The Facts

Obsessive compulsive disorder (OCD) is a chronic, potentially disabling anxiety disorder. This condition is characterized by persistent, unwanted thoughts (obsessions) or certain behaviours that are repetitive and unnecessary but are extremely difficult to overcome (compulsions). People with OCD often feel powerless, distressed, and anxious because of the condition.

Generally, the obsessive rituals are performed privately because affected people believe others may not understand their feelings and behaviour. People with OCD also realize that their actions have no real purpose but still feel unable to stop.

OCD affects up to 3% of the population and occurs in all ethnic groups. It affects men and women equally. It is sometimes confused with other anxiety disorders but, in reality, the condition is an illness that requires treatment. As many as 30% of people diagnosed with OCD also have a history of a tic disorder such as Tourette syndrome

Causes

OCD is caused by a combination of biological, genetic, and environmental factors. Researchers have shown that changes in the level and balance of chemicals in the brain are associated with anxiety and related disorders. Research also indicates that OCD runs in families (i.e., it has a genetic component), and rarely, OCD can develop after certain childhood bacterial infections (streptococcal) or after brain or head injuries or traumas.

Symptoms and Complications

OCD usually begins slowly, with a few obsessions that develop into rituals. People with OCD are usually preoccupied with cleanliness and avoiding germs. In this case, the repetitive behaviours begin slowly but then become increasingly difficult to control. For example, hand-washing, daily showering, and housework may become frequent, precise, and prolonged.

Some other common compulsions and obsessions include:

• fear of fire – appliances are checked repeatedly to be sure they are turned off
• concern about being attacked – door locks are checked several times before leaving the house or retiring for the night
• a need for orderliness – a large amount of time is spent organizing and perfecting closet contents
• a compulsion for consistency – following the same path daily when walking to work, or crossing the street at exactly the same spot every day
• counting – brushing hair a particular number of strokes, or touching the table a certain number of times before it can be passed
• fear of losing control or fear of becoming angry
• intrusive sexual thoughts

While some habits or routines can have a place in everyday life, rituals that begin to disturb the quality of life become a problem. People with OCD are unable to skip any steps in the ritualistic behaviour because the compulsive thoughts will bother them until they perform the ritual exactly as they think it must be done. While they feel relieved after completing the series of actions, the relief is short-lived. They are soon compelled to repeat the ritual all over again.

Avoidance behaviour is a common complication of OCD as individuals attempt to prevent triggering obsessions or compulsions. Fear of contaminants can lead to avoidance of public spaces, while fear of unwanted thoughts about harm can lead to avoidance of social interactions.

Making the Diagnosis

Generally, the disorder is diagnosed if the repetitive thoughts or behaviours interfere with daily activities, are time-consuming, and cause distress. Sometimes, diagnosing OCD is difficult because a person with the condition performs their rituals or compulsions privately. Also, people with the condition may be aware that something is wrong but may feel afraid to seek help.

If OCD is suspected, the doctor may first perform a physical examination and obtain a medical history to help make the diagnosis.

Treatment and Prevention

OCD can be treated with psychological therapy, medications, or a combination.

The main psychological intervention is cognitive behavioural therapy – specifically, exposure or response prevention - that can result in a high success rate in motivated people with OCD, with very few relapses. Cognitive behaviour therapists deliberately expose you to your obsessions to encourage you to confront the accompanying behaviours. You are then prevented from carrying out the rituals. For example, if the ritual is to knock on a door five times before unlocking it, the therapist accompanies you and prevents you from knocking on the door, having you unlock it without knocking.

Therapy needs to be repeated frequently, over the course of weeks or months, until you are able to push aside the obsessive thoughts that demand the behaviour. As the compulsive thoughts become less frequent, the ritualistic behaviours should begin to disappear. At this stage, it is important to look for new compulsive behaviours that you might be developing to replace the conquered ones. New behaviours must be actively discouraged if they appear.

Behaviour therapy will only be effective if you are motivated and truly want to manage your condition. It helps you to learn different ways of thinking about and reacting to situations that make you anxious. Because it is challenging and can be demanding on both you and your family, family support is vital to help you overcome the condition.

Treatment using medications can also be very effective in the treatment of OCD. Antidepressants that affect serotonin brain pathways are very useful in controlling the symptoms of OCD. These medications include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine*, paroxetine, fluvoxamine, sertraline, escitalopram, and the tricyclic antidepressant clomipramine. It can take up to 4 to 6 weeks for medications to show results, so if you are taking these medications, it's important to be patient and to continue taking the medication as directed by your doctor and pharmacist.

Also, medications may work differently for different people, so it might be necessary to change medication or dosages until the right combination is found. Therapy with these medications is not a "quick fix" – people with the disorder need to continue to take the medications and actively participate in treatment to prevent a relapse. With time and effort, your strong desire to stop the behaviour, along with ongoing medical and family support, can help you overcome OCD.