SSRIs prevent excess [[serotonin]] from being pumped back into the original [[neuron]] that released it. Instead, serotonin can then bind to the [[receptor (biochemistry)|receptor]] sites of nearby neurons and send chemical messages or signals that can help regulate the excessive [[anxiety]] and obsessive thoughts. In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious. [[Serotonergic]] [[antidepressant]]s typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. In addition to this, the treatment usually requires high doses. [[Fluoxetine]], for example, is usually prescribed in doses of 20&nbsp;mg per day for clinical depression, whereas with OCD the dose will often range from 20&nbsp;mg to 80&nbsp;mg or higher, if necessary. In most cases [[antidepressant therapy]] alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Other medications such as [[riluzole]], [[memantine]], [[gabapentin|gabapentin (Neurontin)]], [[lamotrigine|lamotrigine (Lamictal)]], and low doses of the newer [[atypical antipsychotic]]s [[olanzapine|olanzapine (Zyprexa)]], [[quetiapine|quetiapine (Seroquel)]] and [[risperidone|risperidone (Risperdal)]] have also been found to be useful as adjuncts in the treatment of OCD. The use of [[antipsychotic]]s in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their [[dopamine receptor]] [[antagonism]]), at high doses these same antipsychotics have proven to cause dramatic obsessive-compulsive symptoms even in those patients who do not normally have OCD. This is most likely due to the antagonism of [[5-HT2A receptors]] becoming very prominent at these doses and outweighing the benefits of [[dopamine]] antagonism. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief [[enzyme]] that is responsible for [[metabolism|metabolising]] antipsychotics &mdash; [[CYP2D6]] &mdash; so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results. Thus, according to the Obsessive Compulsive Foundation, the antipsychotic treatment that is not added into SSRI treatment can cause on-set OCD symptoms.
+
===Cognitive Behavioral Therapy===
 
+
At the core of [[Cognitive Behavioral Therapy]] is the belief that changing the way a person thinks can change the way they feel. Cognitive therapy focuses not only on thoughts that contribute to depression and anxiety, but also on beliefs that serve the same function. The difference between thoughts and beliefs is that thoughts are events in time lasting only for a moment, whereas beliefs are more stable and long-lasting.
 
 
The naturally occurring sugar [[inositol]] may be an effective treatment for OCD. Inositol appears to modulate the actions of serotonin and has been found to reverse [[desensitisation]] of the [[neurotransmitter]]'s receptors.<ref>{{cite web |url=http://www.biopsychiatry.com/inositol.htm |title=Inositol in psychiatry |accessdate=2007-06-28 |format= |work=}}</ref>
 
 
 
[[St John's Wort]] has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities, and studies have emerged that have shown positive results. However, a double-blind study, using a flexible-dose schedule (600-1800 mg/day), found no difference between St John's Wort and the placebo.<ref>{{cite journal |author=Kobak KA, ''et al'' |title=St John's wort versus placebo in obsessive-compulsive disorder: results from a double-blind study.
 
|journal=Int Clin Psychopharmacol. |volume=20 |issue=6 |pages=299-304 |year=2005 |pmid=16192837 |doi= |url=http://www.ncbi.nlm.nih.gov/pubmed/16192837?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum | doi = 10.1097/00004850-200511000-00003 <!--Retrieved from CrossRef by DOI bot—>
 
}}</ref>
 
 
 
Recent research has found increasing evidence that [[opioid]]s may significantly reduce OCD symptoms, though the addictive property of these drugs likely stands as an obstacle to their sanctioned approval for OCD treatment. Anecdotal reports suggest that some OCD sufferers have successfully self-medicated with opioids such as [[Ultram]] and [[hydrocodone|Vicodin]], though the off-label use of such [[painkiller]]s is not widely accepted, again because of their addictive qualities. [[Tramadol]] is an atypical opioid that may be a viable option as it has a low potential for [[substance abuse|abuse]] and [[addiction]], mild side effects, and shows signs of rapid efficacy in OCD. Tramadol not only provides the anti-OCD effects of an [[opiate]], but also inhibits the [[re-uptake]] of serotonin (in addition to [[norepinephrine]]). This may provide additional benefits, but should not be taken in combination with [[antidepressant]] medication unless under careful medical supervision due to potential [[serotonin syndrome]].<ref>{{cite journal |author=Goldsmith TB, Shapira NA, Keck PE |title=Rapid remission of OCD with tramadol hydrochloride |journal=The American journal of psychiatry |volume=156 |issue=4 |pages=660-1 |year=1999 |pmid=10200754 |doi= |url=http://ajp.psychiatryonline.org/cgi/content/full/156/4/660a}}</ref>
 
