Obsessive Compulsive Disorder Disease

BASICS

DESCRIPTION

Psychiatric condition classified as an anxiety disorder in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and characterized by recurrent, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions)

Obsessions and compulsions consume more than an hour per day and cause occupational/social impairment
Patients know thoughts (obsessions) come from their own minds and are not imposed from outside (as in thought insertion). Thoughts are not associated with another disorder (for example, thought of food if an eating disorder is present).
Compulsions are ritualistic behaviors designed to relieve the anxiety of obsessions
Common obsessive themes:
- Violence, such as harming a beloved child
- Doubt, such as whether doors or windows locked or iron turned off
- Blasphemous thoughts, such as in a devoutly religious person
- Contamination, dirt or disease
- Symmetry or orderliness
Common rituals or compulsions:
- Hand washing
- Checking
- Counting
- Hoarding
- Repeaters - such as dressing rituals
System(s) affected: Nervous
Genetics: Positive family history in about 20% of cases, no mode of transmission identified
Incidence/Prevalence in USA: 2.5% lifetime prevalence, 1.5-2.1% one year prevalence
Predominant age: Mean age 20. 1/3 cases present by age 15, new cases after age 50 rare, 80% of cases before age 35
Predominant sex: Male = Female (males tend to present at a younger age)

SIGNS AND SYMPTOMS

Obsessions and/or compulsions that consume more than an hour a day and cause significant distress or impairment
Obsessions (thoughts) are recurrent; patient attempts to ignore or neutralize thoughts with another thought or action
Neither obsessions nor compulsions are related to another mental disorder
Compulsions (actions) are repetitive, purposeful behaviors in response to thoughts in attempt to neutralize the thought – such as checking in response to doubt (locks, doors, windows, or driving back over a route to check for any possible damage inadvertently done while driving one’s car)
Repeated handwashing or ritualistic handwashing in response to fear of contamination
80–90% of patients have obsessions and compulsions
10–19% are pure obsessional
5% perform rituals until they “feel right” and may not have an identifiable obsession

CAUSES

Dysregulation of neurotransmitter, serotonin

RISK FACTORS

Greater concordance in monozygotic twins family history as above

DIAGNOSIS

LABORATORY

N/A
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
Maudsley Obsessive-Compulsive Inventory (MOCI)

IMAGING

PET scan - abnormal metabolism in frontal cortex and caudate nuclei (not generally available other than in research centers)

DIAGNOSTIC PROCEDURES

Psychiatric interview

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Combine medications and cognitive behavior therapy
Psychiatric referral for therapy (in vivo exposure and response prevention)
Family psycho-education
Parent behavior management training if OCD patient is a child or adolescent

SURGICAL MEASURES

Psychosurgery (last resort)

ACTIVITY

No restriction

DIET

With use of phenelzine must have tyramine-free diet to prevent precipitation of hypertensive crisis

PATIENT EDUCATION

Obsessive-Compulsive Foundation, P.O. Box 70, Milford, CT 06460-0070, (203) 878-5669 or (203) 874-3843 for recorded information
Printed patient information available from: Obsessive-Compulsive Anonymous, P.O. Box 215, New Hyde Park, NY 11040, (516) 741-4901

FOLLOW UP

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Depression in one-third of OCD patients
Avoidant behavior (phobic avoidance)
Anxiety and panic-like episodes associated with obsessions

EXPECTED COURSE AND PROGNOSIS

Chronic waxing and waning course in the majority of patients
24–33% have a fluctuating course
11–14% have a phasic course with periods of remission
54–61% have a chronic progressive course
Early onset is a poor outcome predictor

MISCELLANEOUS

ASSOCIATED CONDITIONS

Depression
Panic disorder
Social phobia
Phobia
Tourette’s
Alcoholism
Substance abuse

AGE-RELATED FACTORS

Pediatric: Child/adolescent onset in 33%. At this age males outnumber females 3:1.
Geriatric: Diagnosis not generally made after age 50
Others: N/A

PREGNANCY

Onset of OCD has been noted after delivery
Safety of fluoxetine and clomipramine has not been established in pregnancy or lactation

OTHER NOTES

Not to be confused with obsessive compulsive personality disorder (see Differential Diagnosis)

ABBREVIATIONS

Y-BOCS = Yale Brown obsessive compulsive scale
OCD = obsessive compulsive disorder
MOCI = Maudsley obsessive-compulsive inventory

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.