Page semi-protected

Obsessive–compulsive disorder

From Wikipedia, the free encyclopedia
  (Redirected from Obsessive compulsive disorder)
Jump to: navigation, search
"OCD" redirects here. For other uses, see OCD (disambiguation). Not to be confused with Obsessive–compulsive personality disorder.
Obsessive–compulsive disorder
OCD handwash.jpg
Frequent, excessive hand washing occurs in some people with OCD
Classification and external resources
Specialty Psychiatry
ICD-10 F42
ICD-9-CM 300.3
OMIM 164230
DiseasesDB 33766
MedlinePlus 000929
eMedicine article/287681
MeSH D009771

Obsessive–compulsive disorder (OCD) is a mental disorder where people feel the need to check things repeatedly, perform certain routines repeatedly (called "rituals"), or have certain thoughts repeatedly. People are unable to control either the thoughts or the activities for more than a short period of time. Common activities include hand washing, counting of things, and checking to see if a door is locked. Some may have difficulty throwing things out. These activities occur to such a degree that the person's daily life is negatively affected.[1] Often they take up more than an hour a day.[2] Most adults realize that the behaviors do not make sense.[1] The condition is associated with tics, anxiety disorder, and an increased risk of suicide.[2][3]

The cause is unknown.[1] There appear to be some genetic components with both identical twins more often affected than both non-identical twins. Risk factors include a history of child abuse or other stress inducing event. Some cases have been documented to occur following infections. The diagnosis is based on the symptoms and requires ruling out other drug related or medical causes.[2] Rating scales such as the Yale–Brown Obsessive Compulsive Scale can be used to assess the severity.[4] Other disorders with similar symptoms include anxiety disorder, major depressive disorder, eating disorders, tic disorders, and obsessive–compulsive personality disorder.[2]

Treatment involves counselling, such as cognitive behavioral therapy (CBT), and sometimes medication, typically selective serotonin reuptake inhibitors (SSRIs).[5][6] CBT for OCD involves increasing exposure to what causes the problems while not allowing the repetitive behavior to occur.[5] While clomipramine appears to work as well as SSRIs, it has greater side effects.[5] Atypical antipsychotics may be useful when used in addition to an SSRI in treatment-resistant cases but are also associated with an increased risk of side effects.[6][7] Without treatment, the condition often lasts decades.[2]

Obsessive–compulsive disorder affects about 2.3% of people at some point in their life.[8] Rates during a given year are about 1.2% and it occurs worldwide.[2] It is unusual for symptoms to begin after the age of thirty-five, and half of people develop problems before twenty.[1][2] Males and females are affected about equally.[1] In English the phrase obsessive–compulsive is often used in an informal manner unrelated to OCD to describe someone who is excessively meticulous, perfectionistic, absorbed, or otherwise fixated.[9]

Signs and symptoms

Video about obsessive compulsive disorder

Obsessions

Main article: Intrusive thought
People with OCD may face intrusive thoughts, such as thoughts about the Devil (shown is a painted interpretation of Hell)

Obsessions are thoughts that recur and persist despite efforts to ignore or confront them.[10] People with OCD frequently perform tasks, or compulsions, to seek relief from obsession-related anxiety. Within and among individuals, the initial obsessions, or intrusive thoughts, vary in their clarity and vividness. A relatively vague obsession could involve a general sense of disarray or tension accompanied by a belief that life cannot proceed as normal while the imbalance remains. A more intense obsession could be a preoccupation with the thought or image of someone close to them dying[11][12] or intrusions related to "relationship rightness."[13] Other obsessions concern the possibility that someone or something other than oneself—such as God, the Devil, or disease—will harm either the person with OCD or the people or things that the person cares about. Other individuals with OCD may experience the sensation of invisible protrusions emanating from their bodies, or have the feeling that inanimate objects are ensouled.[14]

Some people with OCD experience sexual obsessions that may involve intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, incest and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", and can include "heterosexual or homosexual content" with persons of any age.[15] As with other intrusive, unpleasant thoughts or images, some disquieting sexual thoughts at times are normal, but people with OCD may attach extraordinary significance to the thoughts. For example, obsessive fears about sexual orientation can appear to the person with OCD, and even to those around them, as a crisis of sexual identity.[16][17] Furthermore, the doubt that accompanies OCD leads to uncertainty regarding whether one might act on the troubling thoughts, resulting in self-criticism or self-loathing.[15]

People with OCD understand that their notions do not correspond with reality; however, they feel that they must act as though their notions are correct. For example, an individual who engages in compulsive hoarding might be inclined to treat inorganic matter as if it had the sentience or rights of living organisms, while accepting that such behavior is irrational on a more intellectual level.

Primarily obsessional

OCD sometimes manifests without overt compulsions.[18] Nicknamed "Pure-O",[19] or referred to as Primarily Obsessional OCD, OCD without overt compulsions could, by one estimate, characterize as many as 50 percent to 60 percent of OCD cases.[20] Primarily obsessional OCD has been called one of the most distressing and challenging forms of OCD.[21] People with this form of OCD have distressing and unwanted thoughts emerging frequently, and these thoughts typically center on a fear that one may do something totally uncharacteristic of oneself, possibly something potentially fatal to oneself or others.[21] The thoughts may likely be of an aggressive or sexual nature.[21]

Rather than engaging in observable compulsions, the person with this subtype might perform more covert, mental rituals, or might feel driven to avoid the situations in which particular thoughts seem likely to intrude.[19] As a result of this avoidance, people can struggle to fulfill both public and private roles, even if they place great value on these roles and even if they had fulfilled the roles successfully in the past.[19] Moreover, the individual's avoidance can confuse others who do not know its origin or intended purpose, as it did in the case of a man whose wife began to wonder why he would not hold their infant child.[19] The covert mental rituals can take up a great deal of a person's time during the day.

