Obsessive-Compulsive Disorder

The Disease of Doubt

What is Obsessive Compulsive Disorder (OCD)?

OCD is characterized by both obsessions and compulsions. Obsessions are intrusive and unwanted thoughts, images, or impulses. Obsessions can be extremely distressing and unwanted, and are often embarrassing and do not make sense. Patients often recognize that these thoughts are not congruent with their normal self. See Elizabeth talk about intrusive and chronic OCD thoughts. Generally, obsessions are followed by a compulsion. Compulsions are behaviors (either physical or mental) used to decrease distress and anxiety. Usually this is the more identifiable aspect of OCD.

The phrase "obsessive-compulsive" has worked its way into the wider English lexicon, and is often used in an offhand manner to describe someone who is meticulous or absorbed in a cause (see "anal retentive"). It is also important to distinguish OCD from other types of anxiety, including the routine tension and stress that appear throughout life. Although these signs are often present in OCD, a person who shows signs of infatuation or fixation with a subject/object, or displays traits such as perfectionism, does not necessarily have OCD, a specific and well-defined condition. See Dr. Blair Simpson's interview, where she addresses this as well as other false impressions of OCD.

What does OCD look like?

OCD presents itself in many different ways. See a full list of OCD symptoms on the Yale-Brown Obsessive Compulsive Scale (YBOCS).

Common obsessions include imagining having harmed other people, having intrusive, unwanted sexual thoughts, and fears of contamination. Others may fear losing control or succumbing to violent urges, have excessive religious or moral doubts, fear forbidden thoughts, or may have a need to have things "just so". People with OCD may spend hours each day performing behavioral or mental rituals to temporarily quell their anxiety. Most people with OCD recognize that their fears are irrational, yet still feel unable to resist the obsessions and compulsions.

• Cleaning/washing
• Taboo/Unacceptable thoughts
• Ordering/arranging
• Doubt/checking
• Hoarding

See our collegue Dr. David Tolin talk about hoarding.

Who is affected by OCD?

Anyone can have OCD, ranging from children and adolescents, to adults. OCD usually begins in adolescence or early adulthood, it may begin in childhood. The majority of individuals have a chronic waxing and waning course, with exacerbation of symptoms that may be related to stress. Men are twice as likely to have OCD, and symptoms generally develop in childhood or adolescents. People can struggle with symptoms for years (on average 10 years) before actually seeking treatment. OCD can be scary and frustrating for its sufferers, family members, and friends.

Barbara Walters presents Elizabeth's case of OCD on Good Morning America. Also, celebrity game show host, Howie Mandel, talks with David Letterman about his struggle with OCD.

Is there treatment for OCD?

Symptoms are often not recognized or are misdiagnosed by doctors as OCD. Fortunately, there are two effective treatments for OCD: medication and therapy.

Medication for OCD

The main medications for OCD are selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that block the re-absorption of serotonin in the brain. Although SSRIs are commonly given for depression, research has shown they can also be effective for the treatment of anxiety. Common side effects may include: headaches, nausea, sexual dysfunction, and diarrhea among others. The most commonly prescribed SSRIs for OCD are:

• SSRIs:
  • Paxil (paroxetine)
  • Luvox (fluvoxamine)
  • Prozac (fluoxetine)
  • Zoloft (sertraline)
  • Lexapro (escitalopram)
  • Celexa (citralopram)
• SRI:
  • Anafranil (clomipramine)

There is some evidence that anafranil may be slightly more effective in treating OCD, however it also tends to have more side effects, thus the trend toward prescribing newer generation SSRIs. Unfortunately, most people only find partial relief of their OCD symptoms from these medications, highlighting the importance of effective therapy strategies. We're currently doing a research study to help adults who are still having OCD symptoms despite taking one of these SRI medications. Read more about our OCD study.

See our collaborator, Dr. Helen Blair Simpson, a psychiatrist at Columbia University, talk about treatments for OCD. Additionally, Dr. Simpson was interviewed by Psychiatric News, in which she talks about the effectiveness of medication and cognitive behavior therapy for OCD

Therapy for OCD

Cognitive-behavior therapy (CBT) is a type of psychotherapy that has been shown to be highly effective for OCD. The goal of CBT is two-fold: to change thoughts and behaviors. The cognitive portion involves the identification and analysis of unhelpful and unrealistic thoughts, which are then challenged. In the behavioral portion, the therapist and client work together to change the compulsive behaviors. This typically includes techniques such as Exposure and Response Prevention, also called Exposure and Ritual Prevention (EX/RP). In the exposure piece of the treatment, patients repeatedly expose themselves to their fears. By facing their obsessions in a systematic order, without performing compulsions, the person learns that there is nothing to fear and the obsessions begin to fade away. Here is a news broadcast about EX/RP, presented by a spokesperson from the Obsessive Compulsive Foundation (OCF). Elizabeth talks about EX/RP and her experience with the treatment. Also, you can see the case of Gail, who has severe contamination based OCD. She works with a therapist to do EX/RP.

Dr. Edna Foa, director of the Center for the Treatment and Study of Anxiety, provides a self-help version of EX/RP in her book Stop Obsessing! How to Overcome your Obsessions and Compulsions.