  
Studies have also been done that show [[nutrition deficiencies]] may also contribute to OCD and other [[mental disorder]]s. Certain [[vitamin]] and [[mineral supplements]] may aid in such disorders and provide the [[nutrients]] necessary for proper [[mental functioning]]. <ref>[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2248201 Nutritional therapies for mental disorders<!-- Bot generated title —>]</ref>
+
The cornerstone of the specific cognitive behavioral therapy that has proven to be effective in treating OCD is a technique called [[Exposure and response|exposure and ritual prevention]] (also known as [[exposure and response prevention]]). Exposure and Response Prevention involves deliberate exposure to anxiety producing situations for the OCD patient who responds ''without'' performing his usual [[ritual]]s. Cognitive therapy alone refers to the learning of strategies that help change distorted thinking and faulty [[belief]] systems. Cognitive techniques help people analyze how they respond to situations and how they could react more positively. There are workbooks designed for the OCD patient that can help support cognitive behavioral strategies and also give suggestions for ways that the family can provide support. It is important to distinguish that supporting someone's irrational fear and response to OCD is different than supporting the patient in letting go of inappropriate responses. Cognitive therapy without medication may be appropriate for those with mild to moderate OCD.
  
Research has generally shown that [[psychotherapy]], in combination with [[psychotropic medication]], is more effective than either option alone.
+
==="Natural" cures===
 +
The naturally occurring [[sugar]] [[inositol]] may be an effective treatment for OCD. Inositol appears to modulate the actions of serotonin and has been found to reverse [[desensitization]] of the [[neurotransmitter]]'s [[receptor]]s.<ref>J. Levine, [https://www.biopsychiatry.com/inositol.htm Controlled trials of inositol in psychiatry] ''Eur Neuropsychopharmacol'' 7(2) (May 1997): 147-155. Retrieved November 27, 2022.</ref>
  
Recent studies at the [[University of Arizona]] using the [[tryptamine]] [[alkaloid]] [[psilocybin]] have shown promising results.<ref>{{cite web |url=http://www.maps.org/research/psilo/azproto.html |title=Psilocybin in the Treatment of Obsessive Compulsive Disorder |accessdate=2007-06-28 |format= |work=}}</ref> There are reports that other [[hallucinogen]]s such as [[LSD]] and [[peyote]] have produced similar benefits. It has been hypothesised that this effect may be due to stimulation of [[5-HT2A receptor]]s and, less importantly, [[Serotonin receptor|5-HT2C receptors]]. This causes, among many other effects, an [[inhibitory effect]] on the [[orbitofrontal cortex]], an area of the brain in which [[hyperactivity]] has been strongly associated with OCD.<ref>{{cite web |url=http://www.ajp.psychiatryonline.org/cgi/content/full/156/7/1123 |title=Hallucinogens and Obsessive-Compulsive Disorder—PERRINE 156 (7): 1123—Am J Psychiatry |accessdate=2007-06-28 |format= |work=}}</ref>
+
[[St. John's Wort]] has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities, and studies have emerged that have shown positive results. However, a double-blind study, using a flexible-dose schedule (600-1800 mg/day), found no difference between St. John's Wort and the [[placebo]].<ref>Kenneth A. Kobak, ''et al'', [https://pubmed.ncbi.nlm.nih.gov/16192837/ St. John's wort versus placebo in obsessive-compulsive disorder: results from a double-blind study] ''Int Clin Psychopharmacol'' 20(6) (November 2005):299-304. Retrieved November 27, 2022.</ref>  
  
Emerging evidence has suggested that regular [[nicotine]] treatment may be helpful in improving symptoms of OCD, although the [[pharmacodynamics|pharmacodynamical]] mechanism by which this improvement is achieved is not yet known, and more detailed studies are needed to fully confirm this [[hypothesis]]. Anecdotal reports suggest OCD can worsen when cigarettes are smoked.<ref>{{cite journal |author=Lundberg S, Carlsson A, Norfeldt P, Carlsson ML |title=Nicotine treatment of obsessive-compulsive disorder |journal=Prog. Neuropsychopharmacol. Biol. Psychiatry |volume=28 |issue=7 |pages=1195-9 |year=2004 |pmid=15610934 |doi=10.1016/j.pnpbp.2004.06.014}}</ref>
+
Studies have also been done that show [[nutrition]] deficiencies may contribute to OCD and other [[mental disorder]]s. Certain [[vitamin]] and [[mineral]] supplements may aid in the treatment of such disorders and provide the [[nutrients]] necessary for proper mental functioning.<ref>Shaheen E. Lakhan and Karen F. Vieira1, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248201/ Nutritional therapies for mental disorders] ''Nutr J.'' 7(2) (2008). Retrieved November 27, 2022. </ref>
  
===Psychosurgery===
+
===Spiritual approach===
 +
[[Buddhism|Buddhist]] teachings about mindfulness are finding their way into the mainstream treatments for OCD. In most mainstream discussions of psychiatric disorders, including OCD, the philosophical and spiritual dimensions of these conditions and the related treatment and care tend to be ignored.
  