Compulsions

Main article: Compulsive behavior

Some people with OCD perform compulsive rituals because they inexplicably feel they have to, others act compulsively so as to mitigate the anxiety that stems from particular obsessive thoughts. The person might feel that these actions somehow either will prevent a dreaded event from occurring, or will push the event from their thoughts. In any case, the individual's reasoning is so idiosyncratic or distorted that it results in significant distress for the individual with OCD or for those around them. Excessive skin picking, hair-pulling, nail biting, and other body-focused repetitive behavior disorders are all on the obsessive–compulsive spectrum.[2] Some individuals with OCD are aware that their behaviors are not rational, but feel compelled to follow through with them to fend off feelings of panic or dread.[2][22]

Some common compulsions include hand washing, cleaning, checking things (e.g., locks on doors), repeating actions (e.g., turning on and off switches), ordering items in a certain way, and requesting reassurance.[23] Compulsions are different than tics (such as touching, tapping, rubbing, or blinking)[24] and stereotyped movements (such as head banging, body rocking, or self-biting), which usually aren't as complex as compulsions and aren't precipitated by obsessions.[2] It can sometimes it may be difficult to tell the difference between compulsions and complex tics.[2] About 10% to 40% of individuals with OCD also have a lifetime tic disorder.[25]

People rely on compulsions as an escape from their obsessive thoughts; however, they are aware that the relief is only temporary, that the intrusive thoughts will soon return. Some people use compulsions to avoid situations that may trigger their obsessions. Although some people do certain things over and over again, they do not necessarily perform these actions compulsively. For example, bedtime routines, learning a new skill, and religious practices are not compulsions. Whether or not behaviors are compulsions or mere habit depends on the context in which the behaviors are performed. For example, arranging and ordering DVDs for eight hours a day would be expected of one who works in a video store, but would seem abnormal in other situations. In other words, habits tend to bring efficiency to one's life, while compulsions tend to disrupt it.[26]

In addition to the anxiety and fear that typically accompanies OCD, sufferers may spend hours performing such compulsions every day. In such situations, it can be hard for the person to fulfill their work, family, or social roles. In some cases, these behaviors can also cause adverse physical symptoms. For example, people who obsessively wash their hands with antibacterial soap and hot water can make their skin red and raw with dermatitis.[27]

People with OCD can use rationalizations to explain their behavior; however, these rationalizations do not apply to the overall behavior but to each instance individually. For example, a person compulsively checking the front door may argue that the time taken and stress caused by one more check of the front door is much less than the time and stress associated with being robbed, and thus checking is the better option. In practice, after that check, the person is still not sure and deems it is still better to perform one more check, and this reasoning can continue as long as necessary.

Overvalued ideas

Some people with OCD 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 people because they may be unwilling to cooperate, at least initially. There are severe cases in which the person has an unshakeable belief in the context of OCD that is difficult to differentiate from psychotic disorders.[28]

Cognitive performance

A 2013 meta-analysis confirmed people with OCD to have mild but wide-ranging cognitive deficits; significantly regarding spatial memory, to a lesser extent with verbal memory, fluency, executive function and processing speed, while auditory attention was not significantly affected.[29] People with OCD show impairment in formulating an organizational strategy for coding information, set-shifting, motor and cognitive inhibition.[30]

Associated conditions

People with OCD may be diagnosed with other conditions, as well or instead of OCD, such as the aforementioned obsessive–compulsive personality disorder, major depressive disorder, bipolar disorder,[31] generalized anxiety disorder, anorexia nervosa, social anxiety disorder, bulimia nervosa, Tourette syndrome, Asperger syndrome, attention deficit hyperactivity disorder, dermatillomania (compulsive skin picking), body dysmorphic disorder, and trichotillomania (hair pulling). In 2009 it was reported that depression among those with OCD is particularly alarming because their risk of suicide is high; more than 50 percent of people experience suicidal tendencies, and 15 percent have attempted suicide.[4] Individuals with OCD have also been found to be affected by delayed sleep phase syndrome at a substantially higher rate than the general public.[32] Moreover, severe OCD symptoms are consistently associated with greater sleep disturbance. Reduced total sleep time and sleep efficiency have been observed in people with OCD, with delayed sleep onset and offset and an increased prevalence of delayed sleep phase disorder.[33]

Behaviorally, there is some research demonstrating a link between drug addiction and the disorder as well. For example, 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 people with OCD may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among people with 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.[34]

Someone exhibiting OCD signs does not necessarily have OCD. Behaviors that present as (or seem to be) obsessive or compulsive can also be found in a number of other conditions as well, including obsessive–compulsive personality disorder (OCPD), autism, disorders where perseveration is a possible feature (ADHD, PTSD, bodily disorders or habit problems),[35] or sub-clinically.

Some with OCD present with features typically associated with Tourette's syndrome, such as compulsions that may appear to resemble motor tics; this has been termed "tic-related OCD" or "Tourettic OCD".[36][37]

There is tentative evidence that OCD may be associated with above-average intelligence or at least a small increase in intelligence.[38][39]

Causes

The cause is unknown.[1] Both environmental and genetic factors are believed to play a role. Risk factors include a history of child abuse or other stress-inducing event.[2]

Genetics

There appear to be some genetic components with identical twins more often affected than non-identical twins.[2] Further, individuals with OCD are more likely to have first-degree family members exhibiting the same disorders than do matched controls. In cases where OCD develops during childhood, there is a much stronger familial link in the disorder than cases in which OCD develops later in adulthood. In general, genetic factors account for 45–65% of the variability in OCD symptoms in children diagnosed with the disorder.[40] Recent evidence supports the possibility of a heritable predisposition for neurological development favoring OCD.[41]

A mutation has been found in the human serotonin transporter gene, hSERT, in unrelated families with OCD.[42]

Per evolutionary psychology moderate versions of compulsive behavior may have had evolutionary advantages. Examples would be moderate constant checking of hygiene, the hearth, or the environment for enemies. Similarly, hoarding may have had evolutionary advantages. In this view OCD may be the extreme statistical "tail" of such behaviors possibly due to a high amount of predisposing genes.[43]

