Obsessive–compulsive disorder: Difference between revisions
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'''Obsessive–compulsive disorder''' ('''OCD''') is a [[mental disorder]] characterized by [[intrusive thoughts]], or obsessions resulting in [[compulsive behavior]]s and mental acts that the person feels driven to perform, according to rules that must be applied rigidly, aimed at reducing [[anxiety]] stemming from the intrusive thoughts. |
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Compulsions may include touching or checking things repeatedly until the anxiety diminishes. In severe cases, OCD affects a person's ability to function in everyday activities. Such a person may take several hours a day to carry out the compulsive acts. Also, the psychological self-awareness of the [[irrationality]] of the disorder can be painful. |
Compulsions may include touching or checking things repeatedly until the anxiety diminishes. In severe cases, OCD affects a person's ability to function in everyday activities. Such a person may take several hours a day to carry out the compulsive acts. Also, the psychological self-awareness of the [[irrationality]] of the disorder can be painful. |
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OCD is the fourth most common mental disorder and is diagnosed nearly as often as the physiological ailments [[asthma]] and [[diabetes mellitus]].<ref>{{cite book|last=Hollander|first=Eric |coauthors=Dan J. Stein|title= |
OCD is the fourth most common mental disorder and is diagnosed nearly as often as the physiological ailments [[asthma]] and [[diabetes mellitus]].<ref>{{cite book|last=Hollander|first=Eric |coauthors=Dan J. Stein|title=Obsessive–compulsive Disorders |publisher=nforma Health Care|date=1997|page=1|chapter=Diagnosis and assessment}}</ref> In the [[United States]], one in 50 adults has OCD.<ref>{{cite book|last=Null|first=Gary |title=Get Healthy Now|publisher=Seven Stories Press|date=2006|pages=269|chapter=Obsessive–compulsive disorder}}</ref> The phrase "obsessive–compulsive" has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is meticulous, [[Perfectionism (psychology)|perfectionistic]], absorbed in a cause, or otherwise fixated on something or someone.<ref>Berrios G E (1985) Obsessional Disorders: A Conceptual History. Terminological and Classificatory Issues. In Bynum W F et al (eds) The Anatomy of Madness Vol I , London, Tavistock, pp 166-187 </ref> Although these signs are often present in OCD, a person who exhibits them does not necessarily have OCD, and may instead have [[obsessive–compulsive personality disorder|obsessive–compulsive ''personality'' disorder]] (OCPD) or some other condition. |
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<!--weasel-wording should be fixed, and psychological causes should be added for balance: Researchers{{who}} believe OCD may be related to levels of a normal chemical in the [[human brain|brain]] called [[serotonin]]. When the proper flow of serotonin is blocked, the brain's "alarm system" overreacts. Danger messages are mistakenly triggered. Instead of the brain filtering out these unnecessary thoughts, the brain dwells on them—and the person experiences unrealistic anxiety. |
<!--weasel-wording should be fixed, and psychological causes should be added for balance: Researchers{{who}} believe OCD may be related to levels of a normal chemical in the [[human brain|brain]] called [[serotonin]]. When the proper flow of serotonin is blocked, the brain's "alarm system" overreacts. Danger messages are mistakenly triggered. Instead of the brain filtering out these unnecessary thoughts, the brain dwells on them—and the person experiences unrealistic anxiety. |
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==Symptoms and prevalence== |
==Symptoms and prevalence== |
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OCD manifests in a variety of forms. Studies have placed the prevalence between one and three percent, although the prevalence of clinically recognized OCD is much lower, suggesting that many individuals with the disorder may not be diagnosed.<ref>{{cite journal |author=Fireman B, Koran LM, Leventhal JL, Jacobson A |title=The prevalence of clinically recognized |
OCD manifests in a variety of forms. Studies have placed the prevalence between one and three percent, although the prevalence of clinically recognized OCD is much lower, suggesting that many individuals with the disorder may not be diagnosed.<ref>{{cite journal |author=Fireman B, Koran LM, Leventhal JL, Jacobson A |title=The prevalence of clinically recognized obsessive–compulsive disorder in a large health maintenance organization |journal=The American journal of psychiatry |volume=158 |issue=11 |pages=1904–10 |year=2001 |pmid=11691699| doi = 10.1176/appi.ajp.158.11.1904}}</ref> The fact that many individuals do not seek treatment may be due in part to [[social stigma|stigma]] associated with OCD. |
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The typical OCD sufferer performs tasks (or [[wikt:compulsion|compulsion]]s) to seek relief from obsession-related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the [[stress]] from building up. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, repeatedly washing hands at regular intervals throughout the day, touching objects a certain number of times before leaving a room, or walking in a certain routine way. Physical symptoms may include those brought on from anxieties and unwanted thoughts, as well as [[tic]]s or [[Parkinson's disease]]-like symptoms: rigidity, tremor, jerking arm movements, or involuntary movements of the limbs. |
The typical OCD sufferer performs tasks (or [[wikt:compulsion|compulsion]]s) to seek relief from obsession-related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the [[stress]] from building up. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, repeatedly washing hands at regular intervals throughout the day, touching objects a certain number of times before leaving a room, or walking in a certain routine way. Physical symptoms may include those brought on from anxieties and unwanted thoughts, as well as [[tic]]s or [[Parkinson's disease]]-like symptoms: rigidity, tremor, jerking arm movements, or involuntary movements of the limbs. |
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Formal diagnosis may be performed by a [[psychologist]], a [[psychiatrist]] or [[psychoanalyst]]. OCD sufferers are aware that their thoughts and behavior are not rational,<ref>{{cite book |title=Introduction to Clinical Psychiatry |last=Elkin |first=G. David |year=1999 |publisher= |
Formal diagnosis may be performed by a [[psychologist]], a [[psychiatrist]] or [[psychoanalyst]]. OCD sufferers are aware that their thoughts and behavior are not rational,<ref>{{cite book |title=Introduction to Clinical Psychiatry |last=Elkin |first=G. David |year=1999 |publisher=McGraw–Hill Professional |isbn=0838543332 }}</ref> but they feel bound to comply with them to fend off feelings of panic or dread. Although everyone may experience unpleasant thoughts at one time or another, these are short-lived and fade away in time.<ref>Carter, K. "Obsessive–compulsive disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. 14 Feb. 2006.</ref> For people with OCD, the thoughts are intrusive and persistent, and can cause them great anxiety and distress.<ref name="Barlow">Barlow, D. H. and V. M. Durand. ''Essentials of Abnormal Psychology''. California: Thomson Wadsworth, 2006.</ref> |
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[[Intrusive thoughts]] are unwelcome, involuntary thoughts, images or unpleasant ideas that may become [[fixation|obsessions]], are upsetting or distressing, and can be difficult to be free of and manage.<ref name=OCDAction>[http://www.ocdaction.org.uk/ocdaction/index.asp?id=433 Intrusive thoughts], OCDAction.org.uk. Retrieved on December 31, 2006.</ref> As with other forms of OCD, the awareness of the irrationality of these thoughts can be frustrating as the individual wishes to stop them but cannot. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, usually falling into three categories: inappropriate aggressive thoughts, inappropriate sexual thoughts, and blasphemous religious thoughts.<ref name="Baerxiv">Baer (2001), p. xiv.</ref> Most people experience these thoughts; when they are associated with OCD or [[clinical depression|depression]], they may become paralyzing, [[anxiety]]-provoking, and persistent. Many people experience the type of unpleasant or unwanted thoughts that people with more troubling intrusive thoughts have, but most people are able to dismiss these thoughts.<ref name=OCDAction/> When intrusive thoughts co-occur with OCD, patients are less capable of ignoring the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing.<ref name=OCDAction/> |
[[Intrusive thoughts]] are unwelcome, involuntary thoughts, images or unpleasant ideas that may become [[fixation|obsessions]], are upsetting or distressing, and can be difficult to be free of and manage.<ref name=OCDAction>[http://www.ocdaction.org.uk/ocdaction/index.asp?id=433 Intrusive thoughts], OCDAction.org.uk. Retrieved on December 31, 2006.</ref> As with other forms of OCD, the awareness of the irrationality of these thoughts can be frustrating as the individual wishes to stop them but cannot. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, usually falling into three categories: inappropriate aggressive thoughts, inappropriate sexual thoughts, and blasphemous religious thoughts.<ref name="Baerxiv">Baer (2001), p. xiv.</ref> Most people experience these thoughts; when they are associated with OCD or [[clinical depression|depression]], they may become paralyzing, [[anxiety]]-provoking, and persistent. Many people experience the type of unpleasant or unwanted thoughts that people with more troubling intrusive thoughts have, but most people are able to dismiss these thoughts.<ref name=OCDAction/> When intrusive thoughts co-occur with OCD, patients are less capable of ignoring the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing.<ref name=OCDAction/> |
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The common underlying theme to the diverse intrusive thoughts is summarised by Bruce ''et al'' with the example, "What if I were to snap, lose control of myself, and do something totally uncharacteristic of |
The common underlying theme to the diverse intrusive thoughts is summarised by Bruce ''et al'' with the example, "What if I were to snap, lose control of myself, and do something totally uncharacteristic of me—perhaps even without my knowing it—that results in harm to myself or someone else?"<ref name="Hyman">{{cite book|last=Hyman|first=Bruce M. |coauthors=Troy DuFrene|title=Coping with OCD|publisher=New Harbinger Publications|date=2008|pages=59–60|chapter=My thoughts are driving me crazy!|url=http://books.google.com/books?id=gA2ul02-64YC&pg=PA60}}</ref> |
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===OCD without Overt compulsions=== |
===OCD without Overt compulsions=== |
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A major subtype of OCD is OCD without overt compulsions.<ref>Freeston, M. & Ladouceur, R(2003). What do patients do with their obsessive thoughts? Behaviour Research and Therapy, 35, 335-348. </ref> OCD without overt compulsions is often referred to as "pure-O" by laymen and sufferers of this disorder. The term is a bit of a misnomer, however, because OCD without overt compulsions is no more "pure" than any other form of OCD. Nonetheless, OCD without overt compulsions represents a major subtype of OCD with some of the estimates as high 50-60%.<ref>Weisman, M.M., Bland, R.C., Canino, G.J., Greenwald, S., Hwu, H.G..Lee, C.K. Newman, S.C., Oakley-Browne, M.A., Rubio-Stipec, M., Wickramaratne, P.J., Wittchen, H.U., & Yeh, E.K. (1994). The cross national epidemiology of |
A major subtype of OCD is OCD without overt compulsions.<ref>Freeston, M. & Ladouceur, R(2003). What do patients do with their obsessive thoughts? Behaviour Research and Therapy, 35, 335-348. </ref> OCD without overt compulsions is often referred to as "pure-O" by laymen and sufferers of this disorder. The term is a bit of a misnomer, however, because OCD without overt compulsions is no more "pure" than any other form of OCD. Nonetheless, OCD without overt compulsions represents a major subtype of OCD with some of the estimates as high 50-60%.<ref>Weisman, M.M., Bland, R.C., Canino, G.J., Greenwald, S., Hwu, H.G..Lee, C.K. Newman, S.C., Oakley-Browne, M.A., Rubio-Stipec, M., Wickramaratne, P.J., Wittchen, H.U., & Yeh, E.K. (1994). The cross national epidemiology of obsessive–compulsive disorder. Journal of Clinical Psychiatry, 55, 5-10. </ref> Rather than engaging in observable rituals and compulsions, the person with OCD without overt compulsions engages in all manner of mental neutralizing behaviours (i.e. "covert" compulsions). |
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Intrusive thoughts may involve violent obsessions about hurting others or oneself.<ref>Baer (2001), p. 33, 78</ref> They can include such thoughts as harming an innocent child, jumping from a bridge, mountain or the top of a tall building, urges to jump in front of a train or automobile, and urges to push another in front of a train or automobile.<ref name="Baerxiv"/> A survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including imagining or wishing harm upon a family member or friend, impulses to attack or kill a small child, or animal, or shout something rude or violent.<ref name="Baer7">Baer (2001), p. 7</ref> |