For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo [[psychosurgery]] as a last resort. In this procedure, a surgical [[lesion]] is made in an area of the brain (the [[cingulate bundle]]). In one study, 30% of participants benefited significantly from this procedure.<ref name="Barlow" /> [[Deep-brain stimulation]] and [[vagus nerve stimulation]] are possible surgical options which do not require the destruction of [[brain tissue]], although their efficacy has not been conclusively demonstrated.
+
In ''Brain Lock'' by Jeffrey Schwartz and Beverly Beyette, in the article ''Buddhism, Behavior Change, and OCD'' by Tom Olsen that appeared in the ''Journal of Holistic Nursing'' (June 2003) and in the article ''Buddhism and Cognitive-Behavioral Therapy (CBT)'' by Dr. Paul Greene, Ph.D., the argument is made that sharing the philosophical and spiritual foundations of [[Buddhism]] are relevant to effective treatment.<ref>Tom Olson, [https://pubmed.ncbi.nlm.nih.gov/12794958/ Buddhism, Behavior Change, and OCD] ''J. Holist Nurs'' 21(2) (June 2003):149-162. Retrieved November 27, 2022.</ref>
  
===Transcranial magnetic stimulation===
+
==Extreme cases of OCD==
 +
===Psychosurgery and Transcranial magnetic stimulation===
 +
For some, neither medication, support groups nor psychological treatments are completely successful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo [[psychosurgery]] as a last resort. In this procedure, a surgical [[lesion]] is made in an area of the brain (the [[cingulate bundle]]). In one study, 30 percent of participants benefited significantly from this procedure.<ref>V. Mark Durand, David H. Barlow, and Stefan G. Hofmann, ''Essentials of Abnormal Psychology'' (Cengage Learning, 2018, ISBN 9781337619370).</ref> [[Deep-brain stimulation]] and [[vagus nerve stimulation]] are possible surgical options which do not require the destruction of [[brain tissue]], although their efficacy has not been conclusively demonstrated.
  
Though in its early stages of research, [[Transcranial magnetic stimulation]] (TMS) has shown promising results. The magnetic pulses are focused on the brain's [[supplementary motor area]] (SMA), which plays a role in filtering out extraneous internal stimuli, such as ruminations, obsessions, and tics. The TMS treatment is an attempt to normalize the SMA's activity, so that it properly filters out thoughts and behaviors associated with OCD. <ref>[http://www.clinicaltrials.gov/ct2/show/NCT00106249 Transcranial Magnetic Stimulation (TMS) and Obsessive Compulsive Disorder (OCD) - Full Text View - ClinicalTrials.gov<!-- Bot generated title —>]</ref><ref>[http://www.clinicaltrials.gov/ct2/show/NCT00396552 Treating Refractory Obsessive Compulsive Disorder With rTMS - Full Text View - ClinicalTrials.gov<!-- Bot generated title —>]</ref>
+
Though in its early stages of research, [[Transcranial magnetic stimulation]] (TMS) has shown promising results. The magnetic pulses are focused on the brain's [[supplementary motor area]] (SMA), which plays a role in filtering out extraneous internal stimuli, such as ruminations, obsessions, and tics. The TMS treatment is an attempt to normalize the SMA's activity, so that it properly filters out thoughts and behaviors associated with OCD.<ref>Antonio Mantovani, [https://www.clinicaltrials.gov/ct2/show/NCT00106249 Transcranial Magnetic Stimulation (TMS) and Obsessive Compulsive Disorder (OCD)] ''New York State Psychiatric Institute''. Retrieved November 27, 2022.</ref><ref>Margaret A. Richter, [https://www.clinicaltrials.gov/ct2/show/NCT00396552 Treating Refractory Obsessive Compulsive Disorder With rTMS] ''Centre for Addiction and Mental Health''. Retrieved November 27, 2022.</ref>
  
==Neuropsychiatry==
+
The anti-[[Alzheimer's disease|Alzheimer]]'s drug [[memantine]] is being studied by the [[OC Foundation]] in its efficacy in reducing OCD symptoms due to it being an [[NMDA antagonist]].
  
Pharmaceuticals that act directly on those core mechanisms are [[aprepitant]] (nk1 antagonist), [[riluzole]] (glutamate release inhibitor), and [[tautomycin]] (NMDA receptor sensitizer). Also, the anti-Alzheimer's drug [[memantine]] is being studied by the [[OC Foundation]] in its efficacy in reducing OCD symptoms due to it being an [[NMDA antagonist]]. One case study published in ''[[The American Journal of Psychiatry]]'' suggests that "memantine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation."<ref>{{cite journal |author=Poyurovsky M, Weizman R, Weizman A, Koran L |title=Memantine for treatment-resistant OCD |journal=The American journal of psychiatry |volume=162 |issue=11 |pages=2191-2 |year=2005 |pmid=16263867 |doi=10.1176/appi.ajp.162.11.2191-a |url=http://www.ajp.psychiatryonline.org/cgi/content/full/162/11/2191-a}}</ref> The drugs that are popularly used to fight OCD lack full efficacy because they do not act upon what are believed to be the core mechanisms.
 
