OCD typically appears either between the ages of 8 and 12 years or between the late teen years and early adulthood. The exact causes of OCD remain unknown, but scientists believe that both brain structure and genetics play a role in the development of the disorder. Genetics have been shown to play a larger role when OCD begins in childhood compared with OCD that develops later in life.
The symptoms of OCD include unreasonable thoughts and fears (obsessions) that cause the patient to perform repetitive behaviors (compulsions) to relieve anxiety. Approximately one-third of patients with OCD also have tics (sudden, brief, intermittent movements or sounds).
OCD obsessions are persistent, unwanted urges or images that cause the patient distress or anxiety. Common obsessions for people with OCD include the fear of dirt or germs, fear of harming other people, fear of mistakes, fear of embarrassment, fear of thinking evil thoughts, need for order, and excessive doubt.
Patients with OCD often feel driven to perform certain repetitive activities, called compulsions. Common compulsions for people with OCD include repeatedly bathing/washing hands, counting in particular patterns, silently repeating a word or phrase, checking repeatedly to make sure doors are locked, and checking repeatedly to make sure the stove is off. Compulsions are meant to prevent or reduce distress, but they are either excessive or not objectively related to the issue they’re trying to fix.
If a patient’s obsessions and/or compulsions are significantly time-consuming and affecting their quality of life, they may meet the criteria for a diagnosis of OCD. Patients with OCD are unable to control these thoughts and behaviors. Additionally, they should derive no pleasure from performing their rituals, although these compulsions can provide a brief respite from their anxiety. Patients may or may not realize that their obsessions and compulsions are unreasonable; children especially are less likely to see them as such.
Exposure and Response Prevention Therapy
Therapy can be effective in alleviating the symptoms of OCD, and one such therapy is called exposure and response prevention (ERP). During ERP, the patient is gradually exposed to their obsessions and taught healthy ways of coping with their anxiety. Through habituation, the patient will eventually reduce the anxiety and/or need for compulsive behavior that had previously been triggered by their obsessions.
Several different psychiatric medications can be used in the treatment of OCD. Usually, antidepressants (including clomipramine, fluvoxamine, fluoxetine, paroxetine, and sertraline) are the first type of medication prescribed to patients with OCD. Atypical antipsychotics have also shown some effectiveness in treating OCD, both when used alone and combined with an antidepressant.
Deep Brain Stimulation
There is ongoing research concerning the efficacy of deep brain stimulation (DBS) for the treatment of OCD. DBS involves implanting a pacemaker in the brain that sends electrical impulses to parts of the brain believed to be involved with particular mental disorders. The FDA has approved DBS for treatment-refractory OCD, but it requires approval from the local institutional review board, patient consent, and psychiatrist attestation that their patient is a suitable candidate.
Two types of brain surgery have been shown to be effective for treatment-refractory OCD: anterior cingulotomy and anterior capsulotomy. In anterior cingulotomy, surgeons drill through the skull and used a heated probe to burn an area within the anterior cingulated cortex. This surgery is effective in approximately 50% of patients with OCD who do not respond to therapy or medication.
Anterior capsulotomy is similar to anterior cingulotomy; in this surgery, however, the surgeons operate on the anterior limb of the internal capsule. The surgery is effective in approximately 50%-60% of patients with treatment-refractory OCD.
Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by uncontrollable obsessions. In order to relieve the anxiety caused by these obsessions, a patient with OCD feels compelled to perform specific rituals or routines, called compulsions. This cycle of obsessions and compulsions significantly interferes with daily life. Read through the slideshow to learn more about the symptoms, diagnosis, and treatment of OCD.