Obsessive-compulsive (ob-SES-iv-kom-PUL-siv) disorder (OCD) causes people to become trapped in a pattern of repeated, unwanted thoughts, called obsessions (ob-SESH-unz), and a pattern of repetitive behavior, called compulsions (kom-PUL-shunz). Thoughts that feel impossible to control cause distress and anxiety (ang-ZY-e-tee) that is often neutralized, or offset, by the particular compulsive behavior patterns.
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Brain chemistry (neurochemistry)
Many people knock on wood to ward off bad luck. Others may walk around, rather than under, ladders, or they may step over, rather than on, cracks in the sidewalk. These are familiar examples of superstitions. Superstitions are irrational beliefs resulting from false ideas, fear of the unknown, or trust in magic or chance. Superstitions are common in everyday life. However, for people with OCD, rituals go much further than that. People with this disorder may feel driven to wash their hands until they bleed, count objects for hours on end, or go through a complex, 30-minute routine before leaving the house.
What Is Obsessive-Compulsive Disorder?
People with OCD can become trapped in a pattern of repeated, unwanted behaviors and thoughts that are senseless and upsetting but that seem impossible to control. The behaviors and thoughts can take up so much time and energy that people have trouble getting on with their daily lives. The problem often begins with disturbing thoughts, called obsessions. People then go through repeated rituals, called compulsions, in an effort to prevent these thoughts or make the distress caused by the thoughts go away. For example, people may wash their hands, count objects on a shelf, or check a door lock over and over again. For people with OCD, there is no pleasure in doing these things. There is only short-lived relief from the upsetting thoughts (for example, that the house will catch on fire or that a close relative is sick), which all too soon return.
Most people have a few odd habits. For example, they may check an oven to be sure it is off and then recheck it a few seconds later. Such behaviors are signs of OCD only when they take considerable amounts of time each day, cause much distress, and interfere with other activities.
What Causes Obsessive-Compulsive Disorder?
About 2 percent of adults in the United States have OCD in any given year. OCD usually begins during childhood or the teenage years, and it affects men and women equally. In the past, it was believed that OCD was due mainly to family problems or attitudes learned as children. Today, however, researchers stress the link between biological factors and life experiences. Brain imaging studies (special brain "x-rays") have shown that people with OCD have patterns of brain activity that differ from the patterns of people with other mental disorders and of people with no disorders at all.
These PANDAS Are
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections) is a term for unusual, OCD-like symptoms that arise in a small number of children after strep throat, a common throat infection caused by bacteria. The behavior of the children usually changes quite suddenly. Almost overnight, they develop obsessions, compulsions, or tics; uncontrollable muscle twitches; or verbal outbursts. The cause is still unknown. One theory, though, is that a strep infection in childhood prompts the body to form antibodies (AN-ti-bo-deez), substances in the blood that fight bacteria and other foreign matter. The next time strep develops, the body is ready to fight back. It releases a barrage of antibodies, but some miss their mark and head for the part of the brain that is thought to affect behavior and movement—resulting in OCD symptoms.
* nervous system is a network of specialized tissue made of nerve cells, or neurons, that processes messages to and from different parts of the human body.
* genetic (je-NE-tik) pertains to genes, which are chemicals in the body that help determine a person's characteristics, such as hair or eye color. They are inherited from a person's parents and are contained in the chromosomes, threadlike structures inside the cells of the body.
OCD occurs more often than average in people with certain other conditions that affect the brain and nervous system * . For example, there is an increased risk of OCD in people with Tourette (tu-RET) syndrome, an inherited nervous system disorder that causes repeated, uncontrollable muscle twitches and verbal outbursts. Researchers now are trying to find out if there is a genetic * link between OCD and Tourette syndrome.
What Are Obsessions?
