Obsessive-Compulsive
Disorder is a mental illness in which
a person experiences recurrent, intrusive thoughts (obsessions)
and
feels compelled to perform certain behaviors (compulsions) again
and
again. Most people have experienced bizarre or inappropriate thoughts
and have
engaged in repetitive behaviors at times. However, people with
obsessive-compulsive disorder find that their disturbing thoughts and
behaviors
consume large amounts of time, cause them anxiety and distress, and
interfere
with their ability to function at work and in social activities. Most
people
with this disorder recognize that their obsessions and compulsions are
irrational but cannot suppress them.
Obsessive-compulsive disorder
usually begins in adolescence
or early adulthood. It affects from 1.5 to 2 percent of people in the
United
States. The disorder affects slightly more women than men.
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SYMPTOMS
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Obsessions can include
a variety of thoughts, images,
and impulses. Common obsessions include fears of contamination from
germs,
doubts about whether doors are locked or appliances are turned off,
nonsensical
impulses such as shouting in public, sexual thoughts that are disturbing
to the
individual, and thoughts of accidentally and unknowingly harming
someone.
People with obsessions may avoid shaking hands with other people because
they
fear contamination, or they may avoid driving because they fear they
will
injure someone in a traffic accident.
People usually perform
compulsions to relieve the
anxiety produced by their obsessions, although not all people with
obsessions
perform compulsions. The most common compulsions involve cleaning
rituals and
checking rituals. For example, people with obsessions about germs may
wash
their hands dozens of times each day until their skin becomes raw.
People with
obsessions about neatness and symmetry may constantly rearrange or
straighten
objects on their desk. People with checking compulsions must repeatedly
check to
make sure they locked doors and windows or turned off water faucets.
Other
compulsions include counting objects, hoarding vast amounts of useless
materials, and repeating words or prayers internally.
Obsessive-compulsive disorder
can have disabling effects on
people’s lives. People with severe cases of this disorder may need
hospitalization to help treat the compulsions. In less extreme
instances,
individuals with compulsions often must allow a great deal of extra time
to
complete seemingly routine tasks, such as preparing to leave the house
in the
morning. Individuals may avoid going to certain places or engaging in
certain
activities because they feel embarrassed about their behavior.
In addition, family members
of someone with this
disorder may feel angry at the person because the compulsive behaviors
intrude
on their time together or interfere with the family’s functioning. For
instance, some individuals hoard things, such as newspapers or
magazines,
because they believe they may someday need certain pieces of
information. The
piles of newspapers may cover the living areas and make other family
members
feel embarrassed to have guests in the home.
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CAUSES
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Like many mental illnesses,
obsessive-compulsive
disorder appears to result from a combination of biological and
psychological
influences. Some people may have a biological predisposition to
experience
anxiety. Research also suggests that abnormal levels of the
neurotransmitter
serotonin may play a role in obsessive-compulsive disorder. Brain scans
of
people with obsessive-compulsive disorder have revealed abnormalities in
the
activity level of the orbital cortex, cingulate cortex, and caudate
nucleus, a
brain circuit that helps control movements of the limbs.
The disorder may develop
when these biological
influences combine with a psychological vulnerability to anxiety. Some
people
may develop a psychological vulnerability to anxiety in childhood. They
may
come to believe that the world is a potentially dangerous place over
which one
has little control. People seem to develop obsessive-compulsive disorder
specifically when they learn that some thoughts are dangerous or
unacceptable
and, while attempting to suppress these thoughts, develop anxiety about
the
recurrence of the thoughts and about the perceived dangerousness and
intrusiveness of the thoughts.
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TREATMENT
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Treatment for obsessive-compulsive
disorder includes
psychotherapy, psychoactive drugs, or both. Mental health professionals
consider exposure and response prevention, a type of
cognitive-behavioral therapy, to be the most effective form of
psychotherapy
for this disorder. In this technique, the therapist exposes the patient
to
feared thoughts or situations and prevents the patient from acting on
his or
her compulsion. For example, a therapist might have patients with
cleaning
compulsions touch something dirty and then prevent them from washing
their
hands. This technique helps 60 to 70 percent of people with
obsessive-compulsive disorder.
Medications to treat obsessive-compulsive
disorder
include selective serotonin reuptake inhibitors, such as fluoxetine
(Prozac)
and fluvoxamine (Luvox). A tricyclic antidepressant, clomipramine
(Anafranil),
also helps relieve symptoms of the disorder. About 80 percent of people
with
the disorder show some improvement with a combined treatment of
medication and
behavioral therapy. However, many patients relapse when they stop taking
the
medication.