Intrusive thoughts may involve violent obsessions about hurting others or oneself.<ref>Baer (2001), p. 33, 78</ref> They can include such thoughts as harming an innocent child, jumping from a bridge, mountain or the top of a tall building, urges to jump in front of a train or automobile, and urges to push another in front of a train or automobile.<ref name="Baerxiv"/> A survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including imagining or wishing harm upon a family member or friend, impulses to attack or kill a small child, or animal, or shout something rude or violent.<ref name="Baer7">Baer (2001), p. 7</ref> |
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===Related conditions=== |
===Related conditions=== |
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OCD is often confused with the separate condition [[ |
OCD is often confused with the separate condition [[obsessive–compulsive personality disorder]]. The two are not the same condition, however. OCD is ''ego [[dystonia|dystonic]]'', meaning that the disorder is incompatible with the sufferer's self-concept. <ref name=Aardema>Aardema, F. & O'Connor. (2003). Seeing white bears that are not there: Inference processes in obsessions. Journal of Cognitive Psychotherapy, 17, 23-37. </ref><ref>Aardema, F. & O'Connor. (2007). The menace within: obsessions and the self. International Journal of Cognitive Therapy, 21, 182-197. </ref> Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ''ego syntonic''—marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with [[anxiety]]; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions.<ref>Carter, K. "Obsessive–compulsive personality disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. April 11, 2006.</ref> This is a significant difference between these disorders. |
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Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is ''still'' not sure, and it is ''still'' better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary. |
Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is ''still'' not sure, and it is ''still'' better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary. |
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Some OCD sufferers exhibit what is known as ''overvalued ideas''. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do [[Exposure and response prevention|ERP therapy]] on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually [[delusion]]al, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not. There are severe cases when the sufferer has an unshakeable belief within the context of OCD which is difficult to differentiate from psychosis.<ref>O'Dwyer, Anne-Marie Carter, |
Some OCD sufferers exhibit what is known as ''overvalued ideas''. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do [[Exposure and response prevention|ERP therapy]] on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually [[delusion]]al, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not. There are severe cases when the sufferer has an unshakeable belief within the context of OCD which is difficult to differentiate from psychosis.<ref>O'Dwyer, Anne-Marie Carter, Obsessive–compulsive disorder and delusions revisited, The British Journal of Psychiatry (2000) 176: 281-284</ref> |
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OCD is different from behaviors such as [[gambling]] addiction and [[overeating]]. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is placed in the anxiety class of [[mental illness]], but like many [[Chronic stress|chronic stress disorders]] it can lead to [[clinical depression]] over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life—particularly its substantial consumption of time—can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available. |
OCD is different from behaviors such as [[gambling]] addiction and [[overeating]]. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is placed in the anxiety class of [[mental illness]], but like many [[Chronic stress|chronic stress disorders]] it can lead to [[clinical depression]] over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life—particularly its substantial consumption of time—can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available. |
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===Related/Spectrum disorders=== |
===Related/Spectrum disorders=== |
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People with OCD may be diagnosed with other conditions, such as [[generalized anxiety disorder]], [[anorexia nervosa]], [[social anxiety disorder]], [[bulimia nervosa]], [[Tourette syndrome]], [[Asperger syndrome]], [[compulsive skin picking]], [[body dysmorphic disorder]], [[trichotillomania]], and (as already mentioned) [[ |
People with OCD may be diagnosed with other conditions, such as [[generalized anxiety disorder]], [[anorexia nervosa]], [[social anxiety disorder]], [[bulimia nervosa]], [[Tourette syndrome]], [[Asperger syndrome]], [[compulsive skin picking]], [[body dysmorphic disorder]], [[trichotillomania]], and (as already mentioned) [[obsessive–compulsive personality disorder]]. There is some research demonstrating a link between [[drug addiction]] and OCD as well. Many who suffer from OCD also suffer from [[panic attack]]s. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of [[coping]] with the heightened levels of [[anxiety]]), but drug addiction among OCD patients may serve as a type of [[compulsive behavior]] and not just as a coping mechanism. [[Clinical depression|Depression]] is also extremely prevalent among sufferers of OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD (or any other [[anxiety disorder]]) may feel depressed because of an "out of control" type of feeling.<ref>{{cite journal |author=Mineka S, Watson D, Clark LA |title=Comorbidity of anxiety and unipolar mood disorders |journal=Annual review of psychology |volume=49 |issue= |pages=377–412 |year=1998 |pmid=9496627 |doi=10.1146/annurev.psych.49.1.377}}</ref> |
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Some cases are thought to be caused at least in part by childhood [[streptococcus|streptococcal]] infections and are termed [[PANDAS]] (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The streptococcal [[antibody|antibodies]] become involved in an [[autoimmune]] process. Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be "caught" via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that [[antibiotic]]s may eventually be used to treat or prevent it.<ref> |
Some cases are thought to be caused at least in part by childhood [[streptococcus|streptococcal]] infections and are termed [[PANDAS]] (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The streptococcal [[antibody|antibodies]] become involved in an [[autoimmune]] process. Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be "caught" via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that [[antibiotic]]s may eventually be used to treat or prevent it.<ref> |
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{{Cite web |
{{Cite web |
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| author = Belkin, L. |
| author = Belkin, L. |
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|title = Can |
|title = Can you catch obsessive–compulsive disorder? |
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|publisher = ''The New York Times Magazine'' |
|publisher = ''The New York Times Magazine'' |
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|url = http://www.nytimes.com/2005/05/22/magazine/22OCD.html?ex=1145419200&en=dac0fb81aa28b46b&ei=5070> |
|url = http://www.nytimes.com/2005/05/22/magazine/22OCD.html?ex=1145419200&en=dac0fb81aa28b46b&ei=5070> |
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==Causes== |
==Causes== |
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===Psychological=== |
===Psychological=== |
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Scientists studying |
Scientists studying obsessive–compulsive disorder generally agree that both psychological and biological factors play a role in causing the disorder, although they differ in their degree of emphasis upon either type of factor. |
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From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual, or other obsessive thoughts were [[spiritual possession|possessed]] by the [[Satan|Devil]].<ref>Aardema, F. & O'Connor. (2007). The menace within: obsessions and the self. International Journal of Cognitive Therapy, 21, 182-197. </ref> Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through [[exorcism]].<ref name="Baer">Baer, L.; M. A. Jenike & W. E. Minichiello. ''Obsessive Compulsive Disorders: Theory and Management''. Littleton, MA: PSG Publishing, 1986.</ref> |
From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual, or other obsessive thoughts were [[spiritual possession|possessed]] by the [[Satan|Devil]].<ref>Aardema, F. & O'Connor. (2007). The menace within: obsessions and the self. International Journal of Cognitive Therapy, 21, 182-197. </ref> Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through [[exorcism]].<ref name="Baer">Baer, L.; M. A. Jenike & W. E. Minichiello. ''Obsessive Compulsive Disorders: Theory and Management''. Littleton, MA: PSG Publishing, 1986.</ref> |
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In the early 1910s, [[Sigmund Freud]] attributed |
In the early 1910s, [[Sigmund Freud]] attributed obsessive–compulsive behavior to unconscious conflicts which manifested as symptoms.<ref name="Baer" /> Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious".<ref>{{cite book |last=Freud |first=Sigmund |authorlink=Sigmund Freud |others=trans. Strachey |title=[[Totem and Taboo:Some Points of Agreement between the Mental Lives of Savages and Neurotics]] |year=1950 |publisher=W. W. Norton & Company |location=New York |isbn=0-393-00143-1 }} p. 29.</ref> |
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The |
The cognitive–behavioral model suggests that compulsive behaviour is carried out to remove anxiety-provoking intrusive thoughts. Unfortunately this only brings about temporary relief as the thought re-emerges. Each time the behaviour occurs it is negatively reinforced (see [[Reinforcement]]) by the relief from anxiety, thereby explaining why the dysfunctional activity increases and generalises (extends to other, related stimuli) over a period of time. For example, after touching a door-knob a person might have the thought that they may develop a disease as a result of contamination. They then experience anxiety, which is relieved when they wash their hands. This might be followed by the thought "but did I wash them properly?" causing an increase in anxiety once more, the hand-washing once again rewarded by the removal of anxiety (albeit briefly) and the cycle being repeated when thoughts of contamination re-occur. The distressing thoughts might then spread to fear of contamination from e.g. a chair (someone might have touched the chair after touching the door handle). |
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===Biological=== |
===Biological=== |
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There are many different theories about the cause of |
There are many different theories about the cause of obsessive–compulsive disorder. The majority of researchers believe that there is some type of abnormality with the [[neurotransmitter]] [[serotonin]], among other possible psychological or biological abnormalities; however, it is possible that this activity is the brain's ''response'' to OCD, and not its cause.{{Original research|date=January 2009}} Serotonin is thought to have a role in regulating anxiety, though it is also thought to be involved in such processes as [[sleep]] and [[memory]] function. In order to send chemical messages, serotonin must bind to the [[receptor (biochemistry)|receptor]] sites located on the neighboring nerve cell. It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential. This suggestion is supported by the fact that many OCD patients benefit from the use of [[selective serotonin reuptake inhibitors]] (SSRIs)—a class of [[antidepressant]] medications that allow for more serotonin to be readily available to other nerve cells.<ref name="bbc">BBC Science and Nature: Human Body and Mind. Causes of OCD. <http://www.bbc.co.uk/science/humanbody/mind/articles/disorders/causesofocd.shtml>. Accessed April 15, 2006.</ref> For more about this class of drugs, see the [[#Treatment|section about potential treatments]] for OCD. |
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The [[Stanford University School of Medicine]] OCD webpage states, "Although the causes of the disorder still elude us, the recent identification of children with OCD caused by an autoimmune response to [[Group A streptococcal infection]] promises to bring increased understanding of the disorder's pathogenesis."<ref>{{cite web |url=http://ocd.stanford.edu/treatment/history.html |title=History of Treatment of OCD |
The [[Stanford University School of Medicine]] OCD webpage states, "Although the causes of the disorder still elude us, the recent identification of children with OCD caused by an autoimmune response to [[Group A streptococcal infection]] promises to bring increased understanding of the disorder's pathogenesis."<ref>{{cite web |url=http://ocd.stanford.edu/treatment/history.html |title=History of Treatment of OCD |publisher= Stanford University School of Medicine |accessdate=2007-06-28 |format= |work=}}</ref> |
