OBSESSIVE COMPULSIVE DISORDER

The symptoms of OCD, which are the obsessions and compulsions, may vary. Common obsessions include:

• Fear of dirt or contamination by germs
• Fear of causing harm to another
• Fear of making a mistake
• Fear of being embarrassed or behaving in a socially unacceptable manner
• Fear of thinking evil or sinful thoughts
• Need for order, symmetry, or exactness
• Excessive doubt and the need for constant reassurance

Common compulsions include:

• Repeatedly bathing, showering, or washing hands
• Refusing to shake hands or touch doorknobs
• Repeatedly checking things, such as locks or stoves
• Constant counting, mentally or aloud, while performing routine tasks
• Constantly arranging things in a certain way
• Eating foods in a specific order
• Being stuck on words, images or thoughts, usually disturbing, that won’t go away and can interfere with sleep
• Repeating specific words, phrases, or prayers
• Needing to perform tasks a certain number of times
• Collecting or hoarding items with no apparent value

DIAGNOSIS

A diagnosis of obsessive-compulsive disorder (OCD) is based on your symptoms, medical history, and a physical exam. Your doctor may also want a mental health assessment, which is an evaluation of your emotional functioning and your ability to think, reason, and remember (cognitive functioning). A mental health assessment may include an examination of your nervous system, written or verbal tests, and laboratory tests (such as blood and urine tests) as well as a review of your appearance, mood, behavior, thinking, reasoning, memory, and ability to express yourself.

General criteria required for a diagnosis of OCD include:

• You must have either obsessions or compulsions or both.
• You may or may not realize that your obsessions and compulsions are excessive or unreasonable.
• Obsessions and compulsions are significantly time-consuming and interfere with your daily routine and social or work functioning.

Your obsessions must meet these criteria:

• Recurrent, persistent and unwelcome thoughts, impulses or images are intrusive and cause distress.
• You try to ignore these thoughts, images or impulses or to suppress them with compulsive behaviors.

Compulsions must meet these criteria:

• Repetitive behavior that you feel driven to perform, such as hand-washing, or repetitive mental acts, such as counting silently.
• You try to neutralize obsessions with another thought or action.
• These behaviors or mental acts are meant to prevent or reduce distress, but they are excessive or not realistically related to the problem they’re intended to fix.

RECOMMENDED MEDICATIONS

OCD is generally treated with psychotherapy, medication, or both.

Psychotherapy. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively.

Medication. Doctors also may prescribe medication to help treat OCD. The most commonly prescribed medications for OCD are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

Antidepressants are used to treat depression, but they are also particularly helpful for OCD, probably more so than anti-anxiety medications. They may take several weeks—10 to 12 weeks for some—to start working. Antidepressants (SSRIs) such as fluoxetine (for example, Prozac), fluvoxamine (Luvox), and sertraline (Zoloft) are commonly prescribed to treat OCD. These medicines are taken as tablets or capsules. The medicine venlafaxine can also help symptoms of OCD. The tricyclic antidepressant clomipramine (Anafranil) is sometimes used as well.