 
==In popular culture==
 
==In popular culture==
As Good As It Gets Movie with Jack Nicholson
+
The 1997 movie, ''As Good As It Gets'' features a somewhat realistic portrayal by [[Jack Nicholson]] of a man who is diagnosed with OCD and displays some of its key features like fear of [[germ]]s, repetitive behavior, and an awareness of his unreasonableness.<ref>Birgit Wolz, [http://www.cinematherapy.com/birgitarticles/as-good-as-it-gets.html Diagnosis in Psychotherapy - Portrayed in a Movie] ''Cinematherapy.com''. Retrieved November 27, 2022.</ref> In the movie, he develops a relationship with a waitress, Carol, who is used to catering to some of his idiosyncrasies. It is through her that he comes to understand how his behavior impacts others.
 
 
==Research==
 
 
 
  
 +
In the 2004 movie ''The Aviator'', [[Leonardo DiCaprio]] as [[Howard Hughes]] addressed his struggles with OCD.
  
 
==Notes==
 
==Notes==
Line 167: Line 121:
  
 
==References==
 
==References==
*[http://familydoctor.org Health Informaton for the Whole Family] Retrieved January 3, 2009.
+
* Baer, Lee. ''The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts''. ISBN 0452283078
 
+
* Cooper, David A. ''The Art of Meditation''. Jaico Publishing House. ISBN 8179921646
==Further reading==
+
* Durand, V. Mark, David H. Barlow, and Stefan G. Hofmann. ''Essentials of Abnormal Psychology''. Cengage Learning, 2018. ISBN 9781337619370
* ''My Worktime Routine'', ISBN 1-59-113901-5, by David Vince.
+
* Grayson, Jonathan. ''Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty''. 2003. ISBN 1585422460
* ''Brain Lock: Free Yourself from Obsessive-Compulsive Behavior'', ISBN 0-06-098711-1, by Jeffrey M. Schwartz.
+
*Landsman, Karen J., Kathleen M. Rupertus, and Cherry Pedrick. ''Loving Someone with OCD: Help for You & Your Family.'' Oakland, CA: New Harbinger Publications, 2005. ISBN 978-1572243293
* ''Treatment of the Obsessive Personality'', ISBN 0-87668-881-4, by Leon Salzman
+
* Osborn, Ian. ''Tormenting Thoughts and Secret Rituals: The Hidden Epidemic of Obsessive-Compulsive Disorder''. ISBN 0440508479
* ''Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty'''' (2003), ISBN 1-58542-246-0, by Jonathan Grayson.
+
* Penzel, Fred. ''Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well''. 2000. ISBN 0195140923
* ''Just Another Day'', ISBN 1-59-113901-5, by Shadi Srour.
+
* Rachman, Stanley. ''The Treatment of Obsessions''. ISBN 0198515375
* ''The Treatment of Obsessions'', ISBN 0-19-851537-5, by Stanley Rachman.
+
* Salzman, Leon. ''Treatment of the Obsessive Personality''. ISBN 0876688814
* ''The Mind and the Brain: Neuroplasticity and the Power of Mental Force'', ISBN 0-06-098847-9, by Jeffrey M. Schwartz, Sharon Begley.
+
* Schwartz, Jeffrey M. ''Brain Lock: Free Yourself from Obsessive-Compulsive Behavior''. ISBN 0060987111
* ''The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts'', ISBN 0-452-28307-8, by Lee Baer.
+
* Schwartz, Jeffrey, Annie Gottlieb, and Patrick Buckley. ''A Return to Innocence: Philosophical Guidance in an Age of Cynicism.'' 1998. ISBN 0060392401
* ''Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well'' (2000), ISBN 0-19-514092-3, by Fred Penzel.
+
* Schwartz, Jeffrey M., and Sharon Begley. ''The Mind and the Brain: Neuroplasticity and the Power of Mental Force''. ISBN 0060988479
* ''What you can change... and what you can't'', ISBN 0-449-90971-9, by Martin E.P. Seligmann, chap. ''"obsessions"''
+
* Seligmann, Martin E.P. ''What you can change... and what you can't''. ISBN 0449909719
* ''Tormenting Thoughts and Secret Rituals: The Hidden Epidemic of Obsessive-Compulsive Disorder'', ISBN 0-440-50847-9, by Ian Osborn.
+
* Srour, Shadi. ''Just Another Day''. ISBN 1591139015
* ''The Art of Meditation'' ISBN 81-7992-164-6 by David A. Cooper, Jaico Publishing House
+
* Veale, David, and Rob Willson. ''Overcoming Obsessive Compulsive Disorder: A self-help guide using Cognitive Behavioral Techniques''. 2005. ISBN 1841199362
* '' Overcoming Obsessive Compulsive Disorder: A self-help guide using Cognitive Behavioural Techniques'' (2005) ISBN 1-84119-936-2 by David Veale and Rob Willson
 
