WHAT IS OCD?
OCD is a
neurological disorder defined by recurrent, unwelcome thoughts
(obsessions) and repetitive behaviors (compulsions) that OCD
driven to perform. People with OCD know their obsessions and
irrational or excessive, yet they have little or no control over
Dirt, germs and
contamination, fear of acting on violent or aggressive impulses,
feeling overly responsible for the safety of others, abhorrent
(blasphemous) and sexual thoughts, and an inordinate concern with
arrangement or symmetry.
FREQUENTLY ASKED QUESTIONS:
Repetitive behaviors such as excessive washing (particulary hand
bathing), cleaning, checking, touching, counting, arranging,
ordering or hoarding.
Ritualistic behaviors seem to lessen the distress from obsessions,
but buy only
short-term comfort at the long-term cost of frequent ritual
What are some of the other symptoms of OCD?
People with OCD may become demoralized or depressed. Feelings of
anxiety, discomfort or disgust are common. Other symptoms that may
to OCD are plucking out strands of hair or eyebrows (Trichotillomania),
preoccupation with a minor or imagined bodily defect (body
disorder), severe or extreme nail biting or the unfounded fear of
having a serious
How many people suffer from OCD in the United States?
OCD is the fourth most common neuropsychiatric illness in the United
One in 40 adults and one in 200 children suffer from OCD at some
point in their
lives. This means that at any one time in the United States, at
least 5 million
people are experiencing the symptoms of OCD.
What is the course of OCD?
If not treated appropriately, OCD is usually chronic with waxing and
symptoms. In some cases, symptoms remain under control; in others,
may follow a progressive deteriorating course and become disabling.
How disabling is OCD?
Impairment ranges from mild to severe. Sometimes symptoms are
Hospitalization may become necessary and regular employment
the other hand, many individuals, including doctors, lawyers,
educators, homemakers, businessmen! women, factory workers,
entertainers continue to function, despite symptoms of OCD. However,
takes a toll on the sufferer, his/her family and co-workers, even
when a sufferer
only experiences symptoms for one-half hour a day. The emotional and
economic costs of OCD to the individual, the family, and society are
Do “compulsive” gamblers and eaters have OCD? How about those
suffering from alcohol or drug abuse?
Although people with pathological gambling, overeating, alcohol or
have a problem they feel they cannot stop, all these activities
have, in some
degree, a pleasurable component. In contrast, the compulsions of OCD
never inherently pleasurable. For several decades, this distinction
Are people with OCD “crazy?”
No.The behaviors may seem “crazy,” but the person performing them is
fact, an OCD sufferer is acutely aware of the excessiveness or
his/her fears or behaviors, yet is unable to control them. This
creates a new fear that others will think he/she is weak or crazy
People with OCD
are very often very secretive about their symptoms and afraid to
This may explain why OCD was previously underreported.
What are the possible causes of OCD?
The exact causes of OCD are still unknown. However, researchers
suspect that a biochemical imbalance is involved. Alterations in one
or more of
the brain’s chemical systems that regulate repetitive behaviors may
be related to
the cause of OCD. These balances may be inherited. Psychological
stress may heighten symptoms.
What types of treatment are available for OCD?
There are two treatments that have been proven effective against OCD.
include cognitive-behavior therapy (CBT) and medication (primarily
combination of medication and CBT is often the most effective
CBT consists of a technique called exposure and response prevention,
and it is
effective for many people with OCD. In this approach, the patient is
and voluntarily exposed to feared objects or ideas (the exposure
either directly or by imagination and then is discouraged or
prevented (with the
patient’s permission) from carrying out the usual compulsive
response prevention component). For example, a compulsive hand
be urged to touch an object believed to be contaminated and then may
the opportunity to wash for several hours. When the treatment works
patient gradually experiences less anxiety from the obsessive
becomes able to do without the compulsive actions for extended
periods of time.
Studies of behavior therapy for QCD have found it to produce lasting
achieve the best results, a combination of factors is necessary. The
should be well trained, the patient must be highly motivated, and
family must be cooperative. In addition to visits to the therapist,
the patient must
be faithful in fulfilling “homework assignments.” For those patients
the course of treatment, the improvements can be significant.
psychotherapy aimed at helping the patient develop insight into his
problem, is generally not helpful specifically for OCD symptoms
However, traditional psychotherapy may be of benefit as part of a
package for patients who have been ill and isolated for many years
or for those
whose illness started at an early age.
There are a number of medications that have been shown to be useful
placebo-controlled studies. In these studies, neither the physician
patient knows whether the patient is receiving the drug or a placebo
sugarpill); about half the patients receive the drug and the other
half receive the
placebo. This is a very good way to evaluate drugs since
improvements can be
evaluated in an unbiased manner and drug effectiveness can be
Drugs that have been shown to be effective in such studies include:
(Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine
(Celexa), escitalopram (Lexapro) and clomipramine (Anafranil).Anafranil
been around the longest and is the best studied throughout the
world, but there is
growing evidence that the other drugs are as effective. In addition
carefully studied drugs, there are hundreds of case reports of other
occasionally being helpful. There are reports of small numbers of
suggest that venlafaxine (Effexor) may also be somewhat effective;
have been no large-scale controlled trials done yet.
Why do these drugs help?
It remains unclear as to why these particular drugs help OCD while
do not. Each has potent effects on a particular neurotransmitter, or
messenger, in the brain called serotonin. It appears that potent
effects on brain
serotonin are necessary (but not sufficient) to produce improvement
Serotonin is one of several neurotransmitter chemicals that nerve
cells in the
brain use in communicating with one another. Unlike some other
neurotransmitters, its receptors are not localized in a few specific
areas of the
brain. Hence, its uptake and release affects much of our mental
OCD and depression.
What about augmenting one drug with another?
The best augmenting technique is to add behavior therapy to ongoing
treatment. However, to boost a drug’s effect, sometimes two or more
are used together. For example, some peopIe respond to combining a
Anafranil. Other drugs are sometimes combined with ongoing SRI
Some that have commonly been used include: buspirone (Buspar),
carbonate (Eskalith), clonazepam (Klonopin), methylphenidate
gabapentin (Neurontin), and other antidepressants (e.g., trazedone,
desipramine, etc.). Other drugs are presently being tested.
in Compulsive Hoarding & OCD Study