Infection

A controversial hypothesis[44] is that some cases of rapid onset of OCD in children and adolescents may be caused by a syndrome connected to Group A streptococcal infections, known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).[44][45]

Mechanisms

Brain scans of people with OCD have shown that they have different patterns of brain activity than people without OCD and that different functioning of circuitry within a certain part of the brain, the striatum, may cause the disorder. Differences in other parts of the brain and neurotransmitter dysregulation, especially serotonin and dopamine, may also contribute to OCD.[46] Independent studies have consistently found unusual dopamine and serotonin activity in various regions of the brain in people with OCD. These can be defined as dopaminergic hyperfunction in the prefrontal cortex (mesocortical dopamine pathway) and serotonergic hypofunction in the basal ganglia.[47][48][49] Glutamate dysregulation has also been the subject of recent research,[50][51] although its role in the disorder's etiology is not yet clear. Glutamate is known to act as a cotransmitter with dopamine in dopamine pathways that project out of the ventral tegmental area.

People with OCD evince increased grey matter volumes in bilateral lenticular nuclei, extending to the caudate nuclei, with decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.[52][53] These findings contrast with those in people with other anxiety disorders, who evince decreased (rather than increased) grey matter volumes in bilateral lenticular / caudate nuclei, while also decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.[53] Orbitofrontal cortex overactivity is attenuated in people who have successfully responded to SSRI medication, a result believed to be caused by increased stimulation of serotonin receptors 5-HT2A and 5-HT2C.[54] The striatum, linked to planning and the initiation of appropriate actions, has also been implicated; mice genetically engineered with a striatal abnormality exhibit OCD-like behavior, grooming themselves three times as frequently as ordinary mice.[55]

Diagnosis

Cleaning is not an OCD activity per se; thoughts, impulses, or images about a topic like cleaning must be of a degree or type that lies outside the normal range of worries about conventional problems.

Formal diagnosis may be performed by a psychologist, psychiatrist, clinical social worker, or other licensed mental health professional. To be diagnosed with OCD, a person must have obsessions, compulsions, or both, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The Quick Reference to the 2000 edition of the DSM states that several features characterize clinically significant obsessions and compulsions. Such obsessions, the DSM says, are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and that cause marked anxiety or distress. These thoughts, impulses, or images are of a degree or type that lies outside the normal range of worries about conventional problems.[56] A person may attempt to ignore or suppress such obsessions, or to neutralize them with some other thought or action, and will tend to recognize the obsessions as idiosyncratic or irrational.

Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress. Therefore, while many people who do not suffer from OCD may perform actions often associated with OCD (such as ordering items in a pantry by height), the distinction with clinically significant OCD lies in the fact that the person who suffers from OCD must perform these actions, otherwise they will experience significant psychological distress. These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or they are excessive. In addition, at some point during the course of the disorder, the individual must realize that their obsessions or compulsions are unreasonable or excessive.

Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day) or cause impairment in social, occupational, or scholastic functioning.[56] It is helpful to quantify the severity of symptoms and impairment before and during treatment for OCD. In addition to the peron's estimate of the time spent each day harboring obsessive-compulsive thoughts or behaviors, concrete tools can be used to gauge the people’s condition. This may be done with rating scales, such as the Yale–Brown Obsessive Compulsive Scale (Y-BOCS). With measurements like these, psychiatric consultation can be more appropriately determined because it has been standardized.[4]

OCD is sometimes placed in a group of disorders called the obsessive–compulsive spectrum.[57]

Differential diagnosis

OCD is often confused with the separate condition obsessive–compulsive personality disorder (OCPD). OCD is egodystonic, meaning that the disorder is incompatible with the sufferer's self-concept.[58][59] Because ego dystonic disorders go against a person's self-concept, they tend to cause much distress. OCPD, on the other hand, is egosyntonic—marked by the person's acceptance that the characteristics and behaviours displayed as a result are compatible with their self-image, or are otherwise appropriate, correct or reasonable.

As a result, people with OCD are often aware that their behavior is not rational, are unhappy about their obsessions but nevertheless feel compelled by them.[60] By contrast people with OCPD are not aware of anything abnormal; they will readily explain why their actions are rational, it is usually impossible to convince them otherwise, and they tend to derive pleasure from their obsessions or compulsions.[60]

Management

A form of psychotherapy called "cognitive behavioral therapy" (CBT) and psychotropic medications are first-line treatments for OCD.[1][61] Other forms of psychotherapy, such as psychodynamic and psychoanalysis may help in managing some aspects of the disorder, but in 2007 the American Psychiatric Association (APA) noted a lack of controlled studies showing their effectiveness "in dealing with the core symptoms of OCD".[62] The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD.[citation needed]

Therapy

One exposure and ritual prevention activity would be to check the lock only once, and then leave.

The specific technique used in CBT is called exposure and response prevention (ERP) which involves teaching the person to deliberately come into contact with the situations that trigger the obsessive thoughts and fears ("exposure"), without carrying out the usual compulsive acts associated with the obsession ("response prevention"), thus gradually learning to tolerate the discomfort and anxiety associated with not performing the ritualistic 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 drops 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.[63]

ERP has a strong evidence base, and it is considered the most effective treatment for OCD.[63] However, this claim was doubted by some researchers in 2000 who criticized the quality of many studies.[64]

It has generally been accepted that psychotherapy, in combination with psychiatric 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.[65]

Medication

A blister pack of clomipramine under the brand name "Anafranil".