Obsessions are unwanted ideas or wishes that repeatedly well up in the minds of people with OCD. The thoughts create constant worry and fear. People who do not experience OCD believe that the worry is silly or strange. People with OCD also can agree that the worry is needless; however, they cannot stop feeling the worry that comes with the thoughts. Interestingly, thoughts and behaviors may not be related. The thought "I might get sick" could be followed by the behavior of counting to seven. Common obsessions include:
- worries about germs and dirt, for example, worrying about getting germs from shaking hands
- repeated doubts, for example, worrying about leaving a door unlocked
- worries about keeping things in order, for example, becoming very upset when things are out of place
- violent impulses, for example, thinking repetitively about hurting someone
- sexual impulses, for example, thinking repetitively about a sexual act.
What Are Compulsions?
People try to keep these unwanted thoughts in check with repeated actions that they feel driven to perform. Some people have set routines, while others have complex, changing rituals. The actions provide some relief from worry, but only temporarily. Common compulsions include:
- Washing: For example, people worried about germs and dirt may spend hours washing their hands.
- Checking: For example, people with repeated doubts about leaving a door unlocked may check the lock over and over.
- Ordering: For example, people worried about keeping things in order may arrange and rearrange the objects on a shelf.
- Counting: For example, people with disturbing violent or sexual thoughts may block them out by counting to 11 again and again.
The word "compulsive" has more than one meaning in the mental health world. When people talk about obsessive-compulsive disorder, they are using the word in a formal way to refer to a specific kind of repeated ritual. When people talk about compulsive gambling or compulsive internet use, however, they are using the word in a less strict sense to refer to people who have an intense craving that is out of control.
Teenagers and adults with OCD know that their behavior is pointless, but the distress is so great that they feel unable to stop the behavior. At times, they may even start to believe their own unreasonable fears. People with OCD may be able to keep their behavior under control at school or at work for a while. They often are afraid to tell others, believing that they will be thought of as "weird." Without treatment, though, the problem may get worse over time. For some individuals, the constant worries and time-consuming rituals can take over their lives.
How Is Obsessive-Compulsive Disorder Treated?
Studies have shown that medicines that affect a brain chemical called serotonin * can reduce the symptoms of OCD. While medicines may help control OCD, the symptoms may return once people stop taking medication. For this reason, doctors often recommend a combination of prescription medication and visits to a behavior therapist. Some individuals whose OCD is not significantly debilitating * might choose behavior therapy alone as the preferred treatment.
Behavioral (be-HAY-vyor-al) therapy helps people change specific unwanted behaviors. For OCD, this often means using an approach called exposure and response prevention. In this approach, people purposely are exposed to a feared object or idea, either directly or through imagination. Then they prevent themselves from carrying out the usual response (the compulsion), instead using other methods to manage the anxiety they feel. For example, people with a hand-washing compulsion might be encouraged to touch objects that they believe to be dirty. Then with the therapist's help, they resist the compulsion to wash for several hours. During this time, the anxiety associated with the obsession decreases and so does the compulsion to wash. Research has shown that this approach can be effective for treating OCD. People who remain in therapy may gradually learn to worry less about their obsessive thoughts, and eventually they may learn to go for long periods of time without falling back on their old compulsive actions. With exposure and response prevention, thoughts and compulsions frequently (and sometimes quickly) disappear or become manageable.
* serotonin (ser-o-TO-nin) is a neurotransmitter, a substance that helps transmit information from one nerve cell to another.
* debilitating (de-BI-li-tay-ting) means making weak or sapping strength.
Rapoport, Judith L. The Boy Who Couldn't Stop Washing. New York: Plume, reissued 1990. One of the first books to bring obsessive-compulsive disorder to public attention.
Anxiety Disorders Association of America, 11900 Parklawn Drive, Suite
100, Rockville, MD 20852. This nonprofit group promotes public awareness
Anxiety Disorders Education Program, U.S. National Institute of Mental
Health, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD
20892-9663. This government program provides reliable information about
Obsessive-Compulsive Foundation, 337 Notch Hill Road, North Branford, CT
06471. This organization is for people with OCD and others with an
interest in the disorder.