What is Obsessive Compulsive Disorder?
Obsessive compulsive disorder (OCD) is a chronic, highly debilitating disorder in which sufferers experience recurrent, distressing thoughts and impulses (obsessions) and / or repetitive behaviours (compulsions) (ref. 1). People with OCD know their obsessions and compulsions are irrational or excessive, yet they have little or no control over them.
Prevalence of OCD:
Although once thought to be rare, OCD affects between 2-3% of the general population3 and is equally common among men and women (ref. 1).
OCD often goes unrecognised. On average, people with OCD see three to four doctors and spend nine years seeking diagnosis and treatment before they receive a correct diagnosis. Studies find that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment (ref. 4).
What are the symptoms: OCD has a number of manifestations but involves having both obsessions and compulsions. Obsessions are recurrent intrusive and unwanted thoughts, impulses or images that the individual feel to be inappropriate, grotesque or forbidden. A common obsession is around dirt and germs. As compulsions are acts performed repeatedly in the hope of obtaining relief from obsessions, those with OCD related to dust or germs for example, may wash ritually and compulsively to the point that hands become raw and inflamed.
As well has having obsession and compulsions, those with OCD may become demoralised or depressed. Feelings of intense anxiety, discomfort or disgust are also common (ref. 2).
Social and economic consequences: Listed amongst the top 10 most debilitating illnesses by the World Health Organisation (WHO) in terms of loss of income and decreased quality of life (ref. 5), OCD is associated with significant functional disability and economic costs (ref. 6). As well, up to two-thirds of individuals with OCD also suffer from depression at some point during their illness (ref. 7).
Some will experience crippling symptoms, requiring regular hospital stays and making it impossible to work, while others can function despite their symptoms. However, OCD takes a great toll on the sufferer and their friends and family, even if they only experience symptoms for a short time each day (ref. 2).
Onset and cause: OCD symptoms start as early as childhood or adolescence and affect a majority of the sufferers for their whole life, requiring long-term care and treatment (ref. 8). For most people with OCD, symptom flare ups are related to life stress.
The exact cause of OCD is unclear, but brain abnormalities, genetic (family) influences, and environmental factors are being studied (ref. 9). People with OCD have been shown to have different patterns of brain activity than those without OCD, suggesting that abnormal functioning within a certain part of the brain may cause the disorder. Abnormalities in other parts of the brain and an imbalance of brain neurotransmitters, particularly serotonin, may also contribute to OCD (ref. 9).
Treatment: There are two treatments that have been proven to effective against OCD. They include cognitive-behaviour therapy (CBT) and medication, primarily through selective serotonin reuptake inhibitors (SSRIs). In CBT, the patient is deliberately exposed to feared objects or ideas and is then discouraged or prevented from carrying out the usual compulsive response. SSRIs have proven to be beneficial as it appears that potent effects on brain serotonin are necessary to produce improvement in OCD (ref. 2). A combination of medication and CBT is often the most effective treatment for OCD.
While 50-60% of patients currently respond to treatment, only a minority recover from the disorder (ref. 9).
References
1. Obsessive Compulsive Disorder. National Institute of Mental Health (NIMH). Last accessed on 26.10.06 from http://www.nimh.nih.gov/Publicat/ocdfacts.cfm
2. OCD Question & Answers. Obsessive Compulsive Foundation. Last accessed on 08.11.06 from http://www.ocfoundation.org/UserFiles/File/Questions-Answers-About-OCD.pdf
3. Stein, DJ et al. “The Cape Town Consensus Statement,” Poster presented at the International Anxiety Disorders Conference (IACD), Cape Town, South Africa, February 2006.
4. About OCD. Obsessive Compulsive Foundation. Last accessed on 26.10.06 from http://www.ocfoundation.org/what-is-ocd.html
5. OCD UK intro. OCD UK. Last accessed on 31.10.06 from http://www.ocduk.org/
6. Stein, DJ et al. Escitalopram in the treatment of obsessive-compulsive disorder. Poster presented at the 159th Annual Meeting American Psychiatric Association, May 2006, Toronto
7. Fineberg, NA et al. Depression within OCD: from neurobiology and clinical responses toward endophenotypes. University of Hertfordshire, Hatfield, UK. Form 7
8. Hollander, E. Anxiety and OC spectrum disorders. Data presented at the European College of Neuropsychopharmacology (ECNP), September 2006, Paris
9. Stein, DJ. Obsessive-compulsive disorder. Lancet. 2002; 360(9330): 397–405