 
 
==Notes==
 
{{reflist|2}}
 
 
 
==External Links==
 
  
{{Mental and behavioural disorders}}
+
==External links==
 +
All links retrieved November 17, 2022.
 +
*[https://www.columbiapsychiatry.org/research-clinics/center-ocd-and-related-disorders Center for OCD & Related Disorders] ''Columbia University Department of Psychiatry''
 +
*[https://iocdf.org/ International OCD Foundation]
 +
*[https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd Obsessive-Compulsive Disorder] ''National Institute of Mental Health''
 +
*[https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432 Obsessive-compulsive disorder (OCD)] ''Mayo Clinic''
 +
*[https://psychcentral.com/quizzes/ocd-quiz#1 Obsessive-Compulsive Disorder (OCD) Screening Quiz] ''PsychCentral''
 +
*[https://www.psycom.net/do-i-have-ocd-test Obsessive-Compulsive Disorder (OCD) Test & Self-Assessment] ''Psycom''
 +
*[https://www.psycom.net/obsessive-compulsive-disorder-ocd Obsessive-Compulsive Disorder (OCD)] A Guide to Signs, Symptoms, Causes, and Treatment, by Christina Gregory PhD.
 +
*[https://damorementalhealth.com/do-i-have-ocd/ Do I Have OCD? Quiz] ''D’Amore Mental Health''
 +
*[https://acerahealth.com/the-connection-between-ocd-and-anxiety/ The Connection Between OCD And Anxiety] ''Acera Health''
  
 
[[Category:Psychology]]
 
[[Category:Psychology]]
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[[Category:Health and disease]]
 
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Latest revision as of 16:09, 27 November 2022

Obsessive compulsive disorder
Classification and external resources
Obsessive-Compulsive Disorder.png
DiseasesDB = 33766
ICD-10 F42
ICD-9 300.3
eMedicine med/1654 
MeSH D009771

Obsessive-compulsive disorder (OCD) is a neurobiobehavioral mental disorder characterized by distressful, time-consuming thoughts (obsessions) followed by repeated behaviors (compulsions) undertaken in the (often sub-conscious) "belief" that they will lessen the stress and anxiety of the sufferer. While all of us have routines in our life that we undertake repeatedly, in the case of OCD the subject's obsessive, and intrusive thoughts and their accompanying related "tasks" or "rituals" interfere with the afflicted person being able to maintain a balanced or healthy lifestyle.

OCD is distinguished from other types of anxiety, including the routine tension and stress that appear throughout life by its excessiveness. However, a person who shows signs of fixation or displays traits such as perfectionism, does not necessarily have OCD, a specific and well-defined condition. As with other disorders there may be varying degrees of intensity and a proper diagnosis is warranted in order to match appropriate treatment to the person. While the cause of OCD is unknown, some studies suggest the possibility of brain lesions while others explore a more psychiatric analysis such as the impact of major depression, organic brain syndrome or schizophrenia.

Although there is no known cure recent developments in brain research, medications, and behavior therapy have all resulted in Obsessive Compulsive Disorder becoming a treatable condition.

Diagnosing and defining OCD

OCD has been defined as follows: "The essential features of OCD are recurrent obsessions or compulsions that are severe enough to be time consuming (that is they take more than one hour a day) or cause marked distress or significant impairment. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable" (American Psychiatric Association [APA] 2000 456-457).[1]

Obsessive–compulsive disorder (OCD) is classified as "Obsessive-Compulsive and Related Disorders" in the American Psychiatric Association (APA)'s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), although it was previously classified as an anxiety disorder in the DSM-IV.[2] Similarly, it was classified as an anxiety disorder in the World Health Organization (WHO)'s International Classification of Diseases (ICD-10), but not in ICD-11.[3]

Did you know?
Most people with OCD are well aware that their obsessions and compulsions are irrational

Obsessions are defined as recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. These thoughts, impulses, or images are not simply excessive worries about real-life problems, and the person in an attempt to ignore, suppress or neutralize the thoughts with some other action, perpetuates a cycle of obsessive/compulsive behavior. In most cases, the sufferer of OCD recognizes that the obsessional thoughts are a product of his or her own mind, and are not based in reality. In cases where the sufferer does not recognize that his thoughts are extreme an analysis of psychosis or "a break with reality" needs to be evaluated.

Compulsions are defined by repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors are aimed at preventing or reducing distress or preventing some dreaded event or situation from occurring; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

OCD, like some other disorders such as anorexia nervosa can be difficult to detect or diagnose if the sufferer keeps such thoughts and behaviors to him or herself, due to feelings of either shame and/or denial about their condition.

