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Obsessive-compulsive disorder (OCD) is a type of anxiety disorder in which you have unreasonable thoughts and fears (obsessions) that lead you to engage in repetitive behaviors (compulsions). With obsessive-compulsive disorder, you may realize that your obsessions aren't reasonable, and you may try to ignore them or stop them. But that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts in an effort to ease your distress. Obsessive-compulsive disorder often centers around themes, such as a fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they're sore and chapped. Despite your efforts, the distressing thoughts of obsessive-compulsive disorder keep coming back. This leads to more ritualistic behavior — and a vicious cycle that's characteristic of obsessive-compulsive disorder.

Complications of Obsessive Compulsive Disorder

Complications that obsessive-compulsive disorder may cause or be associated with include:

  • Suicidal thoughts and behavior
  • Alcohol or substance abuse
  • Other anxiety disorders
  • Depression
  • Eating disorders
  • Contact dermatitis from frequent hand washing
  • Inability to attend work or school
  • Troubled relationships
  • Overall poor quality of life

Causes of Obsessive Compulsive Disorder

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

  • Biology. Some evidence shows that OCD may be a result of changes in your body's own natural chemistry or brain functions. Some evidence also shows that OCD may have a genetic component, but specific genes have yet to be identified.
  • Environment. Some researchers believe that OCD stems from behavior-related habits that you learned over time.
  • Insufficient serotonin. An insufficient level of serotonin, one of your brain's chemical messengers, may contribute to obsessive-compulsive disorder. Some studies that compare images of the brains of people who have obsessive-compulsive disorder with the brains of those who don't show differences in brain activity patterns. In addition, people with obsessive-compulsive disorder who take medications that enhance the action of serotonin often have fewer OCD symptoms.
  • Strep throat. Some studies suggest that some children develop OCD after infection with group A beta-hemolytic streptococcal pharyngitis — strep throat. However, these studies are controversial and more evidence is needed before strep throat can be blamed.

Signs & Symptoms of Obsessive Compulsive Disorder

Obsessive-compulsive disorder symptoms include both obsessions and compulsions.

OCD obsession symptoms

OCD obsessions are repeated, persistent and unwanted ideas, thoughts, images or impulses that you have involuntarily and that seem to make no sense. These obsessions typically intrude when you're trying to think of or do other things.

Obsessions often have themes to them, such as:

  • Fear of contamination or dirt
  • Having things orderly and symmetrical
  • Aggressive or horrific impulses
  • Sexual images or thoughts

OCD symptoms involving obsessions may include:

  • Fear of being contaminated by shaking hands or by touching objects others have touched
  • Doubts that you've locked the door or turned off the stove
  • Thoughts that you've hurt someone in a traffic accident
  • Intense distress when objects aren't orderly or facing the right way
  • Images of hurting your child
  • Impulses to shout obscenities in inappropriate situations
  • Avoidance of situations that can trigger obsessions, such as shaking hands
  • Replaying pornographic images in your mind
  • Dermatitis because of frequent hand washing
  • Skin lesions because of picking at your skin
  • Hair loss or bald spots because of hair pulling

OCD compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors are meant to prevent or reduce anxiety or distress related to your obsessions. For instance, if you believe you ran over someone in your car, you may return to the apparent scene over and over because you just can't shake your doubts. You may also make up rules or rituals to follow that help control the anxiety you feel when having obsessive thoughts.

As with OCD obsessions, compulsions typically have themes, such as:

  • Washing and cleaning
  • Counting
  • Checking
  • Demanding reassurances
  • Performing the same action repeatedly
  • Orderliness

OCD symptoms involving compulsions may include:

  • Hand washing until your skin becomes raw
  • Checking doors repeatedly to make sure they're locked
  • Checking the stove repeatedly to make sure it's off
  • Counting in certain patterns
  • Making sure all your canned goods face the same way

Diagnosis of Obsessive Compulsive Disorder

If your doctor or mental health provider believes you may have obsessive-compulsive disorder, he or she typically runs a series of medical and psychological tests and exams. These can help pinpoint a diagnosis, rule out other problems that could be causing your symptoms and check for any related complications.

These exams and tests generally include:

  • Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
  • Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
  • Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide, self-harm or harming others. Your doctor may also want to talk to family or friends, if possible.

