Obsessive-Compulsive Disorder
Obsessive-compulsive disorder is characterized by the presence of recurring, unwanted, intrusive ideas, images, or impulses that may even seem silly, weird, nasty, or horrible (obsessions) to the person experiencing them, accompanied by urges to do something that will relieve the discomfort caused by the obsession (compulsions).
Obsessive-compulsive disorder occurs about equally in men and women and affects about 1.5% of the population during any 6-month period.
The obsessions are usually related to a sense of harm, risk, or danger. Common obsessions include concerns about contamination (for example, worrying that touching doorknobs will cause disease), doubts (for example, worrying that the front door was not locked), fear of loss, and fear of physically injuring someone.
More than 95% of people with obsessive-compulsive disorder feel compelled to perform rituals--repetitive, purposeful, intentional acts. Rituals used to control an obsession include washing or cleaning to be rid of contamination, checking to allay doubt, hoarding to prevent loss, and avoiding the people who might become objects of aggression. Most rituals, such as excessive hand washing or repeated checking to make sure a door has been locked, can be observed. Other rituals, such as repetitive counting or making statements intended to diminish danger, cannot be observed. Obsessions are not always accompanied by compulsions.
Most people with obsessive-compulsive disorder are aware that their obsessive thoughts do not reflect actual risks and that their compulsive behaviors are ineffective. Obsessive-compulsive disorder, therefore, differs from psychotic disorders, in which people lose contact with reality. Obsessive-compulsive disorder also differs from obsessive-compulsive personality disorder (see Section 7, Chapter 105), in which specific personality traits are defined (for example, being a perfectionist). Because people with obsessive-compulsive disorder are aware that their compulsive behaviors are excessive to the point of being bizarre and are afraid they will be embarrassed or stigmatized, they often perform their rituals secretly, even though the rituals may occupy several hours each day.
About one third of people with obsessive-compulsive disorder are depressed at the time the disorder is diagnosed. Altogether, two thirds become depressed at some point.
Treatment
Exposure therapy is effective in treating obsessive-compulsive disorder. Exposure therapy involves exposing the person to the situations or people that trigger obsessions, rituals, or discomfort. The person's discomfort or anxiety will gradually diminish if he prevents himself from performing the ritual during repeated exposure to the provocative stimulus. In this way, the person learns that rituals are unnecessary for decreasing discomfort. The improvement usually persists for years, probably because people who have mastered this self-help approach continue to practice it as a way of life without much effort after formal treatment has ended.
Selective serotonin reuptake inhibitors and clomipramine, a tricyclic antidepressant, are effective. Certain other antidepressant drugs are also used, but much less often. Many experts believe that a combination of behavior therapy and drug therapy is the best treatment for people with obsessive-compulsive disorder.
Psychodynamic psychotherapy and psychoanalysis have generally not been effective for people with obsessive-compulsive disorder.
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