Prevalance

According to the National Institute of Mental Health (NIMH) OCD affects both men and women equally and some estimates say that as many as 3.3 million Americans ages 18 to 54, an estimated 2.3 percent of the population, may have OCD at any one time. If children were included in this figure it would increase to seven million. The onset of symptoms usually occurs between the ages of 20 and 30 with 75 percent of patients being diagnosed before the age of 30.[1] Although children may also suffer from OCD, they can go undiagnosed for a long period of time or may appear in conjunction with a constellation of symptoms such as Attention-deficit hyperactivity disorder (ADHD), dyslexia, or depression.

OCD and children

As the understanding of mental illness grows, along with better and more effective treatments, children can be diagnosed earlier, thus preventing future problems. A child psychiatrist or other qualified mental health professional usually diagnoses anxiety disorders and OCD in children or adolescents following a comprehensive psychiatric evaluation. Parents who note signs of severe anxiety or obsessive or compulsive behaviors in their child or teen can help by seeking an evaluation and early treatment.[4]

In order for a diagnosis of OCD to be made, the obsessions and compulsions must be pervasive, severe, and disruptive enough that the child or adolescent's daily routines are adversely affected. The average onset age for OCD in children is around 10.2 years of age. The disorder tends to develop earlier in boys than in girls and most often symptoms occur between ages nine and 13. Nearly half of all adults with OCD have had an onset in childhood, although they may have received help much later.[1]

Possible causes of OCD

The brain

Research into OCD focuses on the brain structure, circuitry, and neurochemical factors that may distinguish people with OCD from the general population. The area of the brain in question is the basal ganglia located in the center of the brain, where information that has entered from the outside world is sorted and unnecessary information is discarded. These areas also control impulsiveness. People with OCD can become overwhelmed with intrusive thoughts that they cannot easily disregard.

The orbital cortex located in the front of the brain and above the eyes is where we interpret information coming in from the senses and to which we apply moral and emotional judgment. Overstimulation in this area of the brain seems to keep people with OCD "on alert," causing an extra sense of unease.

The cingulate gyrus is also located in the center of the brain and alerts us to danger. This part of the brain also helps us to shift from one thought to another and it's possible that this area is what gives trouble to the OCD person who becomes a slave to his repeated behaviors. Through PET scan studies Dr. Jeffrey Schwartz and Dr. Lewis Baxter demonstrated that there was an increased energy use in this area of the brain with people who had OCD. Their studies and subsequent treatment breakthroughs with medication and cognitive behavioral therapy actually proved to decrease the overactivity in this area. This new research combined with technological advancements, such as brain imaging, prove a positive link between the disorder and the brain circuitry and demonstrates that people with OCD have slightly more hyperactivity in their brains that can be controlled successfully.

Chemical imbalance

The neurochemical imbalance that appears to be associated with OCD involves serotonin, an important neurotransmitter. A neurotransmitter is a chemical messenger that enables communication between nerve cells. Serotonin controls many biological processes including sleep, mood, aggression, appetite and even pain. Medications that increase the amount of serotonin for OCD sufferers appear to make a marked difference in their quality of life. Serotonin imbalance has been implicated in other afflictions, as well, such as self mutilation, eating disorders, and depression.

Strep connection

Some cases of OCD in children have been associated with streptococcal infections (called PANDAS or pediatric autoimmune neuropsychiatric disorder). Other autoimmune diseases have also been associated with OCD symptoms such as lupus, Sydenham's chorea, and rhuematic fever. These are more rare and OCD generally occurs without such a precipitating or traumatic event.

Genetic basis

Although the presence of a genetic link has not yet been definitely established it appears that either differences in specific genes or possibly several combinations of genes predispose a person to OCD. There appears to be more of a genetic link in childhood-onset OCD (Geller 1998), and there are findings of higher rates of OCD when Tourette's syndrome and/or tics is experienced by related family members (Alsobrok and Pauls 1998).[1]

OCD symptoms

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession-related anxiety. While obsessions are persistent thoughts compulsions are repetitive behaviors that are performed in response to them. To others, these tasks may appear odd and unnecessary, but for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and the build up of stress. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, or repeatedly washing hands at regular intervals throughout the day.

Obsessions and their related compulsions may include but are not limited to the following:

  • Fear of dirt or germs/repetitive washing and cleaning
  • Fear of disorder/arranging things in a certain way, over concern with symmetry (balance) and exactness
  • Worry that a task has been done poorly, even when the person knows this is not true/checking it over and over
  • Irrational fear of harm coming to them or a loved one/checking locks, household appliances, or on the safety of others, etc.
  • Fear of thinking evil or sinful thoughts/developing superstitious rituals
  • Recall and review of distressing situations/ thinking about certain sounds, images, words or numbers repeatedly
Frequent and excessive hand washing occurs in some people with OCD

There are many other possible symptoms, and it is not necessary to display those described in the list above to be considered as suffering from OCD.

Often the person with OCD will truly be uncertain whether the fears that cause him or her to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually delusional, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not. Since fear and doubt can feed the cycle of obsessive compulsive behavior the person will often seek continual reassurance.