The medications most frequently used are the selective serotonin reuptake inhibitors (SSRIs).[5] Clomipramine, a medication belonging to the class of tricyclic antidepressants appears to work as well as SSRIs but has a higher rate of side effects.[5]

SSRIs are a second line treatment of adult obsessive compulsive disorder (OCD) with mild functional impairment and as first line treatment for those with moderate or severe impairment. In children, SSRIs can be considered as a second line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects.[61] SSRIs are efficacious in the treatment of OCD; people treated with SSRIs are about twice as likely to respond to treatment as those treated with placebo.[66][67] Efficacy has been demonstrated both in short-term (6–24 weeks) treatment trials and in discontinuation trials with durations of 28–52 weeks.[68][69][70]

In 2006, the National Institute of Clinical and Health Excellence (NICE) guidelines recommended anti-psychotics for OCD that does not improve with SSRI treatment.[6] For OCD the evidence for the atypical antipsychotic drugs risperidone and quetiapine is tentative with insufficient evidence for olanzapine.[71] A 2014 review article found two studies that indicated that aripiprazole was "effective in the short-term" and found that "[t]here was a small effect-size for risperidone or anti-psychotics in general in the short-term"; however, the study authors found "no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo."[6] While quetiapine may be useful when used in addition to an SSRI in treatment-resistant OCD, these drugs are often poorly tolerated, and have metabolic side effects that limit their use. None of the atypical antipsychotics appear to be useful when used alone.[7]

Procedures

Electroconvulsive therapy (ECT) has been found to have effectiveness in some severe and refractory cases.[72]

Surgery may be used as a last resort in people who do not improve with other treatments. In this procedure, a surgical lesion is made in an area of the brain (the cingulate cortex). In one study, 30% of participants benefited significantly from this procedure.[73] Deep-brain stimulation and vagus nerve stimulation are possible surgical options that do not require destruction of brain tissue. In the US, the Food and Drug Administration approved deep-brain stimulation for the treatment of OCD under a humanitarian device exemption requiring that the procedure be performed only in a hospital with specialist qualifications to do so.[74]

In the US, psychosurgery for OCD is a treatment of last resort and will not be performed until the person 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.[75] Likewise, in the United Kingdom, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive–behavioral therapist has been carried out.

Children

Therapeutic treatment may be effective in reducing ritual behaviors of OCD for children and adolescents.[76] Similar to the treatment of adults with OCD, CBT stands as an effective and validated first line of treatment of OCD in children.[77] Family involvement, in the form of behavioral observations and reports, is a key component to the success of such treatments.[78] Parental interventions also provide positive reinforcement for a child who exhibits appropriate behaviors as alternatives to compulsive responses. In a recent meta-analysis of evidenced-based treatment of OCD in children, family-focused individual CBT was labeled as "probably efficacious", establishing it as one of the leading psychosocial treatments for youth with OCD.[77] After one or two years of therapy, in which a child learns the nature of his or her obsession and acquires strategies for coping, that child may acquire a larger circle of friends, exhibit less shyness, and become less self-critical.[79]

Although the causes of OCD in younger age groups range from brain abnormalities to psychological preoccupations, life stress such as bullying and traumatic familial deaths may also contribute to childhood cases of OCD, and acknowledging these stressors can play a role in treating the disorder.[80]

Epidemiology

Age-standardized disability-adjusted life year estimated rates for obsessive-compulsive disorder per 100,000 inhabitants in 2004.
  no data
  <45
  45–52.5
  52.5–60
  60–67.5
  67.5–75
  75–82.5
  82.5–90
  90–97.5
  97.5–105
  105–112.5
  112.5–120
  >120

Obsessive–compulsive disorder affects about 2.3% of people at some point in their life.[8] Rates during a given year are about 1.2% and it occurs worldwide.[2] It is unusual for symptoms to begin after the age of thirty five and half of people develop problems before twenty.[1][2] Males and females are affected about equally.[1]

Prognosis

Psychological interventions such as behavioral therapy and cognitive-behavioral therapy as well as medication can lead to a reduction of OCD symptoms for a number of people. However, symptoms may persist at moderate levels even following adequate treatment courses, and completely symptom-free periods are uncommon.[81]

History

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.[58] Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through exorcism.[82][83] In the early 1910s, Sigmund Freud attributed obsessive–compulsive behavior to unconscious conflicts that manifest as symptoms.[82] 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".[84]

Society and culture

This ribbon represents Trichotillomania and other body focused repetitive behaviors. Concept for the ribbon was started by Jenne Schrader. Colors were voted on by the Trichotillomania Facebook community, and made official by Trichotillomania Learning Center in August 2013

Notable cases

Some notable historical and contemporary figures known to have had OCD are listed below.

  • The American aviator and filmmaker Howard Hughes is known to have OCD.[85] Friends of Hughes have also mentioned his obsession with minor flaws in clothing.[86] This was conveyed in the The Aviator (2004), a film biography of Hughes.[87]
  • British poet, essayist, and lexicographer Samuel Johnson is an example of an historical figure with a retrospective diagnosis of OCD. He had elaborate rituals for crossing the thresholds of doorways, and repeatedly walked up and down staircases counting the steps.[88]

Art, entertainment, and media

Movies and television shows often portray idealized representations of disorders such as OCD. These depictions may lead to increased public awareness, understanding, and sympathy for such disorders.[89]

  • In the film As Good as it Gets (1997), actor Jack Nicholson portrays a man "with Obsessive Compulsive Disorder (OCD)".[90] "Throughout the film, [he] engages in ritualistic behaviors (i.e., compulsions) that disrupt his interpersonal and professional life", a "cinematic representation of psychopathology [that] accurately depicts the functional interference and distress associated with OCD".[90]
  • The film Matchstick Men (2003), directed by Ridley Scott, portrays a con-man named Roy (Nicolas Cage) who has obsessive-compulsive disorder. The film "opens with Roy, at home, suffering with his numerous obsessive compulsive symptoms, which take the form of a need for order and cleanliness and a compulsion to open and close doors three times, whilst counting aloud, before he can walk through them."[91]
  • In the USA Network American comedy-drama detective mystery television series Monk (2002–2009), the titular Adrian Monk fears both human contact and dirt.[92][93]

Research

The naturally occurring sugar inositol has been suggested as a treatment for OCD.[94]

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.[95]