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Recent research has revealed a possible [[genetic mutation]] that could help to cause OCD. Researchers funded by the [[National Institutes of Health]] have found a [[mutation]] in the human serotonin transporter gene, [[hSERT]], in unrelated families with OCD. Moreover, in his study of identical twins, Rasmussen (1994) produced data that supported the idea that there is a "heritable factor for neurotic anxiety".<ref>Rasmussen, S.A. "Genetic Studies of Obsessive Compulsive Disorder" in ''Current Insights in Obsessive Compulsive Disorder'', eds. E. Hollander; J. Zohar; D. Marazziti & B. Oliver. Chichester, England: John Wiley & Sons, 1994, pp. 105-114. </ref> In addition, he noted that environmental factors also play a role in how these anxiety symptoms are expressed. However, various studies on this topic are still being conducted and the presence of a genetic link is not yet definitely established. |
Recent research has revealed a possible [[genetic mutation]] that could help to cause OCD. Researchers funded by the [[National Institutes of Health]] have found a [[mutation]] in the human serotonin transporter gene, [[hSERT]], in unrelated families with OCD. Moreover, in his study of identical twins, Rasmussen (1994) produced data that supported the idea that there is a "heritable factor for neurotic anxiety".<ref>Rasmussen, S.A. "Genetic Studies of Obsessive Compulsive Disorder" in ''Current Insights in Obsessive Compulsive Disorder'', eds. E. Hollander; J. Zohar; D. Marazziti & B. Oliver. Chichester, England: John Wiley & Sons, 1994, pp. 105-114. </ref> In addition, he noted that environmental factors also play a role in how these anxiety symptoms are expressed. However, various studies on this topic are still being conducted and the presence of a genetic link is not yet definitely established. |
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Another possible genetic cause of OCD was discovered in August 2007 by scientists at [[Duke University Medical Center]] in North Carolina. They genetically engineered mice that lacked a [[gene]] called [[SAPAP3]]. This [[protein]] is highly expressed in the [[striatum]], an area of the [[brain]] linked to planning and the initiation of appropriate actions. The mice spent three times as much time grooming themselves as ordinary mice, to the point that their fur fell off.<ref>[http://www.newscientist.com/channel/life/genetics/mg19526183.400-missing-gene-creates-obsessivecompulsive-mouse-.html Missing gene creates |
Another possible genetic cause of OCD was discovered in August 2007 by scientists at [[Duke University Medical Center]] in North Carolina. They genetically engineered mice that lacked a [[gene]] called [[SAPAP3]]. This [[protein]] is highly expressed in the [[striatum]], an area of the [[brain]] linked to planning and the initiation of appropriate actions. The mice spent three times as much time grooming themselves as ordinary mice, to the point that their fur fell off.<ref>[http://www.newscientist.com/channel/life/genetics/mg19526183.400-missing-gene-creates-obsessivecompulsive-mouse-.html Missing gene creates obsessive–compulsive mouse], ''[[New Scientist]]'', August 2007</ref> |
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Using tools like [[positron emission tomography]] (PET scans), it has been shown that those with OCD tend to have brain activity{{Vague|date=April 2009}} that differs from those who do not have this disorder.<ref>Tennen, M. 2005, June. "Causes of OCD Remain a Mystery". <http://www.healthatoz.com/ healthatoz/Atoz/dc/cen/ment/obcd/alert07172003.jsp>. Accessed April 14, 2006.</ref> In the book, ''Brain Lock'', [[Jeffrey M. Schwartz]] suggests that OCD is caused by the part of the brain{{Vague|date=April 2009}} that is responsible for translating complex intentions (e.g., "I will pick up this cup") into fundamental actions (e.g., "move arm forward, rotate hand 15 degrees, etc.") failing correctly to communicate the chemical message that an action has been completed. This is perceived as a feeling of doubt and incompleteness, which then leads the individual to attempt consciously to deconstruct their own prior behavior—a process which induces anxiety in most people, even those without OCD {{Fact|date=June 2008}}. |
Using tools like [[positron emission tomography]] (PET scans), it has been shown that those with OCD tend to have brain activity{{Vague|date=April 2009}} that differs from those who do not have this disorder.<ref>Tennen, M. 2005, June. "Causes of OCD Remain a Mystery". <http://www.healthatoz.com/ healthatoz/Atoz/dc/cen/ment/obcd/alert07172003.jsp>. Accessed April 14, 2006.</ref> In the book, ''Brain Lock'', [[Jeffrey M. Schwartz]] suggests that OCD is caused by the part of the brain{{Vague|date=April 2009}} that is responsible for translating complex intentions (e.g., "I will pick up this cup") into fundamental actions (e.g., "move arm forward, rotate hand 15 degrees, etc.") failing correctly to communicate the chemical message that an action has been completed. This is perceived as a feeling of doubt and incompleteness, which then leads the individual to attempt consciously to deconstruct their own prior behavior—a process which induces anxiety in most people, even those without OCD {{Fact|date=June 2008}}. |
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It has been theorized that a miscommunication between the [[orbitofrontal cortex]], the [[caudate nucleus]], and the [[thalamus]] may be a factor in the explanation of OCD. The orbitofrontal cortex (OFC) is the first part of the brain to notice whether or not something is wrong.{{Vague|date=September 2008}} When the OFC notices that something is wrong, it sends an initial "worry signal" to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to interpret the worrying event. The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in [[compulsive behaviors]] in an attempt to relieve this apprehension.<ref name="bbc" /> This overactivity of the OFC is shown to be attenuated in patients who have successfully responded to [[SSRI]] medication. The increased stimulation of the [[serotonin]] receptors [[5-HT2A receptor|5-HT2A]] and [[serotonin receptor|5-HT2C]] in the OFC is believed to cause this inhibition. <ref>[http://neuro.psychiatryonline.org/cgi/content/full/14/1/88 |
It has been theorized that a miscommunication between the [[orbitofrontal cortex]], the [[caudate nucleus]], and the [[thalamus]] may be a factor in the explanation of OCD. The orbitofrontal cortex (OFC) is the first part of the brain to notice whether or not something is wrong.{{Vague|date=September 2008}} When the OFC notices that something is wrong, it sends an initial "worry signal" to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to interpret the worrying event. The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in [[compulsive behaviors]] in an attempt to relieve this apprehension.<ref name="bbc" /> This overactivity of the OFC is shown to be attenuated in patients who have successfully responded to [[SSRI]] medication. The increased stimulation of the [[serotonin]] receptors [[5-HT2A receptor|5-HT2A]] and [[serotonin receptor|5-HT2C]] in the OFC is believed to cause this inhibition. <ref>[http://neuro.psychiatryonline.org/cgi/content/full/14/1/88 Obsessive–compulsive disorder associated with a left orbitofrontal infarct] J Neuropsychiatry Clin Neurosci 14 (1): 88</ref> |
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Some research has discovered an association between a type of size abnormality in different [[brain structures]] and the predisposition to develop OCD. Through the use of [[magnetic resonance imaging]] (MRI), researchers at [[Cambridge's Brain Mapping Unit]] were able to discover distinctive patterns in the brain structure of individuals with OCD and their close family members. <ref>[http://www.admin.cam.ac.uk/news/dp/2007112601 Brain pattern associated with genetic risk of Obsessive Compulsive Disorder<!-- Bot generated title -->]</ref> This is the first instance in which it has been demonstrated that those with a familial risk of developing OCD have anatomical differences when compared with ordinary individuals. The discovery of these structural differences in the area of the brain associated with stopping [[motor response]] may ultimately aid researchers who seek to determine which genes contribute to the development of OCD. |
Some research has discovered an association between a type of size abnormality in different [[brain structures]] and the predisposition to develop OCD. Through the use of [[magnetic resonance imaging]] (MRI), researchers at [[Cambridge's Brain Mapping Unit]] were able to discover distinctive patterns in the brain structure of individuals with OCD and their close family members. <ref>[http://www.admin.cam.ac.uk/news/dp/2007112601 Brain pattern associated with genetic risk of Obsessive Compulsive Disorder<!-- Bot generated title -->]</ref> This is the first instance in which it has been demonstrated that those with a familial risk of developing OCD have anatomical differences when compared with ordinary individuals. The discovery of these structural differences in the area of the brain associated with stopping [[motor response]] may ultimately aid researchers who seek to determine which genes contribute to the development of OCD. |
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In some patients, the consumption of [[caffeine]] may make OCD symptoms worse. <ref>[http://findarticles.com/p/articles/mi_m0ISW/is_249/ai_114820684 Caffeine anaphylaxis-stage II: |
In some patients, the consumption of [[caffeine]] may make OCD symptoms worse. <ref>[http://findarticles.com/p/articles/mi_m0ISW/is_249/ai_114820684 Caffeine anaphylaxis-stage II: obsessive–compulsive disorder], Townsend Letter for Doctors and Patients, April, 2004, by Ruth Whalen</ref> |
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== Demographics and other statistics == |
== Demographics and other statistics == |
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In a 1980 study of 20,000 adults from [[New Haven]], [[Baltimore]], [[St. Louis]], [[Durham]], and [[Los Angeles]], the lifetime prevalence rate of OCD for both sexes was recorded at 2.5 percent. Education also appears to be a factor. The lifetime prevalence of OCD is lower for those who have graduated high school than for those who have not (1.9 percent versus 3.4 percent). However, in the case of college education, lifetime prevalence is higher for those who graduate with a degree (3.1 percent) than it is for those who have only some college background (2.4 percent). As far as age is concerned, the onset of OCD usually ranges from the late teenage years until the mid-20s in both sexes, but the age of onset tends to be slightly younger in males than in females.<ref>Antony, M. M.; F. Downie & R. P. Swinson. "Diagnostic |
In a 1980 study of 20,000 adults from [[New Haven]], [[Baltimore]], [[St. Louis]], [[Durham]], and [[Los Angeles]], the lifetime prevalence rate of OCD for both sexes was recorded at 2.5 percent. Education also appears to be a factor. The lifetime prevalence of OCD is lower for those who have graduated high school than for those who have not (1.9 percent versus 3.4 percent). However, in the case of college education, lifetime prevalence is higher for those who graduate with a degree (3.1 percent) than it is for those who have only some college background (2.4 percent). As far as age is concerned, the onset of OCD usually ranges from the late teenage years until the mid-20s in both sexes, but the age of onset tends to be slightly younger in males than in females.<ref>Antony, M. M.; F. Downie & R. P. Swinson. "Diagnostic issues and epidemiology in obsessive–compulsive disorder". in ''Obsessive–Compulsive Disorder: Theory, Research, and Treatment'', eds. M. M. Antony; S. Rachman; M. A. Richter & R. P. Swinson. New York: The Guilford Press, 1998, pp. 3-32. </ref> |
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It has been alleged that sufferers are generally of above-average [[intelligence]], as the very nature of the disorder necessitates complicated thinking patterns<ref>[http://books.google.com/books?id=vzFN_g-d7aoC&pg=PA19&lpg=PA19&dq=ocd+high+intelligence&source=web&ots=JOgDKEj9X_&sig=0UyjOlDNLpUaw879g9PBsNBkHmM&hl=en&sa=X&oi=book_result&resnum=10&ct=result]</ref>. |
It has been alleged that sufferers are generally of above-average [[intelligence]], as the very nature of the disorder necessitates complicated thinking patterns<ref>[http://books.google.com/books?id=vzFN_g-d7aoC&pg=PA19&lpg=PA19&dq=ocd+high+intelligence&source=web&ots=JOgDKEj9X_&sig=0UyjOlDNLpUaw879g9PBsNBkHmM&hl=en&sa=X&oi=book_result&resnum=10&ct=result]</ref>. |
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==Treatment== |
==Treatment== |
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According to the Expert Consensus Guidelines for the Treatment of |
According to the Expert Consensus Guidelines for the Treatment of obsessive–compulsive disorder, [[behavioral therapy]] (BT), [[cognitive therapy]] (CT), and [[Psychiatric medication|medications]] are first-line treatments for OCD. [[Psychodynamic psychotherapy]] may help in managing some aspects of the disorder, but there are no controlled studies that demonstrate effectiveness of [[psychoanalysis]] or [[dynamic psychotherapy]] in OCD.<ref name="APAguidelines">Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB; American Psychiatric Association. {{PDFlink|"[http://www.psych.org/psych_pract/treatg/pg/OCDPracticeGuidelineFinal05-04-07.pdf Practice guideline for the treatment of patients with obsessive–compulsive disorder]."|1.10 [[Mebibyte|MiB]]<!-- application/pdf, 1161779 bytes -->}} Am J Psychiatry 2007; 164(7 Suppl): 5-53. PMID 17849776.</ref> |
