What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder in which you are often or always troubled by ideas or images that stick in your mind. These thoughts, called obsessions, are sometimes bizarre. They cause you to feel anxious and force you to behave in ways that make no sense. You may perform repeated, ritualized acts to reduce your anxiety. These acts are called compulsions.

OCD affects between 1% and 2.5% of people in this country. Men with OCD usually begin having symptoms in their teenage years, women in their early 20s.

How does it occur?

No one knows what causes OCD, but it tends to run in families. Some studies show that parts of the brain work differently in people with OCD. OCD often occurs along with mood disorders such as depression and bipolar disorder.

What are the symptoms?

People with OCD are usually aware that their obsessions or compulsions are keeping them from living fully and well. They often describe their behavior as foolish or pointless, but they cannot change it.

Their obsessions often concern doubts about matters of safety (like whether they have shut off the stove). Sometimes, however, their thoughts have to do with a fear that something awful 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 how much the behavior disrupts the person's everyday life.

Some of the typical compulsions or rituals of OCD include:

• Cleaning: Fearing germs, a person may shower over and over again during the course of a 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 complex 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 check over and over again to see that it is done.
• Hoarding: A person may collect useless items that he or she repeatedly counts and stacks.

People with OCD often have depression or the symptoms of depression. These include:

• guilt
• low self-esteem
• anxiety
• extreme fatigue.

OCD symptoms often create problems in relationships and daily living. In extreme cases, people with OCD become totally disabled, have no friends, and can't leave home because they spend their days engaged in rituals or having obsessive thoughts.

How is it diagnosed?

There is no lab test for OCD. Your doctor will make the diagnosis by talking with you and someone close to you about your symptoms. He or she will ask very specific questions about the type of obsessions or compulsions you have.

You may have OCD if your obsessions or compulsions:

• cause you marked distress
• get in the way of your normal routine, work, social activities, or relationships.

Your doctor may ask such questions as:

• Do you have troubling thoughts you cannot ignore or get rid of no matter how hard you try?
• Do you keep things very clean or wash your hands a lot more 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?

Your doctor will have to make sure that a medication or drug is not adding to your symptoms. Also, because fears (phobias) and depression can occur along with OCD, it is important for your doctor to be able to tell which is which.

How is it treated?

Combining antidepressant drugs and behavior therapy has been most helpful in treating OCD. Anafranil, Prozac, Zoloft, Paxil, and Luvox have been used with good results. Very rarely, brain surgery is done.

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. With help from your doctor, you learn to suppress your obsessions and compulsions.

If, for example, you wash your hands all the time 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 ways to control your body's response to anxiety, such as breathing exercises.

How long will the effects last?

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. Advances in 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 videos on OCD, and from joining support groups.

Follow your doctor's instructions for taking your medicine and and don't miss your therapy sessions.

Know that you are not alone. There are millions of people affected by OCD, and there are national groups 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 that provides 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://www.ocfoundation.org.

The National Mental Health Association (NMHA), through its national office and affiliates, is dedicated to improving the mental health of all Americans and achieving victory over mental illness. For information on support groups or community mental health services, call NMHA's Information Center toll free at 1-800-969-NMHA. NMHA's website address is http://www.NMHA.org.