μ-Opioids, such as hydrocodone and tramadol, may improve OCD symptoms.[96] Administration of opiate treatment may be contraindicated in individuals concurrently taking CYP2D6 inhibitors such as fluoxetine and paroxetine.[97]

Much current research is devoted to the therapeutic potential of the agents that affect the release of the neurotransmitter glutamate or the binding to its receptors. These include riluzole,[51] memantine, gabapentin, N-acetylcysteine, topiramate and lamotrigine.[citation needed]

Other animals

References

  1. ^ a b c d e f g h i The National Institute of Mental Health (NIMH) (January 2016). "What is Obsessive-Compulsive Disorder (OCD)?". U.S. National Institutes of Health (NIH). Retrieved 24 July 2016. 
  2. ^ a b c d e f g h i j k l m n o Diagnostic and statistical manual of mental disorders : DSM-5 (5 ed.). Washington: American Psychiatric Publishing. 2013. pp. 237–242. ISBN 9780890425558. 
  3. ^ Angelakis, I; Gooding, P; Tarrier, N; Panagioti, M (25 March 2015). "Suicidality in obsessive compulsive disorder (OCD): A systematic review and meta-analysis.". Clinical Psychology Review. 39: 1–15. doi:10.1016/j.cpr.2015.03.002. PMID 25875222. 
  4. ^ a b c Fenske JN, Schwenk TL (August 2009). "Obsessive compulsive disorder: diagnosis and management". Am Fam Physician. 80 (3): 239–45. PMID 19621834. 
  5. ^ a b c d e Grant JE (14 August 2014). "Clinical practice: Obsessive-compulsive disorder.". The New England Journal of Medicine. 371 (7): 646–53. doi:10.1056/NEJMcp1402176. PMID 25119610. 
  6. ^ a b c d Veale, D; Miles, S; Smallcombe, N; Ghezai, H; Goldacre, B; Hodsoll, J (29 November 2014). "Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review and meta-analysis.". BMC Psychiatry. 14: 317. doi:10.1186/s12888-014-0317-5. 
  7. ^ a b Decloedt EH, Stein DJ (2010). "Current trends in drug treatment of obsessive-compulsive disorder". Neuropsychiatr Dis Treat. 6: 233–42. doi:10.2147/NDT.S3149. PMC 2877605free to read. PMID 20520787. 
  8. ^ a b Goodman, WK; Grice, DE; Lapidus, KA; Coffey, BJ (September 2014). "Obsessive-compulsive disorder.". The Psychiatric clinics of North America. 37 (3): 257–67. doi:10.1016/j.psc.2014.06.004. PMID 25150561. 
  9. ^ Bynum, W.F.; Porter, Roy; Shepherd, Michael (1985). "Obsessional Disorders: A Conceptual History. Terminological and Classificatory Issues.". The anatomy of madness : essays in the history of psychiatry. London: Routledge. pp. 166–187. ISBN 9780415323826. 
  10. ^ Markarian Y, Larson MJ, Aldea MA, Baldwin SA, Good D, Berkeljon A, Murphy TK, Storch EA, McKay D (February 2010). "Multiple pathways to functional impairment in obsessive-compulsive disorder". Clin Psychol Rev. 30 (1): 78–88. doi:10.1016/j.cpr.2009.09.005. PMID 19853982. 
  11. ^ Baer (2001), p. 33, 78
  12. ^ Baer (2001), p. xiv.
  13. ^ Doron G, Szepsenwol O, Karp E, Gal N (2013). "Obsessing About Intimate-Relationships: Testing the Double Relationship-Vulnerability Hypothesis". Journal of Behavior Therapy and Experimental Psychiatry. 44 (4): 433–440. doi:10.1016/j.jbtep.2013.05.003. PMID 23792752. 
  14. ^ Mash, E. J., & Wolfe, D. A. (2005). Abnormal child psychology (3rd ed.). Belmont, CA: Thomson Wadsworth, p. 197.
  15. ^ a b Osgood-Hynes, Deborah. Thinking Bad Thoughts (PDF). MGH/McLean OCD Institute, Belmont, MA, published by the OCD Foundation, Milford, CT. Retrieved on 30 December 2006.
  16. ^ Steven Phillipson I Think It Moved Center for Cognitive-Behavioral Psychotherapy, OCDOnline.com. Retrieved on 14 May 2009.
  17. ^ Mark-Ameen Johnson, I'm Gay and You're Not : Understanding Homosexuality Fears brainphysics.com. Retrieved on 14 May 2009.
  18. ^ Freeston M, Ladouceur R (2003). "What do patients do with their obsessive thoughts?". Behaviour Research and Therapy. 35 (4): 335–348. doi:10.1016/S0005-7967(96)00094-0. 
  19. ^ a b c d Hyman, B. M., & Pedrick, C. (2005). The OCD workbook: Your guide to breaking free from obsessive–compulsive disorder (2nd ed.). Oakland, CA: New Harbinger, pp. 125–126.
  20. ^ Weisman M.M.; Bland R.C.; Canino G.J.; Greenwald S.; Hwu H.G.; Lee C.K.; et al. (1994). "The cross national epidemiology of obsessive–compulsive disorder". Journal of Clinical Psychiatry. 55: 5–10. 
  21. ^ a b c Hyman, Bruce and Troy DeFrene. Coping with OCD. 2008. New Harbinger Publications.
  22. ^ Highlights of Changes from DSM-IV-TR to DSM-5 (PDF), American Psychiatric Association, 2013, p. 7, retrieved 12 Apr 2016 
  23. ^ Boyd MA (2007). Psychiatric Nursing. Lippincott Williams & Wilkins. p. 418. ISBN 0-397-55178-9. 
  24. ^ Storch; et al. (2008), "Obsessive-compulsive disorder in youth with and without a chronic tic disorder", Depression and Anxiety, 25 (9): 761–767, doi:10.1002/da.20304, PMID 17345600 
  25. ^ Conelea; et al. (2014), "Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II", Journal of the American Academy of Child & Adolescent Psychiatry, 53 (12): 1308–16, doi:10.1016/j.jaac.2014.09.014, PMC 4254546free to read, PMID 25457929 