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===Behavioral therapy === |
===Behavioral therapy === |
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The specific technique used in BT/CBT is called [[Exposure and response|exposure and ritual prevention]] (also known as "[[exposure and response prevention]]") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly [[habituation|habituates]] to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking. |
The specific technique used in BT/CBT is called [[Exposure and response|exposure and ritual prevention]] (also known as "[[exposure and response prevention]]") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly [[habituation|habituates]] to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking. |
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Exposure ritual/response prevention has been demonstrated to be the most effective treatment for OCD. It has generally been accepted that [[psychotherapy]], in combination with [[psychotropic medication]], is more effective than either option alone. However, more recent studies have shown no difference in outcomes for those treated with the combination of medicine and CBT versus CBT alone.<ref>Foa EB, Liebowitz MR, Kozak MJ, Davies S, Campeas R, Franklin ME, Huppert JD, Kjernisted K, Rowan V, Schmidt AB, Simpson HB, Tu X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of |
Exposure ritual/response prevention has been demonstrated to be the most effective treatment for OCD. It has generally been accepted that [[psychotherapy]], in combination with [[psychotropic medication]], is more effective than either option alone. However, more recent studies have shown no difference in outcomes for those treated with the combination of medicine and CBT versus CBT alone.<ref>Foa EB, Liebowitz MR, Kozak MJ, Davies S, Campeas R, Franklin ME, Huppert JD, Kjernisted K, Rowan V, Schmidt AB, Simpson HB, Tu X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive–compulsive disorder. Am J Psychiatry, 162(1):151-61.</ref> |
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Recently it has been reported simultaneous administration of D-Cycloserin (an antibiotic) substantially improves effectiveness of Exposure and Response prevention.<ref>{{cite journal|last=Wilhelm|coauthors=Buhlmann U, Tolin DF, Meunier SA, Pearlson GD, Reese HE, Cannistraro P, Jenike MA, Rauch SL.|date=2008 March|title=Augmentation of behavior therapy with D-cycloserine for |
Recently it has been reported simultaneous administration of D-Cycloserin (an antibiotic) substantially improves effectiveness of Exposure and Response prevention.<ref>{{cite journal|last=Wilhelm|coauthors=Buhlmann U, Tolin DF, Meunier SA, Pearlson GD, Reese HE, Cannistraro P, Jenike MA, Rauch SL.|date=2008 March|title=Augmentation of behavior therapy with D-cycloserine for obsessive–compulsive disorder.|journal=Am J Psychiatry|volume=165|issue=3|pages=335–41|url=http://www.ncbi.nlm.nih.gov/pubmed/18245177|doi=10.1176/appi.ajp.2007.07050776|pmid=18245177}}</ref> |
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===Medication=== |
===Medication=== |
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Medications as treatment include [[selective serotonin reuptake inhibitor]]s (SSRIs) such as [[paroxetine]], [[sertraline]], [[fluoxetine]], [[escitalopram]], and [[fluvoxamine]] as well as the [[tricyclic antidepressant]]s, in particular [[clomipramine]]. SSRIs prevent excess [[serotonin]] from being pumped back into the original [[neuron]] that released it. Instead, serotonin can then bind to the [[receptor (biochemistry)|receptor]] sites of nearby neurons and send chemical messages or signals that can help regulate the excessive [[anxiety]] and obsessive thoughts. In some treatment-resistant cases, a combination of [[clomipramine]] and an SSRI has shown to be effective even when neither drug on its own has been efficacious. |
Medications as treatment include [[selective serotonin reuptake inhibitor]]s (SSRIs) such as [[paroxetine]], [[sertraline]], [[fluoxetine]], [[escitalopram]], and [[fluvoxamine]] as well as the [[tricyclic antidepressant]]s, in particular [[clomipramine]]. SSRIs prevent excess [[serotonin]] from being pumped back into the original [[neuron]] that released it. Instead, serotonin can then bind to the [[receptor (biochemistry)|receptor]] sites of nearby neurons and send chemical messages or signals that can help regulate the excessive [[anxiety]] and obsessive thoughts. In some treatment-resistant cases, a combination of [[clomipramine]] and an SSRI has shown to be effective even when neither drug on its own has been efficacious. |
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[[Benzodiazepines]] are also used in treatment. It's not uncommon to administer this class of drugs during the "latency period" for SSRIs or as synergistic adjunct long-term. Although widely prescribed, benzodiazepines have not been demonstrated as an effective treatment for OCD and may be habit-forming in those with a history of substance abuse.<ref>Blanco C, Olfson M, Stein DJ, Simpson HB, Gameroff MJ, Narrow WH. (2006). Treatment of |
[[Benzodiazepines]] are also used in treatment. It's not uncommon to administer this class of drugs during the "latency period" for SSRIs or as synergistic adjunct long-term. Although widely prescribed, benzodiazepines have not been demonstrated as an effective treatment for OCD and may be habit-forming in those with a history of substance abuse.<ref>Blanco C, Olfson M, Stein DJ, Simpson HB, Gameroff MJ, Narrow WH. (2006). Treatment of obsessive–compulsive disorder by U.S. psychiatrists. J Clin Psychiatry, 67(6):946-51.</ref> |
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[[Serotonergic]] [[antidepressant]]s typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. In addition to this, the treatment usually requires high doses. [[Fluoxetine]], for example, is usually prescribed in doses of 20 mg per day for clinical depression, whereas with OCD the dose will often range from 20 mg to 80 mg or higher, if necessary. In most cases [[Antidepressant|antidepressant therapy]] alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Much current research is devoted to the therapeutic potential of the agents that effect the release of the neurotransmitter [[glutamate]] or the binding to its receptors. These include [[riluzole]], [[memantine]], [[gabapentin]] and [[lamotrigine]]. |
[[Serotonergic]] [[antidepressant]]s typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. In addition to this, the treatment usually requires high doses. [[Fluoxetine]], for example, is usually prescribed in doses of 20 mg per day for clinical depression, whereas with OCD the dose will often range from 20 mg to 80 mg or higher, if necessary. In most cases [[Antidepressant|antidepressant therapy]] alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Much current research is devoted to the therapeutic potential of the agents that effect the release of the neurotransmitter [[glutamate]] or the binding to its receptors. These include [[riluzole]], [[memantine]], [[gabapentin]] and [[lamotrigine]]. |
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Low doses of the newer [[atypical antipsychotic]]s [[olanzapine]], [[quetiapine]], [[ziprasidone]] and [[risperidone]] have also been found to be useful as adjuncts in the treatment of OCD. The use of [[antipsychotic]]s in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their [[dopamine receptor]] [[antagonism]]), at high doses these same antipsychotics have proven to cause dramatic |
Low doses of the newer [[atypical antipsychotic]]s [[olanzapine]], [[quetiapine]], [[ziprasidone]] and [[risperidone]] have also been found to be useful as adjuncts in the treatment of OCD. The use of [[antipsychotic]]s in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their [[dopamine receptor]] [[antagonism]]), at high doses these same antipsychotics have proven to cause dramatic obsessive–compulsive symptoms even in those patients who do not normally have OCD{{Fact|date=March 2009}}. This can be due to the antagonism of [[5-HT2A receptors]] becoming very prominent at these doses and outweighing the benefits of [[dopamine]] antagonism. However antidepressant mirtazapine which is a 5-HT2A antagonist has shown to be of benefit to OCD patients<ref>Koran LM, Gamel NN, Choung HW, Smith EH, Aboujaoude EN (2005). "Mirtazapine for obsessive–compulsive disorder: an open trial followed by double-blind discontinuation". Journal of Clinical Psychiatry 66 (4): 515–520.</ref>. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief [[enzyme]] that is responsible for [[metabolism|metabolising]] antipsychotics—[[CYP2D6]]—so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results. |
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===Alternative drug treatments=== |
===Alternative drug treatments=== |
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The naturally occurring sugar [[inositol]] has been suggested as a treatment for OCD<ref>{{cite web |url=http://www.biopsychiatry.com/inositol.htm |title=Inositol in psychiatry |accessdate=2007-06-28 |format= |work=}}</ref>, as it appears to modulate the actions of serotonin and reverse [[desensitisation]] of [[neurotransmitter]] receptors. [[St John's Wort]] has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities{{Facts|date=March 2009}}, although a double-blind study using a flexible-dose schedule (600-1800 mg/day) found no difference between St John's Wort and a placebo<ref>{{cite journal |author=Kobak KA, ''et al'' |title=St John's wort versus placebo in |
The naturally occurring sugar [[inositol]] has been suggested as a treatment for OCD<ref>{{cite web |url=http://www.biopsychiatry.com/inositol.htm |title=Inositol in psychiatry |accessdate=2007-06-28 |format= |work=}}</ref>, as it appears to modulate the actions of serotonin and reverse [[desensitisation]] of [[neurotransmitter]] receptors. [[St John's Wort]] has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities{{Facts|date=March 2009}}, although a double-blind study using a flexible-dose schedule (600-1800 mg/day) found no difference between St John's Wort and a placebo<ref>{{cite journal |author=Kobak KA, ''et al'' |title=St John's wort versus placebo in obsessive–compulsive disorder: results from a double-blind study. |
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|journal=Int Clin Psychopharmacol. |volume=20 |issue=6 |pages=299–304 |year=2005 |pmid=16192837 | doi = 10.1097/00004850-200511000-00003 |
|journal=Int Clin Psychopharmacol. |volume=20 |issue=6 |pages=299–304 |year=2005 |pmid=16192837 | doi = 10.1097/00004850-200511000-00003 |
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}}</ref>. |
}}</ref>. |
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[[Opioid]]s may significantly reduce OCD symptoms, though their use is not sanctioned for treatment due to [[physical dependence]] and long term drug tolerance{{Facts|date=March 2009}}. Tramadol is an atypical opioid that appears to provide the anti-OCD effects of an [[opiate]] and inhibit the [[re-uptake]] of serotonin (in addition to [[norepinephrine]])<ref>{{cite journal |author=Goldsmith TB, Shapira NA, Keck PE |title=Rapid remission of OCD with tramadol hydrochloride |journal=The American journal of psychiatry |volume=156 |issue=4 |pages=660–1 |year=1999 |pmid=10200754 |doi= |url=http://ajp.psychiatryonline.org/cgi/content/full/156/4/660a}}</ref>. |
[[Opioid]]s may significantly reduce OCD symptoms, though their use is not sanctioned for treatment due to [[physical dependence]] and long term drug tolerance{{Facts|date=March 2009}}. Tramadol is an atypical opioid that appears to provide the anti-OCD effects of an [[opiate]] and inhibit the [[re-uptake]] of serotonin (in addition to [[norepinephrine]])<ref>{{cite journal |author=Goldsmith TB, Shapira NA, Keck PE |title=Rapid remission of OCD with tramadol hydrochloride |journal=The American journal of psychiatry |volume=156 |issue=4 |pages=660–1 |year=1999 |pmid=10200754 |doi= |url=http://ajp.psychiatryonline.org/cgi/content/full/156/4/660a}}</ref>. |
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[[Tryptamine]] [[alkaloid]] [[psilocybin]] has been attempted as treatment<ref>{{cite web |url=http://www.maps.org/research/psilo/azproto.html |title=Psilocybin in the Treatment of Obsessive Compulsive Disorder |accessdate=2007-06-28 |format= |work=}}</ref>. There are reports that other [[hallucinogen]]s such as [[LSD]] and [[peyote]] have produced similar effects{{Facts|date=March 2009}}. It has been hypothesised that this effect may be due to stimulation of [[5-HT2A receptor]]s and, less significantly, [[Serotonin receptor|5-HT2C receptors]]; this causes an inhibitory effect on the [[orbitofrontal cortex]], an area of the brain in which [[hyperactivity]] has been strongly associated with OCD<ref>{{cite journal |author=Perrine DM |title=Hallucinogens and |
[[Tryptamine]] [[alkaloid]] [[psilocybin]] has been attempted as treatment<ref>{{cite web |url=http://www.maps.org/research/psilo/azproto.html |title=Psilocybin in the Treatment of Obsessive Compulsive Disorder |accessdate=2007-06-28 |format= |work=}}</ref>. There are reports that other [[hallucinogen]]s such as [[LSD]] and [[peyote]] have produced similar effects{{Facts|date=March 2009}}. It has been hypothesised that this effect may be due to stimulation of [[5-HT2A receptor]]s and, less significantly, [[Serotonin receptor|5-HT2C receptors]]; this causes an inhibitory effect on the [[orbitofrontal cortex]], an area of the brain in which [[hyperactivity]] has been strongly associated with OCD<ref>{{cite journal |author=Perrine DM |title=Hallucinogens and obsessive–compulsive disorder |journal=Am J Psychiatry |volume=156 |issue=7 |pages=1123 |year=1999 |month=July |pmid=10401480 |doi= |url=http://www.ajp.psychiatryonline.org/cgi/content/full/156/7/1123 }}</ref>. |
