Obsessive-Compulsive Disorders (OCD)

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a condition in which a person has obsessions and/or compulsions that cause significant distress or impairment in social, occupational, or other important areas of functioning. The obsessions or compulsions are time-consuming, occupying more than 1 hour of attention per day. The obsessive-compulsive symptoms are not attributable to the effects of a substance (drug of abuse or medication) or another mental disorder or medical condition.

Epidemiology

  • OCD has a lifetime prevalence in the general population of 1 to 3 percent. Some researchers have estimated that the disorder is found in as many as 10 percent of outpatients in psychiatric clinics.
  • OCD is the fourth most common psychiatric diagnosis after phobias, substance-related disorders, and major depressive disorder.
  • Men and women are equally affected with a slight trend toward women in some studies. Among adolescents, however, boys are more common affected than girls.
  • The mean age of onset is about 20 years. However, the onset of OCD can occur in adolescence or childhood, in some cases as early as 2 years of age.
  • Single people are more frequently affected with OCD than married people.
  • OCD occurs less often among blacks than among whites, although access to healthcare may explain the variation.

Comorbidity

  • Individuals with OCD are commonly affected by other mental disorders.
  • The lifetime prevalence for major depressive disorder in persons with OCD is about 67 percent and for social phobia about 25 percent.
  • Other common comorbid psychiatric diagnoses in patients with OCD include alcohol use disorder, generalized anxiety disorder, specific phobia, panic disorder, eating disorders, and personality disorders.
What are obsessions?

Obsessions are recurrent and persistent thoughts, urges or images that are experienced as intrusive and unwanted, causing most individuals to feel anxiety or distress. An individual who has obsessions will try to ignore or suppress the thoughts, urges or images, or to neutralize them with some other thought or action, including a compulsive act.

What are compulsions?

Compulsions are repetitive behaviors that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The behaviors or thoughts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation. However, the behaviors or thoughts are not connected in a realistic way to what they are designed to neutralize or prevent, or are clearly excessive. Examples of compulsions include hand washing, checking things, praying, counting, repeating words silently.

Is Obsessive-Compulsive Disorder (OCD) Genetic?

Genetic studies indicate that relatives of persons with OCD have a threefold to fivefold higher probability of having OCD or obsessive-compulsive features. Studies of twins have consistently found a much higher rate of OCD among both identical twins than among both fraternal twins. However, it’s not yet clear if the higher probability of OCD among relatives is always due to genetics versusthe influence of cultural and behavioral factors.

What are the most common types of Obsessive-Compulsive Disorder (OCD)?

The most common pattern of OCD is an obsession of contamination, followed by washing or accompanied by compulsive avoidance of the presumably contaminated object. Patients may literally rub the skin off their hands by excessive hand washing or may be unable to leave their home due to fear of germs.

The second most common pattern in OCD is obsession of doubt, followed by a compulsion of checking. The obsession often implies some danger of violence, such as forgetting to turn off the stove or not locking a door. The checking may involve multiple trips back into the house to check the stove, for example.

The third most common pattern of OCD involves intrusive obsession thoughts without a compulsion. Such obsessions are usually repetitious thoughts of a sexual or aggressive act that is reprehensible to the patient. Patients obsessed with thoughts of aggressive or sexual acts may report themselves to police or confess to a priest.

The fourth most common pattern of OCD is the need for symmetry or precision, which can lead to a compulsion of slowness. For example, individuals with this form of OCD can take hours to eat a meal or shave their faces.

What is Body Dysmorphic Disorder?

Body dysmorphic disorder is a preoccupation that a person has with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. The individual also performs repetitive behaviors, such as excessive grooming, mirror checking or reassurance seeking, or mental acts, such as appearing one’s appearance to others, in response to the concern.

The preoccupation causes significant distress or impairment in social, occupational, or other important areas of functioning. The preoccupation with one’s appearance is not better explained by symptoms of an eating disorder. The diagnosis will include” muscle dysmorphia” if the individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular.

What is a Hoarding Disorder?

A hoarding disorder is defined as a persistent difficult discarding or parting with possessions, regardless of their actual value. The difficulty is due to a perceived need to save the items, resulting in the accumulation of possessions that congest and clutter active living areas. The hoarding causes significant distress or impairment in social, occupational, or other important areas of functioning, including maintaining a safe environment for one’s self and others. The hoarding is not better explained by the symptoms of another mental disorder or medical condition.

What is Trichotillomania (Hair-Pulling Disorder)?