  26. ^ "Obsessive-Compulsive Disorder, (2005)". Retrieved 15 December 2009. 
  27. ^ "Hygiene of the Skin: When Is Clean Too Clean? Subtopic: "Skin Barrier Properties and Effect of Hand Hygiene Practices", Paragraph 5.". Retrieved 26 March 2009. 
  28. ^ O'Dwyer, Anne-Marie Carter, Obsessive–compulsive disorder and delusions revisited, The British Journal of Psychiatry (2000) 176: 281–284
  29. ^ Shin NY, Lee TY, Kim E, Kwon JS (19 July 2013). "Cognitive functioning in obsessive-compulsive disorder: a meta-analysis". Psychological Medicine. 44: 1–10. doi:10.1017/S0033291713001803. PMID 23866289. 
  30. ^ Çetinay Aydın P, Güleç Öyekçin D (2013). "Cognitive functions in patients with obsessive compulsive disorder". Turk psikiyatri dergisi (Turkish journal of psychiatry). 24 (4): 266–74. doi:10.5080/u7172. PMID 24310094. 
  31. ^ Chen YW, Dilsaver SC (1995). "Comorbidity for obsessive-compulsive disorder in bipolar and unipolar disorders". Psychiatry Research. 59 (1–2): 57–64. doi:10.1016/0165-1781(95)02752-1. PMID 8771221. 
  32. ^ Turner J, Drummond LM, Mukhopadhyay S, Ghodse H, White S, Pillay A, Fineberg NA (June 2007). "A prospective study of delayed sleep phase syndrome in patients with severe resistant obsessive–compulsive disorder". World Psychiatry. 6 (2): 108–111. PMC 2219909free to read. PMID 18235868. 
  33. ^ >Paterson JL, Reynolds AC, Ferguson SA, Dawson D (2013). "Sleep and obsessive-compulsive disorder (OCD)". Sleep Medicine Reviews. 17 (6): 465–74. doi:10.1016/j.smrv.2012.12.002. PMID 23499210. 
  34. ^ 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. 
  35. ^ Pediatric Obsessive-Compulsive Disorder Differential Diagnoses – 2012
  36. ^ Mansueto CS, Keuler DJ (2005). "Tic or compulsion?: it's Tourettic OCD.". Behavior Modification. 29 (5): 784–99. doi:10.1177/0145445505279261. PMID 16046664. 
  37. ^ "OCD and Tourette Syndrome: Re-examining the Relationship". International OCD Foundation. Retrieved 30 October 2013. 
  38. ^ Clark, David (2012). Cognitive-Behavioral Therapy for OCD. Guilford Press. p. Chapter 4. ISBN 9781462506651. 
  39. ^ Ozertugrul,, Engin (April 21, 2015). Interview with OCD: Forty-five Days to End of a New Beginning. 
  40. ^ Abramowitz JS, Taylor S, McKay D (2009). "Obsessive-compulsive disorder". Lancet. 374 (9688): 491–9. doi:10.1016/S0140-6736(09)60240-3. PMID 19665647. 
  41. ^ Menzies L, Achard S, Chamberlain SR, Fineberg N, Chen CH, del Campo N, Sahakian BJ, Robbins TW, Bullmore E (2007). "Neurocognitive endophenotypes of obsessive-compulsive disorder". Brain. 130 (Pt 12): 3223–36. doi:10.1093/brain/awm205. PMID 17855376. 
  42. ^ Ozaki N, Goldman D, Kaye WH, Plotnicov K, Greenberg BD, Lappalainen J, Rudnick G, Murphy DL (2003). "Serotonin transporter missense mutation associated with a complex neuropsychiatric phenotype". Mol. Psychiatry. 8 (11): 933–6. doi:10.1038/sj.mp.4001365. PMID 14593431. 
  43. ^ Bracha HS (2006). "Human brain evolution and the "Neuroevolutionary Time-depth Principle:" Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 30 (5): 827–853. doi:10.1016/j.pnpbp.2006.01.008. PMID 16563589. 
  44. ^ a b Boileau B (2011). "A review of obsessive-compulsive disorder in children and adolescents". Dialogues Clin Neurosci. 13 (4): 401–11. PMC 3263388free to read. PMID 22275846. 
  45. ^ Moretto, Germana; Pasquini, Massimo; et al. (2008), "What every psychiatrist should know about PANDAS: a review", Clinical Practice and Epidemiology in Mental Health, Department of Psychiatric Sciences and Psychological Medicine, Sapienza University of Rome 
  46. ^ "Obsessive-Compulsive Disorder (OCD) – Cause". WebMD. 21 June 2010. Retrieved 10 December 2011. 
  47. ^ van der Wee NJ, Stevens H, Hardeman JA, Mandl RC, Denys DA, van Megen HJ, Kahn RS, Westenberg HM (2004). "Enhanced dopamine transporter density in psychotropic-naive patients with obsessive-compulsive disorder shown by [123I]{beta}-CIT SPECT". Am J Psychiatry. 161 (12): 2201–6. doi:10.1176/appi.ajp.161.12.2201. PMID 15569890. 
  48. ^ Kim CH, Cheon KA, Koo MS, Ryu YH, Lee JD, Chang JW, Lee HS (2007). "Dopamine transporter density in the basal ganglia in obsessive-compulsive disorder, measured with [123I]IPT SPECT before and after treatment with serotonin reuptake inhibitors". Neuropsychobiology. 55 (3–4): 156–62. doi:10.1159/000106474. PMID 17657168. 
  49. ^ Harsányi A, Csigó K, Demeter G, Németh A (2007). "New approach to obsessive-compulsive disorder: Dopaminergic theories". Psychiatria Hungarica : A Magyar Pszichiatriai Tarsasag tudomanyos folyoirata. 22 (4): 248–258. PMID 18167420. 
  50. ^ Pittenger C, Bloch MH, Williams K (2011). "Glutamate abnormalities in obsessive compulsive disorder: Neurobiology, pathophysiology, and treatment". Pharmacology & Therapeutics. 132 (3): 314–332. doi:10.1016/j.pharmthera.2011.09.006. PMC 3205262free to read. PMID 21963369. 