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Regular [[nicotine]] treatment may ameliorate symptoms of OCD, although the [[pharmacodynamics|pharmacodynamical]] mechanism by which this is achieved is not yet known, and more detailed studies are needed to fully confirm this [[hypothesis]]<ref>{{cite journal |author=Lundberg S, Carlsson A, Norfeldt P, Carlsson ML |title=Nicotine treatment of |
Regular [[nicotine]] treatment may ameliorate symptoms of OCD, although the [[pharmacodynamics|pharmacodynamical]] mechanism by which this is achieved is not yet known, and more detailed studies are needed to fully confirm this [[hypothesis]]<ref>{{cite journal |author=Lundberg S, Carlsson A, Norfeldt P, Carlsson ML |title=Nicotine treatment of obsessive–compulsive disorder |journal=Prog. Neuropsychopharmacol. Biol. Psychiatry |volume=28 |issue=7 |pages=1195–9 |year=2004 |pmid=15610934 |doi=10.1016/j.pnpbp.2004.06.014}}</ref>. |
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===Psycho-surgery=== |
===Psycho-surgery=== |
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For some, neither medication, support groups nor psychological treatments are helpful in alleviating |
For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive–compulsive symptoms. These patients may choose to undergo [[psychosurgery]] as a last resort. In this procedure, a surgical [[lesion]] is made in an area of the brain (the [[cingulate bundle]]). In one study, 30% of participants benefited significantly from this procedure.<ref name="Barlow" /> [[Deep-brain stimulation]] and [[vagus nerve stimulation]] are possible surgical options which do not require the destruction of [[brain tissue]], although their efficacy has not been conclusively demonstrated. |
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In the US, psychosurgery for OCD is a treatment of last resort and will not be performed until the patient has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive [[ |
In the US, psychosurgery for OCD is a treatment of last resort and will not be performed until the patient has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive [[cognitive–behavioral therapy]] with exposure and ritual/response prevention.<ref>[http://www.brainphysics.com/surgery.php Surgical Procedures for Obsessive–Compulsive Disorder], by M. Jahn and M. Williams, Ph.D,. BrainPhysics OCD Resource, Accessed July 6, 2008. </ref> Likewise, in the UK, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive–behavioral therapist has been carried out. |
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==Neuropsychiatry== |
==Neuropsychiatry== |
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== Notable cases == |
== Notable cases == |
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*British poet, essayist, and lexicographer [[Samuel Johnson]] is an example of a historical figure with a [[retrospective diagnosis]] of OCD. He had elaborate rituals for crossing the thresholds of doorways, repeatedly walked up and down staircases counting the steps, and had compulsions regarding repetitive prayer which were most likely a form of religious scrupulosity.<ref>http://connection.ebscohost.com/content/article/1025069545.html;jsessionid=938C34157D8D0790770F0238141B4493.ehctc1 Samuel Johnson, literary genius and OCD victim. Nutrition Health Review: The Consumer's Medical Journal; Winter91, Issue 57, p5.</ref><ref>http://westsuffolkpsych.homestead.com/Johnson.html SAMUEL JOHNSON (1709-1784): |
*British poet, essayist, and lexicographer [[Samuel Johnson]] is an example of a historical figure with a [[retrospective diagnosis]] of OCD. He had elaborate rituals for crossing the thresholds of doorways, repeatedly walked up and down staircases counting the steps, and had compulsions regarding repetitive prayer which were most likely a form of religious scrupulosity.<ref>http://connection.ebscohost.com/content/article/1025069545.html;jsessionid=938C34157D8D0790770F0238141B4493.ehctc1 Samuel Johnson, literary genius and OCD victim. Nutrition Health Review: The Consumer's Medical Journal; Winter91, Issue 57, p5.</ref><ref>http://westsuffolkpsych.homestead.com/Johnson.html SAMUEL JOHNSON (1709-1784): |
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A Patron Saint of OCD? by Fred Penzel, Ph.D. from the Science Advisory Board of the |
A Patron Saint of OCD? by Fred Penzel, Ph.D. from the Science Advisory Board of the Obsessive–Compulsive Foundation</ref><ref>http://www.mindpub.com/art067.htm Obsessive Thinking, Compulsive Behaviors. Vijai P. Sharma, Ph.D. Clinical Psychologist</ref> |
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*American aviator and filmmaker [[Howard Hughes]] is known to have suffered from OCD and it is believed that his mother may have also been a sufferer. Friends of Hughes have mentioned his obsession with minor flaws in clothing and he is reported to have had a great fear of germs, common among OCD patients.<ref>{{cite journal | url=http://www.apa.org/monitor/julaug05/hughes.html |title=Hughes's germ phobia revealed in psychological autopsy | journal=APA Online: Monitor on Psychology | volume=36 | issue=7 | date=July/August 2005}}</ref> He did also suffer from Social Anxiety Disorder (SAD) and Post-traumatic Stress Disorder (PTSD) due to an aviation accident in which he was severely injured. This resulted in him becoming reclusive later in life. |
*American aviator and filmmaker [[Howard Hughes]] is known to have suffered from OCD and it is believed that his mother may have also been a sufferer. Friends of Hughes have mentioned his obsession with minor flaws in clothing and he is reported to have had a great fear of germs, common among OCD patients.<ref>{{cite journal | url=http://www.apa.org/monitor/julaug05/hughes.html |title=Hughes's germ phobia revealed in psychological autopsy | journal=APA Online: Monitor on Psychology | volume=36 | issue=7 | date=July/August 2005}}</ref> He did also suffer from Social Anxiety Disorder (SAD) and Post-traumatic Stress Disorder (PTSD) due to an aviation accident in which he was severely injured. This resulted in him becoming reclusive later in life. |
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{{Col-2-of-3}} |
{{Col-2-of-3}} |
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* [[Intrusive thoughts]] |
* [[Intrusive thoughts]] |
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* ''[[Monk (TV series)]]'' about a detective with |
* ''[[Monk (TV series)]]'' about a detective with obsessive–compulsive disorder |
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* [[Mysophobia]] |
* [[Mysophobia]] |
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* [[ |
* [[Obsessive–compulsive personality disorder]] |
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* [[Orbitofrontal cortex]] |
* [[Orbitofrontal cortex]] |
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* [[PANDAS]] – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections |
* [[PANDAS]] – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections |
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* [[Tourette syndrome]] |
* [[Tourette syndrome]] |
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* [[Trichotillomania]] |
* [[Trichotillomania]] |
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* [[ |
* [[Yale–Brown Obsessive Compulsive Scale]] |
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{{col-end}} |
{{col-end}} |
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==Further reading== |
==Further reading== |
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* ''My Worktime Routine'', ISBN 1-59-113901-5, by David Vince. |
* ''My Worktime Routine'', ISBN 1-59-113901-5, by David Vince. |
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*{{cite book |author=Beyette, Beverly; Schwartz, Jeffrey H. |title=Brain lock: free yourself from |
*{{cite book |author=Beyette, Beverly; Schwartz, Jeffrey H. |title=Brain lock: free yourself from obsessive–compulsive behavior: a four-step self-treatment method to change your brain chemistry |publisher=ReganBooks |location=New York |year=1997 |pages= |isbn=0-06-098711-1 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=Salzman, Leon |title=Treatment of the obsessive personality |publisher=J. Aronson |location=Northvale, N.J |year=1985 |pages= |isbn=0-87668-881-4 |oclc= |doi= |accessdate=}} |
*{{cite book |author=Salzman, Leon |title=Treatment of the obsessive personality |publisher=J. Aronson |location=Northvale, N.J |year=1985 |pages= |isbn=0-87668-881-4 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=Jonathan Grayson |title=Freedom From |
*{{cite book |author=Jonathan Grayson |title=Freedom From Obsessive–Compulsive Disorder: A Personalized Recovery Program For Living With Uncertainty |publisher=Jeremy P. Tarcher |location=New York |year=2003 |pages= |isbn=1-58542-246-0 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=Rachman, Stanley; Rachman, S. J. |title=The treatment of obsessions |publisher=Oxford University Press |location=Oxford [Oxfordshire] |year=2003 |pages= |isbn=0-19-851537-5 |oclc= |doi= |accessdate=}} |
*{{cite book |author=Rachman, Stanley; Rachman, S. J. |title=The treatment of obsessions |publisher=Oxford University Press |location=Oxford [Oxfordshire] |year=2003 |pages= |isbn=0-19-851537-5 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=Sharon Begley; Schwartz, Jeffrey H. |title=The Mind and the Brain : Neuroplasticity and the Power of Mental Force |publisher=Regan Books |location=New York |year=2003 |pages= |isbn=0-06-098847-9 |oclc= |doi= |accessdate=}} |
*{{cite book |author=Sharon Begley; Schwartz, Jeffrey H. |title=The Mind and the Brain : Neuroplasticity and the Power of Mental Force |publisher=Regan Books |location=New York |year=2003 |pages= |isbn=0-06-098847-9 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=Lee, PhD. Baer |title=The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts |publisher=Plume Books |location=New York |year=2002 |pages= |isbn=0-452-28307-8 |oclc= |doi= |accessdate=}} |
*{{cite book |author=Lee, PhD. Baer |title=The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts |publisher=Plume Books |location=New York |year=2002 |pages= |isbn=0-452-28307-8 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=Penzel, Fred |title= |
*{{cite book |author=Penzel, Fred |title=Obsessive–compulsive disorders: a complete guide to getting well and staying well |publisher=Oxford University Press |location=Oxford [Oxfordshire] |year=2000 |pages= |isbn=0-19-514092-3 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=Seligman, Martin E. P. |chapter=Obsessions |title=What you can |
*{{cite book |author=Seligman, Martin E. P. |chapter=Obsessions |title=What you can change—and what you can't: the complete guide to successful self-improvement: learning to accept who you are |publisher=Fawcett Columbine |location=New York |year=1995 |pages= |isbn=0-449-90971-9 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=IAN OSBORN |title=Tormenting Thoughts and Secret Rituals : The Hidden Epidemic of |
*{{cite book |author=IAN OSBORN |title=Tormenting Thoughts and Secret Rituals : The Hidden Epidemic of Obsessive–Compulsive Disorder |publisher=Dell |location=New York |year=1999 |pages= |isbn=0-440-50847-9 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=Cooper, David A. |title=The Art of Meditation |publisher=Jaico Publishing House |location= |year=2005 |pages= |isbn=81-7992-164-6 |oclc= |doi= |accessdate=}} |
*{{cite book |author=Cooper, David A. |title=The Art of Meditation |publisher=Jaico Publishing House |location= |year=2005 |pages= |isbn=81-7992-164-6 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=Wilson, Rob; David Veale |title=Overcoming |
*{{cite book |author=Wilson, Rob; David Veale |title=Overcoming Obsessive–Compulsive Disorder |publisher=Constable & Robinson Ltd |location= |year=2005 |pages= |isbn=1-84119-936-2 |oclc= |doi= |accessdate=}} |
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*{{cite book |author=John B. |title=The Boy Who Finally Stopped Washing: OCD From Both Sides of the Couch |publisher=Cooper Union Press |year=2008 |pages= |isbn=9780979133961}} |
*{{cite book |author=John B. |title=The Boy Who Finally Stopped Washing: OCD From Both Sides of the Couch |publisher=Cooper Union Press |year=2008 |pages= |isbn=9780979133961}} |
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== External links == |
== External links == |
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* [http://www.brainphysics.com/ocdfaq.php Frequently Asked Questions about |
* [http://www.brainphysics.com/ocdfaq.php Frequently Asked Questions about Obsessive–Compulsive Disorder], at BrainPhysics OCD Resource, developed by the OC and Spectrum Disorders Association |
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{{Mental and behavioral disorders}} |
{{Mental and behavioral disorders}} |
Revision as of 07:21, 15 April 2009
Obsessive–compulsive disorder | |
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Specialty | Psychiatry, psychology ![]() |
Obsessive–compulsive disorder (OCD) is a mental disorder characterized by intrusive thoughts, or obsessions resulting in compulsive behaviors and mental acts that the person feels driven to perform, according to rules that must be applied rigidly, aimed at reducing anxiety stemming from the intrusive thoughts.
