What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive behavior is an anxiety disorder in which you are frequently or constantly troubled by ideas or images that stick in your mind and that you can't ignore (obsessions). These troubling and sometimes bizarre thoughts cause anxiety and compel you to behave in an unreasonable way. You may carry out repetitive, ritualistic acts (compulsions) to reduce this anxiety. Between 1% and 2.5% of the U.S. population suffers from OCD.

How does it occur?

The cause of obsessive-compulsive disorder (OCD) is unknown. The disorder may run in families. Men tend to begin experiencing the illness in their teenage years and women usually begin getting symptoms in their early 20s. Some studies have shown that the actual functioning of parts of the brain are different in people suffering from OCD. It used to be believed that OCD was caused by a deep unconscious conflict, but that theory is less supported today. The disorder is closely associated with mood disorder, including depression and bipolar disorder.

What are the symptoms?

People with OCD usually recognize that their obsessions or compulsions are preventing them from living fully and productively. They commonly describe their behavior as foolish or pointless, but they can't change it. Obsessional thoughts are often doubts about matters of safety (for example, shutting off the stove), but sometimes they have to do with a fear that something terrible will happen or that they will do something terrible, like kill loved ones for no reason. People with OCD may spend hours each day performing compulsive acts. The amount of time spent is less important than the degree of disruption caused in everyday life.

Some of the typical compulsions or rituals of OCD are the following:

• Cleaning: Fearing germs, a person may shower repeatedly throughout the entire day or wash his or her hands until the skin is cracked and painful.

• Repeating: To reduce anxiety, a person may repeat a name or phrase many times.

• Completing: A person may perform a series of complicated steps in an exact order or repeat them until they are done perfectly.

• Checking: A person who fears harming himself or others by forgetting to lock the door or unplug the toaster will thus check repeatedly.

• Hoarding: A person may constantly collect useless items that he or she repeatedly counts and stacks.

People with OCD often have depression or symptoms associated with depression. These include guilt, low self-esteem, anxiety, and extreme fatigue. However, many of these depressive symptoms can be secondary to the frustration brought on by an obsessive-compulsive problem. Obsessive- compulsive symptoms frequently create problems in interpersonal relationships and day-to-day functioning.

In extreme cases, people with OCD become totally disabled, have no friends, and can't leave home because they spend the day performing rituals or having obsessive thoughts.

How is it diagnosed?

There is no laboratory test for OCD. It is diagnosed by your doctor talking with you and someone close to you about your symptoms and asking very specific questions regarding the type of obsessions or compulsions you have. Your doctor may diagnose obsessive-compulsive disorder if your obsessions or compulsions cause you marked distress, take more than an hour of your time a day, or significantly interfere with your normal routine, occupation, social activities, or relationships with others.

Your doctor may ask you such questions as:

• Do you have troubling thoughts that you cannot ignore or get rid of regardless of how hard you try?

• Do you keep things extremely clean or wash your hands a lot, more so than other people you know?

• Do you check things over and over, even though you know that the oven has been turned off or that the front door is locked?

OCD is not concern about life's normal worries and your doctor will have to make sure that a medication or drug is not contributing to your symptoms. Also, phobias and chronic depression can occur along with OCD and it is important for your doctor to recognize which is which.

What is the treatment?

A combination of antidepressant drugs and behavior therapy has been most helpful in treating the disorder. Anafranil, Prozac, Zoloft, Paxil, and Luvox have been used with good results. In very rare circumstances neurosurgery is performed.

The type of behavior therapy most often used to treat OCD is called exposure and response prevention. It consists of having you confront your fears head-on by gradually exposing you to more and more of them and, while aided by your doctor, learning to suppress your obsessional thoughts and compulsive acts. If, for example, you wash your hands continually because you fear being dirty, your doctor may stand at the sink with you and prevent you from washing your hands until the anxiety goes away. This process also involves learning strategies for controlling your body's response to anxiety, such as breathing exercises.

How long will the effects of obsessive-compulsive disorder last?

Obsessive-compulsive disorder usually appears in the late teens or early twenties. It may appear in childhood. Without treatment, the disorder may last a lifetime, becoming less severe from time to time, but rarely going away completely. In some people, OCD occurs in episodes, with years free of symptoms before a relapse. Developments in behavior therapy and new medications are helping many people with OCD live productive lives.

How can I take care of myself?

Include your family in your therapy. You and your family may benefit from reading books and viewing videotapes on OCD, and from attending support groups. Take your medication as recommended by your doctor and don't miss your behavioral therapy sessions.

Know that you are not alone. There are millions of people affected by OCD and there are national organizations devoted to helping people with this disorder.

When should I call the doctor?

Call your doctor if you feel that any of your ideas or actions are slipping out of your control.

Where can I get more information?

The Obsessive-Compulsive Foundation is a worldwide, not-for- profit organization providing support and information to those who have OCD, their families and friends, and medical professionals. The address is: The Obsessive-Compulsive Foundation, Inc., P.O. Box 70, Milford, CT 06460-0070. The phone number is (203) 878-5669. The website address is http://pages.prodigy.com/alwillen/ocf.html.