  51. ^ a b Wu K, Hanna GL, Rosenberg DR, Arnold PD (2012). "The role of glutamate signaling in the pathogenesis and treatment of obsessive–compulsive disorder". Pharmacology Biochemistry and Behavior. 100 (4): 726–735. doi:10.1016/j.pbb.2011.10.007. PMC 3437220free to read. PMID 22024159. 
  52. ^ Radua J, Mataix-Cols D (November 2009). "Voxel-wise meta-analysis of grey matter changes in obsessive–compulsive disorder". British Journal of Psychiatry. 195 (5): 393–402. doi:10.1192/bjp.bp.108.055046. PMID 19880927. 
  53. ^ a b Radua J, van den Heuvel OA, Surguladze S, Mataix-Cols D (5 July 2010). "Meta-analytical comparison of voxel-based morphometry studies in obsessive-compulsive disorder vs other anxiety disorders". Archives of General Psychiatry. 67 (7): 701–711. doi:10.1001/archgenpsychiatry.2010.70. PMID 20603451. 
  54. ^ Kim KW, Lee DY (2002). "Obsessive-Compulsive Disorder Associated With a Left Orbitofrontal Infarct". Journal of Neuropsychiatry and Clinical Neurosciences. 14 (1): 88–89. doi:10.1176/appi.neuropsych.14.1.88. PMID 11884667. 
  55. ^ Welch JM, Lu J, Rodriguiz RM, Trotta NC, Peca J, Ding JD, Feliciano C, Chen M, Adams JP, Luo J, Dudek SM, Weinberg RJ, Calakos N, Wetsel WC, Feng G (August 2007). "Cortico-striatal synaptic defects and OCD-like behaviours in Sapap3-mutant mice". Nature. 448 (7156): 894–900. doi:10.1038/nature06104. PMC 2442572free to read. PMID 17713528. 
  56. ^ a b Quick Reference to the Diagnostic Criteria from DSM-IV-TR. Arlington, VA: American Psychiatric Association, 2000.
  57. ^ Starcevic, V; Janca, A (January 2011). "Obsessive-compulsive spectrum disorders: still in search of the concept-affirming boundaries.". Current opinion in psychiatry. 24 (1): 55–60. doi:10.1097/yco.0b013e32833f3b58. PMID 20827198. 
  58. ^ a b Aardema F., O'Connor (2007). "The menace within: obsessions and the self". International Journal of Cognitive Therapy. 21: 182–197. doi:10.1891/088983907781494573. 
  59. ^ Aardema F., O'Connor (2003). "Seeing white bears that are not there: Inference processes in obsessions". Journal of Cognitive Psychotherapy. 17: 23–37. doi:10.1891/jcop.17.1.23.58270. 
  60. ^ a b Carter, K. "Obsessive–compulsive personality disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. 11 April 2006.
  61. ^ a b National Institute for Health and Clinical Excellence (NICE) (November 2005). "Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder". Information about NICE Clinical Guideline 31. UK National Health Service (NHS). Retrieved 24 July 2016. 
  62. ^ Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB (July 2007). "Practice guideline for the treatment of patients with obsessive-compulsive disorder". The American Journal of Psychiatry. 164 (7 Suppl): 5–53. PMID 17849776. 
  63. ^ a b Huppert & Roth: (2003) Treating Obsessive-Compulsive Disorder with Exposure and Response Prevention. The Behavior Analyst Today, 4 (1), 66 – 70 BAO
  64. ^ Klein DF (2000). "Flawed meta-analyses comparing psychotherapy with pharmacotherapy". Am J Psychiatry. 157 (8): 1204–11. doi:10.1176/appi.ajp.157.8.1204. PMID 10910778. 
  65. ^ 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. doi:10.1176/appi.ajp.162.1.151. PMID 15625214. 
  66. ^ Arroll B, Elley CR, Fishman T, Goodyear-Smith FA, Kenealy T, Blashki G, Kerse N, Macgillivray S (2009). Arroll, Bruce, ed. "Antidepressants versus placebo for depression in primary care". The Cochrane Database of Systematic Reviews (3): CD007954. doi:10.1002/14651858.CD007954. PMID 19588448. 
  67. ^ "Medscape Log In". Archived from the original on 13 April 2013. 
  68. ^ Fineberg NA, Brown A, Reghunandanan S, Pampaloni I (2012). "Evidence-based pharmacotherapy of obsessive-compulsive disorder". The International Journal of Neuropsychopharmacology. 15 (8): 1173–91. doi:10.1017/S1461145711001829. PMID 22226028. 
  69. ^ "Sertraline prescribing information" (PDF). Retrieved 30 January 2015. 
  70. ^ "Paroxetine prescribing information" (PDF). Retrieved 30 January 2015. 
  71. ^ Komossa, K; Depping, AM; Meyer, M; Kissling, W; Leucht, S (8 Dec 2010). "Second-generation antipsychotics for obsessive compulsive disorder.". The Cochrane database of systematic reviews (12): CD008141. doi:10.1002/14651858.CD008141.pub2. PMID 21154394. 
  72. ^ Cybulska Eva M (2006). "Obsessive Compulsive disorder, the brain and electroconvulsive therapy". British Journal of Hospital Medicine. 67 (2): 77–82. doi:10.12968/hmed.2006.67.2.20466. 
  73. ^ Barlow, D. H. and V. M. Durand. Essentials of Abnormal Psychology. California: Thomson Wadsworth, 2006.
  74. ^ Barlas S (8 April 2009). "FDA Approves Pioneering Treatment for Obsessive- Compulsive Disorder". Psychiatric Times. 26 (4). 