Compulsions may include touching or checking things repeatedly until the anxiety diminishes. In severe cases, OCD affects a person's ability to function in everyday activities. Such a person may take several hours a day to carry out the compulsive acts. Also, the psychological self-awareness of the irrationality of the disorder can be painful.
OCD is the fourth most common mental disorder and is diagnosed nearly as often as the physiological ailments asthma and diabetes mellitus.[1] In the United States, one in 50 adults has OCD.[2] The phrase "obsessive–compulsive" has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is meticulous, perfectionistic, absorbed in a cause, or otherwise fixated on something or someone.[3] Although these signs are often present in OCD, a person who exhibits them does not necessarily have OCD, and may instead have obsessive–compulsive personality disorder (OCPD) or some other condition.
Diagnostic criteria
To be diagnosed with OCD, a person must have obsessions and/or compulsions, according to the DSM-IV-TR diagnostic criteria. The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000)[4] states six characteristics of obsessions and compulsions:
- Obsessions
- Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and that cause marked anxiety or distress.
- The thoughts, impulses, or images are not simply excessive worries about real-life problems.
- The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.
- The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.
- Compulsions
- Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
- The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not actually connected to the issue, or they are excessive.
In addition to these criteria, at some point during the course of the disorder, the individual must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning.[4] OCD often causes feelings similar to those of depression.
Symptoms and prevalence
OCD manifests in a variety of forms. Studies have placed the prevalence between one and three percent, although the prevalence of clinically recognized OCD is much lower, suggesting that many individuals with the disorder may not be diagnosed.[5] The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD.
The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession-related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, repeatedly washing hands at regular intervals throughout the day, touching objects a certain number of times before leaving a room, or walking in a certain routine way. Physical symptoms may include those brought on from anxieties and unwanted thoughts, as well as tics or Parkinson's disease-like symptoms: rigidity, tremor, jerking arm movements, or involuntary movements of the limbs.
Formal diagnosis may be performed by a psychologist, a psychiatrist or psychoanalyst. OCD sufferers are aware that their thoughts and behavior are not rational,[6] but they feel bound to comply with them to fend off feelings of panic or dread. Although everyone may experience unpleasant thoughts at one time or another, these are short-lived and fade away in time.[7] For people with OCD, the thoughts are intrusive and persistent, and can cause them great anxiety and distress.[8]
Intrusive thoughts are unwelcome, involuntary thoughts, images or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to be free of and manage.[9] As with other forms of OCD, the awareness of the irrationality of these thoughts can be frustrating as the individual wishes to stop them but cannot. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, usually falling into three categories: inappropriate aggressive thoughts, inappropriate sexual thoughts, and blasphemous religious thoughts.[10] Most people experience these thoughts; when they are associated with OCD or depression, they may become paralyzing, anxiety-provoking, and persistent. Many people experience the type of unpleasant or unwanted thoughts that people with more troubling intrusive thoughts have, but most people are able to dismiss these thoughts.[9] When intrusive thoughts co-occur with OCD, patients are less capable of ignoring the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing.[9]
The common underlying theme to the diverse intrusive thoughts is summarised by Bruce et al with the example, "What if I were to snap, lose control of myself, and do something totally uncharacteristic of me—perhaps even without my knowing it—that results in harm to myself or someone else?"[11]
OCD without Overt compulsions
A major subtype of OCD is OCD without overt compulsions.[12] OCD without overt compulsions is often referred to as "pure-O" by laymen and sufferers of this disorder. The term is a bit of a misnomer, however, because OCD without overt compulsions is no more "pure" than any other form of OCD. Nonetheless, OCD without overt compulsions represents a major subtype of OCD with some of the estimates as high 50-60%.[13] Rather than engaging in observable rituals and compulsions, the person with OCD without overt compulsions engages in all manner of mental neutralizing behaviours (i.e. "covert" compulsions).
Intrusive thoughts may involve violent obsessions about hurting others or oneself.[14] They can include such thoughts as harming an innocent child, jumping from a bridge, mountain or the top of a tall building, urges to jump in front of a train or automobile, and urges to push another in front of a train or automobile.[10] A survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including imagining or wishing harm upon a family member or friend, impulses to attack or kill a small child, or animal, or shout something rude or violent.[15]
The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and anger over bad thoughts are different from those who actually act on bad thoughts. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts, and has never acted on them before, is an excellent predictor that they won't act upon the thoughts. According to Baer, a patient should be concerned that intrusive thoughts are dangerous if the person doesn't feel upset by the thoughts, rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others don't see; or feels uncontrollable irresistible anger.[16]
Sexual obsessions may involve intrusive thoughts or images of "kissing, hugging a lot, touching, fondling, oral sex, anal sex, intercourse, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", involving "heterosexual or homosexual content" with persons of any age.[17] Like other intrusive, unpleasant thoughts or images, most people have some sexual thoughts at times, but people with OCD may attach significance to the unwanted sexual thoughts, generating anxiety and distress. The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the bad thoughts, resulting in self-criticism or loathing.[17]
OCD with Overt Compulsions
Other major subtypes of OCD frequently revolve around washing or checking; some sufferers may fear the presence of human body secretions such as saliva, blood, semen, sweat, tears, vomit, or mucus, or excretions such as urine or feces. Some OCD sufferers even fear that the soap they are using is contaminated.[18] These anxiety-driven fears often result in various compulsive cleaning behaviours, and may cause a person to experience significant distress, which may make it difficult for a person with OCD to tolerate a workplace, venture into public locations, or conduct normal social relationships.
Symptoms related to performing tasks may include repeated hand washing[19] or clearing of the throat; specific counting systems or counting of steps; doing repetitive actions—more generally, this can involve an obsession with numbers or types of numbers (e.g., odd numbers). For example, when somebody suffering from OCD leaves the house, they might tap the door knob 9 times and if they don't they will go into distress, panic and even at certain times, they will pass out. These obsessive behaviors can cause individuals to feel psychological distress, because they are very concerned about having "made mistakes" in the number of steps that they have taken, or the number of stairs on a staircase. For some people with OCD, these obsessive counting and re-counting tasks, along with the attendant anxiety and fear, can take hours of each day, which can make it hard for the person to fulfill their work, family, or social roles. In some cases, these behaviors can also cause adverse physical symptoms: people who obsessively wash their hands with antibacterial soap and hot water (to remove germs) can make their skin red and raw with dermatitis.[20]
Related conditions
OCD is often confused with the separate condition obsessive–compulsive personality disorder. The two are not the same condition, however. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer's self-concept. [21][22] Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic—marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with anxiety; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions.[23] This is a significant difference between these disorders.
Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.
Some OCD sufferers exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually delusional, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not. There are severe cases when the sufferer has an unshakeable belief within the context of OCD which is difficult to differentiate from psychosis.[24]
OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life—particularly its substantial consumption of time—can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available.
Related/Spectrum disorders
People with OCD may be diagnosed with other conditions, such as generalized anxiety disorder, anorexia nervosa, social anxiety disorder, bulimia nervosa, Tourette syndrome, Asperger syndrome, compulsive skin picking, body dysmorphic disorder, trichotillomania, and (as already mentioned) obsessive–compulsive personality disorder. There is some research demonstrating a link between drug addiction and OCD as well. Many who suffer from OCD also suffer from panic attacks. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among OCD patients may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among sufferers of OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an "out of control" type of feeling.[25]
Some cases are thought to be caused at least in part by childhood streptococcal infections and are termed PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The streptococcal antibodies become involved in an autoimmune process. Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be "caught" via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that antibiotics may eventually be used to treat or prevent it.[26]
Causes
Psychological
Scientists studying obsessive–compulsive disorder generally agree that both psychological and biological factors play a role in causing the disorder, although they differ in their degree of emphasis upon either type of factor.
From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual, or other obsessive thoughts were possessed by the Devil.[27] Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through exorcism.[28] In the early 1910s, Sigmund Freud attributed obsessive–compulsive behavior to unconscious conflicts which manifested as symptoms.[28] Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious".[29]
The cognitive–behavioral model suggests that compulsive behaviour is carried out to remove anxiety-provoking intrusive thoughts. Unfortunately this only brings about temporary relief as the thought re-emerges. Each time the behaviour occurs it is negatively reinforced (see Reinforcement) by the relief from anxiety, thereby explaining why the dysfunctional activity increases and generalises (extends to other, related stimuli) over a period of time. For example, after touching a door-knob a person might have the thought that they may develop a disease as a result of contamination. They then experience anxiety, which is relieved when they wash their hands. This might be followed by the thought "but did I wash them properly?" causing an increase in anxiety once more, the hand-washing once again rewarded by the removal of anxiety (albeit briefly) and the cycle being repeated when thoughts of contamination re-occur. The distressing thoughts might then spread to fear of contamination from e.g. a chair (someone might have touched the chair after touching the door handle).
Biological
There are many different theories about the cause of obsessive–compulsive disorder. The majority of researchers believe that there is some type of abnormality with the neurotransmitter serotonin, among other possible psychological or biological abnormalities; however, it is possible that this activity is the brain's response to OCD, and not its cause.
![]() | This article possibly contains original research. (January 2009) |
Serotonin is thought to have a role in regulating anxiety, though it is also thought to be involved in such processes as sleep and memory function. In order to send chemical messages, serotonin must bind to the receptor sites located on the neighboring nerve cell. It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential. This suggestion is supported by the fact that many OCD patients benefit from the use of selective serotonin reuptake inhibitors (SSRIs)—a class of antidepressant medications that allow for more serotonin to be readily available to other nerve cells.[30] For more about this class of drugs, see the section about potential treatments for OCD.
The Stanford University School of Medicine OCD webpage states, "Although the causes of the disorder still elude us, the recent identification of children with OCD caused by an autoimmune response to Group A streptococcal infection promises to bring increased understanding of the disorder's pathogenesis."[31]
Recent research has revealed a possible genetic mutation that could help to cause OCD. Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD. Moreover, in his study of identical twins, Rasmussen (1994) produced data that supported the idea that there is a "heritable factor for neurotic anxiety".[32] In addition, he noted that environmental factors also play a role in how these anxiety symptoms are expressed. However, various studies on this topic are still being conducted and the presence of a genetic link is not yet definitely established.
