Summary of obsessive compulsive disorder (OCD) including the causes, symptoms and treatment of the disorder, including various therapies and medications
- Obsessive compulsive disorder is an anxiety disorder in which patients have recurring, unwanted
thoughts, ideas and sensations (obsessions) that drive them to do something repetitively
(compulsions)
- Repetitive behaviours include handwashing, checking on things, cleaning, etc.
- For patients with OCD, distressing thoughts are persistent, and the obsessive behaviours are rigid.
Many patients are well aware that their obsessions are unrealistic (while others think they are true –
limited insight) yet they have difficulty disengaging from these thoughts or stopping their compulsions
- Diagnosis requires the presence of obsessions/ compulsions which are time consuming (more than
1 hour per day), cause significant distress, and impair work/ social functions
- In the United States, OCD affects ~2-3% of the population, more in women than men, with incidence
during childhood, adolescence or early adulthood, with the average age of symptoms appearing at
19 years
Obsessions
- Recurrent and persistent thoughts, impulses or images that can cause distressing emotions such as
anxiety or disgust
- Many patients realise that these thoughts, images and impulses are a product of their mind, yet the
distress caused by this cannot be resolved logically
- Most patients try to ease their obsessions with compulsions, ignore or suppress the obsessions or
distract themselves with other activities
- Typical obsessions include:
o Fear of contamination by people or the environment
o Disturbing sexual thoughts or images
o Blocking out obscenities or insults
o Extreme concern with order, symmetry or precision
o Recurrent intrusive thoughts of sound, images, letters or numbers
o Fear of losing/ discarding something important
Compulsions
- Repetitive behaviours or mental acts that a patient feels driven to perform in response to an
obsession
- Behaviours typically prevent/ reduce distress relating to an obsession
- May be an excessive direct response to an obsession, or actions that are completely unrelated
- In more severe cases, constant repetition of rituals fills the day, making a normal routine impossible
- Typical compulsions include:
o Excessive or ritualized hand washing, showering, teeth brushing or toileting
o Repeated cleaning of household objects
o Ordering or arranging things in a particular way
o Repeatedly checking locks, switches or appliances
o Constantly seeking approval or reassurance
o Repeatedly counting to a certain number
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