OCD is different from behaviors such as addiction to gambling or overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is, likewise, not to be confused with Obsessive Compulsive Personality Disorder which is a separate syndrome.

OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical depression over time if the patient is not able to find the necessary supports and strategies for coping. OCD's effects on day-to-day life, particularly its substantial consumption of time, can produce difficulties with work, finances, and relationships.

Treatment

For years, people with OCD suffered in secret and even when their behaviors were brought into the open adequate treatment was unavailable. Today, with improvements in neuropsychiatric research OCD is quite treatable and those who suffer from it can live productive and normal lives.

What seems to be most effective is a combination of cognitive behavioral therapy (CBT), and medications, with medication being the first line of treatment until symptoms are under control, and a patient is feeling motivated to change the behavioral patterns that contribute to OCD. While medications provide immediate relief for OCD, behavioral therapy is long lasting and will teach strategies that can be implemented for a lifetime.

Medication

Antidepressants called serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are used to treat OCD. In addition to reducing the obsessive/compulsive urges they can also improve related depression which can work to contribute to a person's sense of well being and motivation towards getting well. Medications found to be effective include: clomipramine (brand name: Anafranil), fluoxetine (brand name: Prozac), sertraline (brand name: Zoloft), paroxetine (brand name: Paxil) and fluvoxamine (brand name: Luvox). A newer mediaction that has found success is Lexapro.[5] Other medications such as riluzole, memantine, gabapentin (Neurontin), lamotrigine (Lamictal), and low doses of the newer atypical antipsychotics olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) have also been found to be useful as adjuncts in the treatment of OCD. However, the use of antipsychotics in treating OCD must be undertaken carefully.[1]

Cognitive Behavioral Therapy

At the core of Cognitive Behavioral Therapy is the belief that changing the way a person thinks can change the way they feel. Cognitive therapy focuses not only on thoughts that contribute to depression and anxiety, but also on beliefs that serve the same function. The difference between thoughts and beliefs is that thoughts are events in time lasting only for a moment, whereas beliefs are more stable and long-lasting.

The cornerstone of the specific cognitive behavioral therapy that has proven to be effective in treating OCD is a technique called exposure and ritual prevention (also known as exposure and response prevention). Exposure and Response Prevention involves deliberate exposure to anxiety producing situations for the OCD patient who responds without performing his usual rituals. Cognitive therapy alone refers to the learning of strategies that help change distorted thinking and faulty belief systems. Cognitive techniques help people analyze how they respond to situations and how they could react more positively. There are workbooks designed for the OCD patient that can help support cognitive behavioral strategies and also give suggestions for ways that the family can provide support. It is important to distinguish that supporting someone's irrational fear and response to OCD is different than supporting the patient in letting go of inappropriate responses. Cognitive therapy without medication may be appropriate for those with mild to moderate OCD.

"Natural" cures

The naturally occurring sugar inositol may be an effective treatment for OCD. Inositol appears to modulate the actions of serotonin and has been found to reverse desensitization of the neurotransmitter's receptors.[6]

St. John's Wort has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities, and studies have emerged that have shown positive results. However, a double-blind study, using a flexible-dose schedule (600-1800 mg/day), found no difference between St. John's Wort and the placebo.[7]

Studies have also been done that show nutrition deficiencies may contribute to OCD and other mental disorders. Certain vitamin and mineral supplements may aid in the treatment of such disorders and provide the nutrients necessary for proper mental functioning.[8]

Spiritual approach

Buddhist teachings about mindfulness are finding their way into the mainstream treatments for OCD. In most mainstream discussions of psychiatric disorders, including OCD, the philosophical and spiritual dimensions of these conditions and the related treatment and care tend to be ignored.

In Brain Lock by Jeffrey Schwartz and Beverly Beyette, in the article Buddhism, Behavior Change, and OCD by Tom Olsen that appeared in the Journal of Holistic Nursing (June 2003) and in the article Buddhism and Cognitive-Behavioral Therapy (CBT) by Dr. Paul Greene, Ph.D., the argument is made that sharing the philosophical and spiritual foundations of Buddhism are relevant to effective treatment.[9]

Extreme cases of OCD

Psychosurgery and Transcranial magnetic stimulation

For some, neither medication, support groups nor psychological treatments are completely successful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. In this procedure, a surgical lesion is made in an area of the brain (the cingulate bundle). In one study, 30 percent of participants benefited significantly from this procedure.[10] Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue, although their efficacy has not been conclusively demonstrated.

Though in its early stages of research, Transcranial magnetic stimulation (TMS) has shown promising results. The magnetic pulses are focused on the brain's supplementary motor area (SMA), which plays a role in filtering out extraneous internal stimuli, such as ruminations, obsessions, and tics. The TMS treatment is an attempt to normalize the SMA's activity, so that it properly filters out thoughts and behaviors associated with OCD.[11][12]

The anti-Alzheimer's drug memantine is being studied by the OC Foundation in its efficacy in reducing OCD symptoms due to it being an NMDA antagonist.