Another possible genetic cause of OCD was discovered in August 2007 by scientists at Duke University Medical Center in North Carolina. They genetically engineered mice that lacked a gene called SAPAP3. This protein is highly expressed in the striatum, an area of the brain linked to planning and the initiation of appropriate actions. The mice spent three times as much time grooming themselves as ordinary mice, to the point that their fur fell off.[33]
Using tools like positron emission tomography (PET scans), it has been shown that those with OCD tend to have brain activity[vague] that differs from those who do not have this disorder.[34] In the book, Brain Lock, Jeffrey M. Schwartz suggests that OCD is caused by the part of the brain[vague] that is responsible for translating complex intentions (e.g., "I will pick up this cup") into fundamental actions (e.g., "move arm forward, rotate hand 15 degrees, etc.") failing correctly to communicate the chemical message that an action has been completed. This is perceived as a feeling of doubt and incompleteness, which then leads the individual to attempt consciously to deconstruct their own prior behavior—a process which induces anxiety in most people, even those without OCD [citation needed].
It has been theorized that a miscommunication between the orbitofrontal cortex, the caudate nucleus, and the thalamus may be a factor in the explanation of OCD. The orbitofrontal cortex (OFC) is the first part of the brain to notice whether or not something is wrong.[vague] When the OFC notices that something is wrong, it sends an initial "worry signal" to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to interpret the worrying event. The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in compulsive behaviors in an attempt to relieve this apprehension.[30] This overactivity of the OFC is shown to be attenuated in patients who have successfully responded to SSRI medication. The increased stimulation of the serotonin receptors 5-HT2A and 5-HT2C in the OFC is believed to cause this inhibition. [35]
Some research has discovered an association between a type of size abnormality in different brain structures and the predisposition to develop OCD. Through the use of magnetic resonance imaging (MRI), researchers at Cambridge's Brain Mapping Unit were able to discover distinctive patterns in the brain structure of individuals with OCD and their close family members. [36] This is the first instance in which it has been demonstrated that those with a familial risk of developing OCD have anatomical differences when compared with ordinary individuals. The discovery of these structural differences in the area of the brain associated with stopping motor response may ultimately aid researchers who seek to determine which genes contribute to the development of OCD.
In some patients, the consumption of caffeine may make OCD symptoms worse. [37]
Demographics and other statistics
In a 1980 study of 20,000 adults from New Haven, Baltimore, St. Louis, Durham, and Los Angeles, the lifetime prevalence rate of OCD for both sexes was recorded at 2.5 percent. Education also appears to be a factor. The lifetime prevalence of OCD is lower for those who have graduated high school than for those who have not (1.9 percent versus 3.4 percent). However, in the case of college education, lifetime prevalence is higher for those who graduate with a degree (3.1 percent) than it is for those who have only some college background (2.4 percent). As far as age is concerned, the onset of OCD usually ranges from the late teenage years until the mid-20s in both sexes, but the age of onset tends to be slightly younger in males than in females.[38]
It has been alleged that sufferers are generally of above-average intelligence, as the very nature of the disorder necessitates complicated thinking patterns[39].
Treatment
According to the Expert Consensus Guidelines for the Treatment of obsessive–compulsive disorder, behavioral therapy (BT), cognitive therapy (CT), and medications are first-line treatments for OCD. Psychodynamic psychotherapy may help in managing some aspects of the disorder, but there are no controlled studies that demonstrate effectiveness of psychoanalysis or dynamic psychotherapy in OCD.[40]
Behavioral therapy
The specific technique used in BT/CBT is called exposure and ritual prevention (also known as "exposure and response prevention") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking.
Exposure ritual/response prevention has been demonstrated to be the most effective treatment for OCD. It has generally been accepted that psychotherapy, in combination with psychotropic medication, is more effective than either option alone. However, more recent studies have shown no difference in outcomes for those treated with the combination of medicine and CBT versus CBT alone.[41]
Recently it has been reported simultaneous administration of D-Cycloserin (an antibiotic) substantially improves effectiveness of Exposure and Response prevention.[42]
Medication
Medications as treatment include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, sertraline, fluoxetine, escitalopram, and fluvoxamine as well as the tricyclic antidepressants, in particular clomipramine. SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Instead, serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety and obsessive thoughts. In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious.
Benzodiazepines are also used in treatment. It's not uncommon to administer this class of drugs during the "latency period" for SSRIs or as synergistic adjunct long-term. Although widely prescribed, benzodiazepines have not been demonstrated as an effective treatment for OCD and may be habit-forming in those with a history of substance abuse.[43]
Serotonergic antidepressants typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. In addition to this, the treatment usually requires high doses. Fluoxetine, for example, is usually prescribed in doses of 20 mg per day for clinical depression, whereas with OCD the dose will often range from 20 mg to 80 mg or higher, if necessary. In most cases antidepressant therapy alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Much current research is devoted to the therapeutic potential of the agents that effect the release of the neurotransmitter glutamate or the binding to its receptors. These include riluzole, memantine, gabapentin and lamotrigine.
Low doses of the newer atypical antipsychotics olanzapine, quetiapine, ziprasidone and risperidone have also been found to be useful as adjuncts in the treatment of OCD. The use of antipsychotics in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their dopamine receptor antagonism), at high doses these same antipsychotics have proven to cause dramatic obsessive–compulsive symptoms even in those patients who do not normally have OCD[citation needed]. This can be due to the antagonism of 5-HT2A receptors becoming very prominent at these doses and outweighing the benefits of dopamine antagonism. However antidepressant mirtazapine which is a 5-HT2A antagonist has shown to be of benefit to OCD patients[44]. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief enzyme that is responsible for metabolising antipsychotics—CYP2D6—so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results.
Alternative drug treatments
The naturally occurring sugar inositol has been suggested as a treatment for OCD[45], as it appears to modulate the actions of serotonin and reverse desensitisation of neurotransmitter receptors. St John's Wort has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities[citation needed], although a double-blind study using a flexible-dose schedule (600-1800 mg/day) found no difference between St John's Wort and a placebo[46].
Nutrition deficiencies may also contribute to OCD and other mental disorders. Vitamin and mineral supplements may aid in such disorders and provide nutrients necessary for proper mental functioning[47].
Opioids may significantly reduce OCD symptoms, though their use is not sanctioned for treatment due to physical dependence and long term drug tolerance[citation needed]. Tramadol is an atypical opioid that appears to provide the anti-OCD effects of an opiate and inhibit the re-uptake of serotonin (in addition to norepinephrine)[48].
Tryptamine alkaloid psilocybin has been attempted as treatment[49]. There are reports that other hallucinogens such as LSD and peyote have produced similar effects[citation needed]. It has been hypothesised that this effect may be due to stimulation of 5-HT2A receptors and, less significantly, 5-HT2C receptors; this causes an inhibitory effect on the orbitofrontal cortex, an area of the brain in which hyperactivity has been strongly associated with OCD[50].
Regular nicotine treatment may ameliorate symptoms of OCD, although the pharmacodynamical mechanism by which this is achieved is not yet known, and more detailed studies are needed to fully confirm this hypothesis[51].
Psycho-surgery
For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive–compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. In this procedure, a surgical lesion is made in an area of the brain (the cingulate bundle). In one study, 30% of participants benefited significantly from this procedure.[8] Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue, although their efficacy has not been conclusively demonstrated.
In the US, psychosurgery for OCD is a treatment of last resort and will not be performed until the patient has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive cognitive–behavioral therapy with exposure and ritual/response prevention.[52] Likewise, in the UK, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive–behavioral therapist has been carried out.
Neuropsychiatry
OCD primarily involves the brain regions of the striatum, the orbitofrontal cortex and the cingulate cortex. OCD involves several different receptors, mostly H2, M4, NK1, NMDA, and non-NMDA glutamate receptors.[citation needed] The receptors 5-HT1D, 5-HT2C, and the μ opioid receptor exert a secondary effect. The H2, M4, NK1, and non-NMDA glutamate receptors are active in the striatum, whereas the NMDA receptors are active in the cingulate cortex.
The activity of certain receptors is positively correlated to the severity of OCD, whereas the activity of certain other receptors is negatively correlated to the severity of OCD. Correlations where activity is positively correlated to severity include the histamine receptor (H2); the Muscarinic acetylcholine receptor(M4); the Tachykinin receptor (NK1); and non-NMDA glutamate receptors. Correlations where activity is negatively correlated to severity include the NMDA receptor (NMDA); the Mu opioid receptor (μ opioid); and two types of 5-HT receptors (5-HT1D and 5-HT2C) The central dysfunction of OCD may involve the receptors nk1, non-NMDA glutamate receptors, and NMDA, whereas the other receptors could simply exert secondary modulatory effects.
Pharmaceuticals that act directly on those core mechanisms are aprepitant (nk1 antagonist), riluzole (glutamate release inhibitor), and tautomycin (NMDA receptor sensitizer). Also, the anti-Alzheimer's drug memantine is being studied by the OC Foundation in its efficacy in reducing OCD symptoms due to it being an NMDA antagonist. One case study published in The American Journal of Psychiatry suggests that "memantine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation."[53] The drugs that are popularly used to fight OCD lack full efficacy because they do not act upon what are believed to be the core mechanisms. Many trials are currently underway to investigate the efficacy of a variety of agents that affect these 'core' neurotransmitters, particularly glutamatergic agents.[2]
Notable cases
- British poet, essayist, and lexicographer Samuel Johnson is an example of a historical figure with a retrospective diagnosis of OCD. He had elaborate rituals for crossing the thresholds of doorways, repeatedly walked up and down staircases counting the steps, and had compulsions regarding repetitive prayer which were most likely a form of religious scrupulosity.[54][55][56]
- American aviator and filmmaker Howard Hughes is known to have suffered from OCD and it is believed that his mother may have also been a sufferer. Friends of Hughes have mentioned his obsession with minor flaws in clothing and he is reported to have had a great fear of germs, common among OCD patients.[57] He did also suffer from Social Anxiety Disorder (SAD) and Post-traumatic Stress Disorder (PTSD) due to an aviation accident in which he was severely injured. This resulted in him becoming reclusive later in life.
- English footballer David Beckham has been outspoken regarding his struggle with OCD. He has told media that he has to count all his clothes, and that magazines have to lie in a straight line. No more than three soda cans are allowed in his refrigerator, and if there are any more at home they have to be placed in a cupboard. He has explained that the reason he gets more tattoos is that he feels addicted to the pain of the needle. In hotels, any books that are on a shelf must be placed in the drawer. He has expressed a desire to get help for his problems.[58]
See also
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References
- ^ Hollander, Eric (1997). "Diagnosis and assessment". Obsessive–compulsive Disorders. nforma Health Care. p. 1.
{{cite book}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ^ Null, Gary (2006). "Obsessive–compulsive disorder". Get Healthy Now. Seven Stories Press. p. 269.
- ^ Berrios G E (1985) Obsessional Disorders: A Conceptual History. Terminological and Classificatory Issues. In Bynum W F et al (eds) The Anatomy of Madness Vol I , London, Tavistock, pp 166-187
- ^ a b Quick Reference to the Diagnostic Criteria from DSM-IV-TR. Arlington, VA: American Psychiatric Association, 2000.
- ^ Fireman B, Koran LM, Leventhal JL, Jacobson A (2001). "The prevalence of clinically recognized obsessive–compulsive disorder in a large health maintenance organization". The American journal of psychiatry. 158 (11): 1904–10. doi:10.1176/appi.ajp.158.11.1904. PMID 11691699.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Elkin, G. David (1999). Introduction to Clinical Psychiatry. McGraw–Hill Professional. ISBN 0838543332.
