OCD is often a disabling and chronic form of anxiety suffered by about one in 50 adults in the United States.
What is OCD?
Obsessions are persistent thoughts and ideas that continually invade the consciousness. Common obsessive themes include fear of contamination by dirt or germs, aggressive impulses, fears that someone is in danger of being harmed, and sexual images.
Compulsions are urges to carry out repetitive, stereotyped behavior in an effort to lessen anxiety that usually arises from their obsessions. Even though the obsessions are recognized as senseless, the compulsive actions are carried out in an intentional manner, at times for fear that some catastrophe may otherwise occur.
Compulsive behaviors include repetitive washing, counting, and checking, for example to be certain that a door is locked. Compulsions may also take the form of touching objects a certain number of times before leaving a room, turning lights on and off, and ordering the pencils on a desk to make sure they are all parallel to each other. (Anyone who has seen my office can be certain that I do not have this compulsion; my compulsion is constant clearing of my throat.) Just as some compulsive people avoid stepping on the cracks in a sidewalk, you may have noted that some major league pitchers carefully avoid touching the baseline as they move from the mound to their dugout.
Treatment of OCD
OCD needs to be treated because the time-consuming obsessions and compulsions are distressful and may interfere with social interactions and function in the workplace. In the absence of treatment two-thirds of patients tend to improve over time, but OCD behavior disappears fully in only about one in five.
People with mild OCD may respond to psychotherapy, but most of those with more severe OCD require medications.
Psychiatric treatment often involves “exposure therapy”: A patient who fears contamination with germs would be placed in contact with the feared object or place that was considered contaminated until the fear is eliminated. It sounds brutal, but repeated exposures may eventually result in loss of the fear.
For many years the tricyclic anti-depressant, clomipramine, was the most common drug used to treat OCD. Because of its side effects, the first choice of drug treatments for OCD is now one of the serotonin-selective reuptake inhibitors (SSRIs) that are commonly used for the management of depression. These drugs include fluoxetine, paroxetine, sertraline, and fluvoxamine. When treatment with a medication is successful, it is continued for one or two years before the drug is slowly tapered.