In popular culture

The 1997 movie, As Good As It Gets features a somewhat realistic portrayal by Jack Nicholson of a man who is diagnosed with OCD and displays some of its key features like fear of germs, repetitive behavior, and an awareness of his unreasonableness.[13] In the movie, he develops a relationship with a waitress, Carol, who is used to catering to some of his idiosyncrasies. It is through her that he comes to understand how his behavior impacts others.

In the 2004 movie The Aviator, Leonardo DiCaprio as Howard Hughes addressed his struggles with OCD.

Notes

  1. 1.0 1.1 1.2 1.3 1.4 Karen Landsman, Kathleen M. Rupertus, and Cherry Pedrick, Loving Someone with OCD (New Harbinger Publications, 2005, ISBN 978-1572243293).
  2. DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison National Library of Medicine, 2016. Retrieved November 17, 2022.
  3. Anna Marras, Naomi Fineberg, and Stefano Pallanti, Obsessive compulsive and related disorders: comparing DSM-5 and ICD-11 CNS Spectr 21(4) (2016):324-333. Retrieved November 17, 2022.
  4. Obsessive-Compulsive Disorder in Children Centers for Disease Control and Prevention. Retrieved November 27, 2022.
  5. Obsessive-Compulsive Disorder National Institute of Mental Health. Retrieved November 27, 2022.
  6. J. Levine, Controlled trials of inositol in psychiatry Eur Neuropsychopharmacol 7(2) (May 1997): 147-155. Retrieved November 27, 2022.
  7. Kenneth A. Kobak, et al, St. John's wort versus placebo in obsessive-compulsive disorder: results from a double-blind study Int Clin Psychopharmacol 20(6) (November 2005):299-304. Retrieved November 27, 2022.
  8. Shaheen E. Lakhan and Karen F. Vieira1, Nutritional therapies for mental disorders Nutr J. 7(2) (2008). Retrieved November 27, 2022.
  9. Tom Olson, Buddhism, Behavior Change, and OCD J. Holist Nurs 21(2) (June 2003):149-162. Retrieved November 27, 2022.
  10. V. Mark Durand, David H. Barlow, and Stefan G. Hofmann, Essentials of Abnormal Psychology (Cengage Learning, 2018, ISBN 9781337619370).
  11. Antonio Mantovani, Transcranial Magnetic Stimulation (TMS) and Obsessive Compulsive Disorder (OCD) New York State Psychiatric Institute. Retrieved November 27, 2022.
  12. Margaret A. Richter, Treating Refractory Obsessive Compulsive Disorder With rTMS Centre for Addiction and Mental Health. Retrieved November 27, 2022.
  13. Birgit Wolz, Diagnosis in Psychotherapy - Portrayed in a Movie Cinematherapy.com. Retrieved November 27, 2022.

References
ISBN links support NWE through referral fees

  • Baer, Lee. The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts. ISBN 0452283078
  • Cooper, David A. The Art of Meditation. Jaico Publishing House. ISBN 8179921646
  • Durand, V. Mark, David H. Barlow, and Stefan G. Hofmann. Essentials of Abnormal Psychology. Cengage Learning, 2018. ISBN 9781337619370
  • Grayson, Jonathan. Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty. 2003. ISBN 1585422460
  • Landsman, Karen J., Kathleen M. Rupertus, and Cherry Pedrick. Loving Someone with OCD: Help for You & Your Family. Oakland, CA: New Harbinger Publications, 2005. ISBN 978-1572243293
  • Osborn, Ian. Tormenting Thoughts and Secret Rituals: The Hidden Epidemic of Obsessive-Compulsive Disorder. ISBN 0440508479
  • Penzel, Fred. Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well. 2000. ISBN 0195140923
  • Rachman, Stanley. The Treatment of Obsessions. ISBN 0198515375
  • Salzman, Leon. Treatment of the Obsessive Personality. ISBN 0876688814
  • Schwartz, Jeffrey M. Brain Lock: Free Yourself from Obsessive-Compulsive Behavior. ISBN 0060987111
  • Schwartz, Jeffrey, Annie Gottlieb, and Patrick Buckley. A Return to Innocence: Philosophical Guidance in an Age of Cynicism. 1998. ISBN 0060392401
  • Schwartz, Jeffrey M., and Sharon Begley. The Mind and the Brain: Neuroplasticity and the Power of Mental Force. ISBN 0060988479
  • Seligmann, Martin E.P. What you can change... and what you can't. ISBN 0449909719
  • Srour, Shadi. Just Another Day. ISBN 1591139015
  • Veale, David, and Rob Willson. Overcoming Obsessive Compulsive Disorder: A self-help guide using Cognitive Behavioral Techniques. 2005. ISBN 1841199362

External links

All links retrieved November 17, 2022.

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