  75. ^ Surgical Procedures for Obsessive–Compulsive Disorder, by M. Jahn and M. Williams, Ph.D,. BrainPhysics OCD Resource, Accessed 6 July 2008.
  76. ^ O'Donohue William; Ferguson Kyle E (2006). "Evidence-Based Practice in Psychology and Behavior Analysis". The Behavior Analyst Today. 7 (3): 335–347. doi:10.1037/h0100155. 
  77. ^ a b Freeman, J; Garcia, A; Frank, H; Benito, K; Conelea, C; Walther, M; Edmunds, J (2014). "Evidence base update for psychosocial treatments for pediatric obsessive-compulsive disorder". Journal of Clinical Child and Adolescent Psychology. 43 (1): 7–26. doi:10.1080/15374416.2013.804386. PMID 23746138. 
  78. ^ Rapoport, J. E. (1989). Obsessive-compulsive Disorder In Children & Adolescents. Washington: American Psychiatric Press.
  79. ^ Adams, P. L. (1973). Obsessive Children: A Sociopsychiatric Study. Philadelphia: Brunner / Mazel.
  80. ^ D'Alessandro TM (2009). "Factors influencing the onset of childhood obsessive compulsive disorder". Pediatr Nurs. 35 (1): 43–6. PMID 19378573. 
  81. ^ Eddy KT, Dutra L, Bradley R, Westen D (2004). "A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder". Clin Psychol Rev. 24 (8): 1011–30. doi:10.1016/j.cpr.2004.08.004. PMID 15533282. 
  82. ^ a b M. A. Jenike; Baer, L.; & W. E. Minichiello. Obsessive Compulsive Disorders: Theory and Management. Littleton, MA: PSG Publishing, 1986.
  83. ^ Berrios G E (1989). "Obsessive Compulsive Disorder: Its conceptual history in France during the 19th Century". Comprehensive Psychiatry. 30: 283–95. doi:10.1016/0010-440x(89)90052-7. 
  84. ^ Freud S (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.
  85. ^ Dittmann, M (July–August 2005). "Hughes's germ phobia revealed in psychological autopsy". American Psychological Association. Retrieved 9 January 2015. 
  86. ^ M. Dittmann (July–August 2005). "Hughes's germ phobia revealed in psychological autopsy". APA Online: Monitor on Psychology. 36 (7). 
  87. ^ Chosak, Anne (12 October 2012). "The Aviator: A real-life portrayal of OCD in the media". =Massachusetts General Hospital OCD and Related Disorders Program. Retrieved 9 January 2015. 
  88. ^ "SAMUEL JOHNSON (1709–1784): A Patron Saint of OCD? by Fred Penzel, Ph.D. from the Scientific Advisory Board of the International OCD Foundation". Westsuffolkpsych.homestead.com. Retrieved 29 November 2013. 
  89. ^ Goldberg FR (2007). Turn box office movies into mental health opportunities: A literature review and resource guide for clinicians and educators (PDF). Beneficial Film Guides, Inc. p. 8. Retrieved February 17, 2010. 
  90. ^ a b Berman, Noah (5 October 2012). "Is This 'As Good as It Gets?': Popular Media's Representation of OCD". Massachusetts General Hospital OCD and Related Disorders Program. Retrieved 9 January 2015. 
  91. ^ Almeida. "Royal College of Psychiatrists, Discover Psychiatry, Minds on Film Blog, Matchstick Men". Royal College of Psychiatrists. Retrieved 14 January 2015. 
  92. ^ Stewart, Susan (September 16, 2007). "Happy to Be Neurotic, at Least Once a Week". The New York Times. Retrieved December 8, 2008. 
  93. ^ Aniety Disorders Association of America. "WHAT IS OCD?". USA Network. Retrieved December 8, 2008. 
  94. ^ Camfield DA, Sarris J, Berk M (1 June 2011). "Nutraceuticals in the treatment of obsessive compulsive disorder (OCD): a review of mechanistic and clinical evidence". Progress in neuro-psychopharmacology & biological psychiatry. 35 (4): 887–95. doi:10.1016/j.pnpbp.2011.02.011. PMID 21352883. 
  95. ^ Lakhan SE, Vieira KF (2008). "Nutritional therapies for mental disorders". Nutr J. 7: 2. doi:10.1186/1475-2891-7-2. PMC 2248201free to read. PMID 18208598. 
  96. ^ Davidson J, Bjorgvinsson T (June 2003). "Current and potential pharmacological treatments for obsessive-compulsive disorder". Expert Opinion on Investigational Drugs. 12 (6): 993–1001. doi:10.1517/13543784.12.6.993. PMID 12783603. 
  97. ^ Koran LM (2007). "Obsessive-Compulsive Disorder: An Update for the Clinician". Focus (5): 3. 

Further reading

  • Abramowitz, Jonathan, S. (2009). Getting over OCD: A 10 step workbook for taking back your life. New York: Guilford Press. ISBN 0-06-098711-1. 
  • Schwartz, Jeffrey M.; Beverly Beyette (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. 
  • Lee Baer (2002). The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts. New York: Plume Books. ISBN 0-452-28307-8. 
  • Osborn, Ian (1999). Tormenting Thoughts and Secret Rituals : The Hidden Epidemic of Obsessive–Compulsive Disorder. New York: Dell. ISBN 0-440-50847-9. 
  • Wilson, Rob; David Veale (2005). Overcoming Obsessive–Compulsive Disorder. Constable & Robinson Ltd. ISBN 1-84119-936-2. 
  • Davis, Lennard J. (2008). Obsession: A History. University of Chicago Press. ISBN 978-0-226-13782-7. 
  • Emily, Colas (1998). Just Checking: Scenes from the Life of an Obsessive-compulsive. New York: Pocket Books. p. 165. ISBN 067102437X. 

External links