Treatments of Obsessive Compulsive Disorder

Obsessive-compulsive disorder treatment can be difficult, and it may not offer a cure. You may need treatment for the rest of your life. However, OCD treatment can help you bring symptoms under control so that they don't rule your daily life.

Main obsessive-compulsive disorder treatments

The two main treatments for obsessive-compulsive disorder are:

  • Psychotherapy
  • Medications

Which option is best for you depend on your personal situation and preferences. Often, treatment is most effective with a combination of medications and psychotherapy.

Psychotherapy for obsessive-compulsive disorder

A type of therapy called cognitive behavioral therapy (CBT) has been shown to be the most effective form of therapy for OCD in both children and adults. Cognitive behavioral therapy involves retraining your thought patterns and routines so that compulsive behaviors are no longer necessary. One CBT approach in particular is called exposure and response prevention. This therapy involves gradually exposing you to a feared object or obsession, such as dirt, and teaching you healthy ways to cope with your anxiety. Learning the techniques and new thought patterns takes effort and practice. But you may enjoy a better quality of life once you learn to manage your obsessions and compulsions. Therapy may take place in individual, family or group sessions.

Medications for obsessive-compulsive disorder

Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first. Antidepressants may be helpful for OCD because they may help increase levels of serotonin, which may be lacking when you have OCD. Antidepressants that have been specifically approved by the Food and Drug Administration to treat OCD include:

  • Clomipramine (Anafranil)
  • Fluvoxamine
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

However, many other antidepressants and other psychiatric medications on the market may also be used to treat OCD off-label. Off-label use is a common and legal practice of using a medication to treat a condition or age group not specifically listed on its prescribing label as an FDA-approved use.

Choosing a medication

In general, the goal of OCD treatment with medications is to effectively control signs and symptoms at the lowest possible dosage. Which medication is best for you depend on your own individual situation. It can take several weeks after first starting a medication to notice an improvement in your symptoms. With obsessive-compulsive disorder, it's not unusual to have to try several medications before finding one that works well to control your symptoms. Your doctor also might recommend combining medications, such as antidepressants and antipsychotic medications, to make them more effective in controlling your symptoms. Don't stop taking your medication without talking to your doctor, even if you're feeling better. You may have a relapse of OCD symptoms if you stop taking your medication. Also, some medication needs to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms.

Medication side effects and risks

All psychiatric medications have side effects and possible health risks. Be sure to talk to your doctor about all of the possible side effects and about any health monitoring that's necessary while taking psychiatric medications, especially antipsychotic medications. Some medications can have dangerous interactions with other medications, foods or other substances. Tell your doctors about all medications and over-the-counter substances you take, including vitamins, minerals and herbal supplements.

Other treatment options

Sometimes, medications and psychotherapy aren't effective enough in controlling your OCD symptoms. In rare cases, other treatment options may include:

  • Psychiatric hospitalization
  • Residential treatment
  • Electroconvulsive therapy (ECT)
  • Transcranial magnetic stimulation
  • Deep brain stimulation

Because these treatments haven't been thoroughly tested for use in obsessive-compulsive disorder, make sure you understand all the pros and cons and possible health risks.

Prevention of Obsessive Compulsive Disorder

There's no sure way to prevent obsessive-compulsive disorder. However, getting treatment as soon as possible may help prevent OCD from worsening.

When to seek Medical Advice

  • There's a difference between being a perfectionist and having obsessive-compulsive disorder. Perhaps you keep the floors in your house so clean that you could eat off them. Or you like your knickknacks arranged just so. That doesn't necessarily mean that you have obsessive-compulsive disorder.
  • Obsessive-compulsive disorder can be so severe and time-consuming that it literally becomes disabling. You may be able to do little else but spend time on your obsessions and compulsions — washing your hands for hours each day, for instance. With OCD, you may have a low quality of life because the condition rules most of your days. You may be very distressed but feel powerless to stop your urges. Most adults can recognize that their obsessions and compulsions don't make sense. Children, however, may not understand what's wrong.
  • If your obsessions and compulsions are affecting your life, see your doctor or mental health provider. It's common for people with OCD to be ashamed and embarrassed about the condition. But even if your rituals are deeply ingrained, treatment can help.

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