- ^ Carter, K. "Obsessive–compulsive disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. 14 Feb. 2006.
- ^ a b Barlow, D. H. and V. M. Durand. Essentials of Abnormal Psychology. California: Thomson Wadsworth, 2006.
- ^ a b c Intrusive thoughts, OCDAction.org.uk. Retrieved on December 31, 2006.
- ^ a b Baer (2001), p. xiv.
- ^ Hyman, Bruce M. (2008). "My thoughts are driving me crazy!". Coping with OCD. New Harbinger Publications. pp. 59–60.
{{cite book}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ^ Freeston, M. & Ladouceur, R(2003). What do patients do with their obsessive thoughts? Behaviour Research and Therapy, 35, 335-348.
- ^ Weisman, M.M., Bland, R.C., Canino, G.J., Greenwald, S., Hwu, H.G..Lee, C.K. Newman, S.C., Oakley-Browne, M.A., Rubio-Stipec, M., Wickramaratne, P.J., Wittchen, H.U., & Yeh, E.K. (1994). The cross national epidemiology of obsessive–compulsive disorder. Journal of Clinical Psychiatry, 55, 5-10.
- ^ Baer (2001), p. 33, 78
- ^ Baer (2001), p. 7
- ^ Baer (2001), pp. 43–44
- ^ a b Osgood-Hynes, Deborah. Thinking Bad Thoughts (PDF). MGH/McLean OCD Institute, Belmont, MA, published by the OCD Foundation, Milford, CT. Retrieved on December 30, 2006.
- ^ "OCD and Contamination". Retrieved 2007-06-28.
- ^ Boyd, Mary Ann (2007). Psychiatric Nursing. Lippincott Williams & Wilkins. p. 418.
- ^ "Hygiene of the Skin: When Is Clean Too Clean? Subtopic: "Skin Barrier Properties and Effect of Hand Hygiene Practices", Paragraph 5". Retrieved 2009-03-26.
- ^ Aardema, F. & O'Connor. (2003). Seeing white bears that are not there: Inference processes in obsessions. Journal of Cognitive Psychotherapy, 17, 23-37.
- ^ Aardema, F. & O'Connor. (2007). The menace within: obsessions and the self. International Journal of Cognitive Therapy, 21, 182-197.
- ^ Carter, K. "Obsessive–compulsive personality disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. April 11, 2006.
- ^ O'Dwyer, Anne-Marie Carter, Obsessive–compulsive disorder and delusions revisited, The British Journal of Psychiatry (2000) 176: 281-284
- ^ Mineka S, Watson D, Clark LA (1998). "Comorbidity of anxiety and unipolar mood disorders". Annual review of psychology. 49: 377–412. doi:10.1146/annurev.psych.49.1.377. PMID 9496627.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^
Belkin, L. > "Can you catch obsessive–compulsive disorder?". The New York Times Magazine. Retrieved 2006-04-12.
{{cite web}}
: Italic or bold markup not allowed in:|publisher=
(help) - ^ Aardema, F. & O'Connor. (2007). The menace within: obsessions and the self. International Journal of Cognitive Therapy, 21, 182-197.
- ^ a b Baer, L.; M. A. Jenike & W. E. Minichiello. Obsessive Compulsive Disorders: Theory and Management. Littleton, MA: PSG Publishing, 1986.
- ^ Freud, Sigmund (1950). Totem and Taboo:Some Points of Agreement between the Mental Lives of Savages and Neurotics. trans. Strachey. New York: W. W. Norton & Company. ISBN 0-393-00143-1. p. 29.
- ^ a b BBC Science and Nature: Human Body and Mind. Causes of OCD. <http://www.bbc.co.uk/science/humanbody/mind/articles/disorders/causesofocd.shtml>. Accessed April 15, 2006.
- ^ "History of Treatment of OCD". Stanford University School of Medicine. Retrieved 2007-06-28.
- ^ Rasmussen, S.A. "Genetic Studies of Obsessive Compulsive Disorder" in Current Insights in Obsessive Compulsive Disorder, eds. E. Hollander; J. Zohar; D. Marazziti & B. Oliver. Chichester, England: John Wiley & Sons, 1994, pp. 105-114.
- ^ Missing gene creates obsessive–compulsive mouse, New Scientist, August 2007
- ^ Tennen, M. 2005, June. "Causes of OCD Remain a Mystery". <http://www.healthatoz.com/ healthatoz/Atoz/dc/cen/ment/obcd/alert07172003.jsp>. Accessed April 14, 2006.
- ^ Obsessive–compulsive disorder associated with a left orbitofrontal infarct J Neuropsychiatry Clin Neurosci 14 (1): 88
- ^ Brain pattern associated with genetic risk of Obsessive Compulsive Disorder
- ^ Caffeine anaphylaxis-stage II: obsessive–compulsive disorder, Townsend Letter for Doctors and Patients, April, 2004, by Ruth Whalen
- ^ Antony, M. M.; F. Downie & R. P. Swinson. "Diagnostic issues and epidemiology in obsessive–compulsive disorder". in Obsessive–Compulsive Disorder: Theory, Research, and Treatment, eds. M. M. Antony; S. Rachman; M. A. Richter & R. P. Swinson. New York: The Guilford Press, 1998, pp. 3-32.
- ^ [1]
- ^ Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB; American Psychiatric Association. Template:PDFlink Am J Psychiatry 2007; 164(7 Suppl): 5-53. PMID 17849776.
- ^ Foa EB, Liebowitz MR, Kozak MJ, Davies S, Campeas R, Franklin ME, Huppert JD, Kjernisted K, Rowan V, Schmidt AB, Simpson HB, Tu X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive–compulsive disorder. Am J Psychiatry, 162(1):151-61.
- ^ Wilhelm (2008 March). "Augmentation of behavior therapy with D-cycloserine for obsessive–compulsive disorder". Am J Psychiatry. 165 (3): 335–41. doi:10.1176/appi.ajp.2007.07050776. PMID 18245177.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ^ Blanco C, Olfson M, Stein DJ, Simpson HB, Gameroff MJ, Narrow WH. (2006). Treatment of obsessive–compulsive disorder by U.S. psychiatrists. J Clin Psychiatry, 67(6):946-51.
- ^ Koran LM, Gamel NN, Choung HW, Smith EH, Aboujaoude EN (2005). "Mirtazapine for obsessive–compulsive disorder: an open trial followed by double-blind discontinuation". Journal of Clinical Psychiatry 66 (4): 515–520.
- ^ "Inositol in psychiatry". Retrieved 2007-06-28.
- ^ Kobak KA; et al. (2005). "St John's wort versus placebo in obsessive–compulsive disorder: results from a double-blind study". Int Clin Psychopharmacol. 20 (6): 299–304. doi:10.1097/00004850-200511000-00003. PMID 16192837.
{{cite journal}}
: Explicit use of et al. in:|author=
(help) - ^ Lakhan SE, Vieira KF (2008). "Nutritional therapies for mental disorders". Nutr J. 7: 2. doi:10.1186/1475-2891-7-2. PMC 2248201. PMID 18208598.
{{cite journal}}
: CS1 maint: unflagged free DOI (link) - ^ Goldsmith TB, Shapira NA, Keck PE (1999). "Rapid remission of OCD with tramadol hydrochloride". The American journal of psychiatry. 156 (4): 660–1. PMID 10200754.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ "Psilocybin in the Treatment of Obsessive Compulsive Disorder". Retrieved 2007-06-28.
- ^ Perrine DM (1999). "Hallucinogens and obsessive–compulsive disorder". Am J Psychiatry. 156 (7): 1123. PMID 10401480.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Lundberg S, Carlsson A, Norfeldt P, Carlsson ML (2004). "Nicotine treatment of obsessive–compulsive disorder". Prog. Neuropsychopharmacol. Biol. Psychiatry. 28 (7): 1195–9. doi:10.1016/j.pnpbp.2004.06.014. PMID 15610934.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Surgical Procedures for Obsessive–Compulsive Disorder, by M. Jahn and M. Williams, Ph.D,. BrainPhysics OCD Resource, Accessed July 6, 2008.
- ^ Poyurovsky M, Weizman R, Weizman A, Koran L (2005). "Memantine for treatment-resistant OCD". The American journal of psychiatry. 162 (11): 2191–2. doi:10.1176/appi.ajp.162.11.2191-a. PMID 16263867.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ http://connection.ebscohost.com/content/article/1025069545.html;jsessionid=938C34157D8D0790770F0238141B4493.ehctc1 Samuel Johnson, literary genius and OCD victim. Nutrition Health Review: The Consumer's Medical Journal; Winter91, Issue 57, p5.
- ^ http://westsuffolkpsych.homestead.com/Johnson.html SAMUEL JOHNSON (1709-1784): A Patron Saint of OCD? by Fred Penzel, Ph.D. from the Science Advisory Board of the Obsessive–Compulsive Foundation
- ^ http://www.mindpub.com/art067.htm Obsessive Thinking, Compulsive Behaviors. Vijai P. Sharma, Ph.D. Clinical Psychologist
- ^ "Hughes's germ phobia revealed in psychological autopsy". APA Online: Monitor on Psychology. 36 (7). July/August 2005.
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: Check date values in:|date=
(help) - ^ http://www.dailymail.co.uk/tvshowbiz/article-381802/The-obsessive-disorder-haunts-life.html
Further reading
- My Worktime Routine, ISBN 1-59-113901-5, by David Vince.
- Beyette, Beverly; Schwartz, Jeffrey H. (1997). Brain lock: free yourself from obsessive–compulsive behavior: a four-step self-treatment method to change your brain chemistry. New York: ReganBooks. ISBN 0-06-098711-1.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - Salzman, Leon (1985). Treatment of the obsessive personality. Northvale, N.J: J. Aronson. ISBN 0-87668-881-4.
- Jonathan Grayson (2003). Freedom From Obsessive–Compulsive Disorder: A Personalized Recovery Program For Living With Uncertainty. New York: Jeremy P. Tarcher. ISBN 1-58542-246-0.
- Rachman, Stanley; Rachman, S. J. (2003). The treatment of obsessions. Oxford [Oxfordshire]: Oxford University Press. ISBN 0-19-851537-5.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - Sharon Begley; Schwartz, Jeffrey H. (2003). The Mind and the Brain : Neuroplasticity and the Power of Mental Force. New York: Regan Books. ISBN 0-06-098847-9.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - Lee, PhD. Baer (2002). The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts. New York: Plume Books. ISBN 0-452-28307-8.
- Penzel, Fred (2000). Obsessive–compulsive disorders: a complete guide to getting well and staying well. Oxford [Oxfordshire]: Oxford University Press. ISBN 0-19-514092-3.
- Seligman, Martin E. P. (1995). "Obsessions". What you can change—and what you can't: the complete guide to successful self-improvement: learning to accept who you are. New York: Fawcett Columbine. ISBN 0-449-90971-9.
- IAN OSBORN (1999). Tormenting Thoughts and Secret Rituals : The Hidden Epidemic of Obsessive–Compulsive Disorder. New York: Dell. ISBN 0-440-50847-9.
- Cooper, David A. (2005). The Art of Meditation. Jaico Publishing House. ISBN 81-7992-164-6.
- Wilson, Rob; David Veale (2005). Overcoming Obsessive–Compulsive Disorder. Constable & Robinson Ltd. ISBN 1-84119-936-2.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - John B. (2008). The Boy Who Finally Stopped Washing: OCD From Both Sides of the Couch. Cooper Union Press. ISBN 9780979133961.
External links
- Frequently Asked Questions about Obsessive–Compulsive Disorder, at BrainPhysics OCD Resource, developed by the OC and Spectrum Disorders Association