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Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder in which people suffer from recurrent, unwanted thoughts or ideas (obsessions); engage in repetitive, irrational behaviors or mental acts (compulsions); or both. Among people with OCD, carrying out compulsive behavior tends to ease feelings of anxiety while repressing compulsive behavior causes stress.

According to the National Institute of Mental Health, OCD affects about 2.3% of the United States population age 18 to 54 years (ie, approximately 3.3 million Americans). An additional 1 million children and adolescents have the disorder. The condition typically begins during early childhood or adolescence and affects men and women equally (National Institute of Mental Health 2006).

Up to two-thirds of people with OCD suffer from additional psychiatric conditions. These conditions, including depression, eating disorders, personality disorder, attention deficit disorder, and other anxiety disorders (eg, social phobia and separation anxiety disorder) can make it difficult for physicians to diagnose and treat OCD due to overlapping symptoms. Of these additional conditions, major depressive disorder appears to be the most common, affecting up to 55% of OCD patients. Bipolar disorder affects as many as 30% of OCD patients, while social phobia impacts 23% (Cosoff 1998; Kruger 1995).

There are many types of obsessions; the most common include repeat thoughts about contamination (by dirt or germs), repeat doubts (eg, whether a door is locked or an appliance left on), need for order or exactness, fear of harming someone, inappropriate or frightening sexual thoughts or imagery, and repeat thoughts of certain images, words, or sounds. In an attempt to relieve the anxiety caused by these thoughts, people with OCD may engage in compulsive behaviors such as excessive showering or hand washing, repeat checking to make sure doors are locked, rearranging objects for order or symmetry, and counting items over and over. Although adults recognize, at least sometimes, that their obsessions and compulsions are unreasonable, children with OCD typically are not capable of this same realization (American Psychiatric Association 2004).

There are no diagnostic tests for OCD. A clinical diagnosis of the disorder requires that the behaviors be extreme enough to interfere with everyday activities (take more than one hour per day) or significantly interfere with a person’s relationships, health, social functioning, or occupational functioning. For example, up to 70% of people report problems with family relationships, and more than half report interference with social and work relationships (Koran 2000; Hollander 1997; Koran 1996; Calvocoressi 1995). As a result, most people with OCD struggle to rid themselves of obsessive thoughts and stop compulsive behaviors.