Obsessive-Compulsive Disorder (OCD) Treatment

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition characterized by obsession, compulsion, or both.  The condition typically affects individuals during childhood or adolescence and often continues until adulthood.  Obsessions are characterized by intrusive thought or urges that lead to anxiety and distress.  Compulsions are repetitive behaviors that the person feels compelled to accomplish according to set rules.

Patients with obsessive-compulsive disorder often have coexisting psychiatric disorders such as depression, anxiety, and substance abuse.  Symptoms may lead to significant social and functional impairment.  Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions:

What causes Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder is likely caused by genetic and environmental factors.  Studies show that a network in the brain called the cortico-striato-thalamo-cortical circuit contributes to the pathogenesis of the disease.  Other brain circuits are also likely involved.  Patients with obsessive-compulsive disorder often have family members that are also affected.  The onset of disease is closely associated with environmental triggers such as stress and traumatic events.  There is also evidence to suggest that stroke and traumatic brain injury can precipitate the onset of the condition.  Lastly - fluctuations in hormones may contribute to the disease as premenstrual and postpartum women can develop new onset disease or exacerbations of disease during these time periods.

OCD is frequently associated with other psychiatric disorders such as:

  • Schizophrenia
  • Bipolar disorder
  • Eating disorders - anorexia nervosa and bulimia nervosa
  • Tourette disorder

How common is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder is a relatively uncommon psychiatric condition that often requires referral to a psychiatry and psychology specialist - particularly if first-line and conservative measures are unsuccessful.

The 12-month prevalence of obsessive-compulsive disorder is approximately 1.2% and the lifetime prevalence of the condition is about 2.3%.  Women are usually affected more often than men in adulthood.  Men are more frequently affected with the disorder during childhood.  Patients with obsessive compulsive disorder often have coexisting anxiety disorder (76%) and major depressive disorder (63%).  About 29% of affected patients also have a tic disorder – this is more prevalent in males who developed OCD during childhood.

What are the symptoms and signs of Obsessive Compulsive Disorder (OCD)?

Symptoms of obsessive compulsive disorder typically include obsessions, compulsions, or both.

Obsessions are characterized by intrusive thought or urges that lead to anxiety and distress.  This often includes thoughts of contamination, violent images, or urges to perform specific actions.  These obsessions are involuntary and unpleasant.

Compulsions are repetitive behaviors that the person feels compelled to accomplish according to set rules.  Compulsions frequently include rituals such as washing, checking, and counting – patients feel an urge to perform these activities in response to an obsession.

How is Obsessive-Compulsive Disorder (OCD) diagnosed?

The diagnosis of obsessive-compulsive disorder is based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders.  The key features of the diagnosis include the presence of intrusive thoughts, images or urges, as well as repetitive behaviors and mental acts.  These symptoms are typically time-consuming and cause significant social and occupational impairment.  They may not be related to another medical or psychiatric diagnosis.

Other psychiatric disorders must be considered in the diagnosis as they can have overlapping symptoms or coexist with OCD – these include major depressive disorder, tic disorder, psychotic disorders, and obsessive-compulsive personality disorder.

Your doctor may order laboratory tests to exclude other metabolic of infectious diseases that can produce similar symptoms.  Commonly ordered blood tests include a CMP (comprehensive metabolic panel), CBC (complete blood cell count), and thyroid function studies, (TSH, free T4).  They will also usually check a urine analysis and urine drug screen.

Occasionally, your doctor will order an MRI of the brain to rule out structural abnormalities such as tumor or stroke.  This is typically the case if you have associated neurologic symptoms such as headache, weakness, or numbness.

How is Obsessive-Compulsive Disorder (OCD) treated?

Obsessive-compulsive disorder is usually treated with cognitive-behavioral therapy, selective serotonin reuptake inhibitors (SSRIs), or both.  Exposure and response prevention is a type of cognitive therapy that may be particularly beneficial.  The most commonly prescribed SSRIs include:

Anafranil (clomipramine) and Effexor (venlafaxine) are additional prescriptions that have been shown to be efficacious.  Most of these medications typically take at least 2 weeks to a month for individuals to notice any symptomatic improvement.  They should be trialed for at least 6 weeks in most cases.  Refractory obsessive-compulsive disorder may require the use of antipsychotic drugs such as Risperdal (risperidone).

Obsessive-Compulsive Disorder (OCD) Patient Summary:

  • Obsessive-compulsive disorder is a chronic a psychiatric condition characterized by obsession, compulsion, or both. It is likely caused by genetic and environmental factors.
  • Studies show that a network in the brain called the cortico-striato-thalamo-cortical circuit contributes to the pathogenesis of the disease.
  • The condition typically affects individuals during childhood or adolescence and often continues until adulthood.
  • Obsession are characterized by intrusive thought or urges that lead to anxiety and distress. Compulsion are repetitive behaviors that the person feels compelled to accomplish according to set rules
  • The diagnosis of obsessive-compulsive disorder is based on criteria set by the diagnostic and statistical manual of mental disorders.
  • The key features include the presence of intrusive thoughts, images or urges, as well as repetitive behaviors and mental acts.
  • Symptoms are time-consuming and cause significant social and occupational impairment. They may not be related to another medical or psychiatric diagnosis. 
  • Obsessive compulsive disorder is usually treated with cognitive-behavioral therapy, selective serotonin reuptake inhibitors (SSRIs), or both.
  • The most commonly prescribed SSRIs include: Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram), Lexapro (escitalopram), and Paxil (paroxetine).
  • Anafranil (clomipramine) and Effexor (venlafaxine) are additional prescriptions that have been shown to be efficacious.
  • These medications typically take at least 2 weeks to a month improve symptoms.

Refractory cases may require the use of antipsychotic drugs such as Risperdal (risperidone).

References:

  1. Soomro GM, Altman D, Rajagopal S, Oakley-Browne M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database Syst Rev 2008; :CD001765.
  2. Dell'Osso B, Nestadt G, Allen A, Hollander E. Serotonin-norepinephrine reuptake inhibitors in the treatment of obsessive-compulsive disorder: A critical review. J Clin Psychiatry 2006; 67:600.
  3. Koran LM, Hanna GL, Hollander E, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry 2007; 164:5.

Popular Obsessive-Compulsive Disorder Medications

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.