Trichotillomania, or hair-pulling disorder, is recurrent pulling out of one’s hair, resulting in hair loss. The hair pulling causes significant distress or impairment in social, occupational, or other important areas of functioning. The hair pulling or hair loss is not attributable to another medical issue, such as a dermatological condition, or another mental disorder.

What is Excoriation (Skin-Picking) Disorder?

Excoriation is recurrent skin picking, resulting in skin lesions. The skin picking causes significant distress or impairment in social, occupational, or other important areas of functioning. The skin picking is not attributable to the effects of a substance (e.g., cocaine), another medical condition (e.g., scabies), or another mental disorder.

What is Substance/Medication Induced Obsessive Compulsive Disorder or Related Disorder?

A substance/medication-induced obsessive-compulsive disorder or related disorder is:

  •  Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and related disorders.
  •  Symptoms occur during or soon after substance intoxication or withdrawal, or after exposure to a medication.
  •  The involved substance/medication is capable of producing the obsessive-compulsive symptoms.
  •  The condition causes significant distress or impairment in social, occupational, or other important areas of functioning.
  •  Diagnoses may specify amphetamine, cocaine, or other known or unknown substance.
Can Obsessive-Compulsive and Related Disorders Be Caused by Another Medical Condition?

Yes. Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other body-focused repetitive behaviors can be caused by other medical conditions, such as a stroke or brain injury.

Can a Person Be Diagnosed with a Type of Obsessive-Compulsive or Related Disorder without Having All the Symptoms?

Yes. Other types of obsessive-compulsive and related disorders that do not include all the typical symptoms include:

  •  Body dysmorphic-like disorder with actual flaws. This issimilarto body dysmorphic disorder except that the defects or flaws in physical appearance are clearly observable by others. In such cases the preoccupation with these flaws is excessive and causes significant distress or impairment.
  • Body dysmorphic-like disorder without repetitive behaviors. Symptoms are similar to body dysmorphic disorder except that the individuals does not perform repetitive behaviors or mental acts in response to the appearance concerns.
  •  Body-focused repetitive behavior disorder. This is characterized by recurrent body-focused repetitive behaviors (e.g., nail biting, lip biting, cheek chewing) and repeated attempts to decrease or stop the behaviors. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning, and are not better explained by another mental disorder or non-suicidal self-injury.
  •  Obsessional jealousy. This is characterized by non-delusional preoccupation with a partner’s perceived infidelity. The preoccupation may lead to repetitive behaviors or mental acts in response to the infidelity concerns. The condition causes significant distress or impairment in social, occupational, or other important areas of functioning, and is not better explained by another mental disorder, such as delusional disorder, jealous type, or paranoid personality disorder.
  •  Shubo-kyofu. A Japanese culture-specific syndrome that is similar to body dysmorphic disorder and is characterized by excessive fear of having a bodily deformity.
  •  Koro syndrome. An episode of sudden and intense anxiety that the penis (or the vulva and nipples in females) will recede into the body, possibly leading to death.
  •  Jikoshu-kyofu. A Japanese culture-specific syndrome characterized by fear of having an offensive body odor, body function or appearance.
Can Other Medical Conditions, such as Tourette syndrome, Be Confused with Obsessive Compulsive Disorder (OCD)?

Yes. OCD is closely related to Tourette syndrome, and the two conditions often occur together. Tourette syndrome is a disorder that involves repetitive movements of unwanted sounds (tics) that cannot be easily controlled. About 90 percent of people with Tourette syndrome have compulsive symptoms and as many as two-thirds meet the diagnostic criteria for OCD. Besides Tourette syndrome, psychosis often leads to obsessive thoughts and compulsive behaviors that can be difficult to distinguish from OCD. In addition, OCD can be difficult to differentiate from depression because the two disorders often occur together, and major depression is often associated with obsessive thoughts. About one-third of patients with OCD have major depressive disorder.

What are treatments for Obsessive Compulsive Disorder (OCD)?

Studies have found that pharmacotherapy, behavior therapy, or a combination of both is effective is significantly reducing the symptoms of patients with OCD.

The standard medication approach is to start with an SSRI or clomipramine and then move to other drug strategies if the serotonin-specific drugs are not effective. If treatment with clomipramine or an SSRI is unsuccessful, many therapists add valproate (Depakene), lithium (Eskalith), or carbamazepine (Tegretol). Other drugs that can be tried in the treatment of OCD are venlafaxine (Effexor), pindolol (Visken) and the monoamine oxidase inhibitors (MAOIs), especially phenelzine (Nardil). Other treatments for unresponsive patients include buspirone (BuSpar), 5-hydroxytrptamine (5-HT), L-triptophan, and clonazepam (Klonopin).

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Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Disclaimer:
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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