Obsessive compulsive disorder: symptoms, diagnosis, and treatment

Obsessive-Compulsive Disorder (OCD) is a neuropsychiatric disorder that often disrupts academic, social, and vocational activities. The primary feature of this disorder is recurring obsessions and compulsions that interfere with one's life (Nissen, Mikkelsen, & Thomsen, 2005):

is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost shows perfectionism that interferes with task completion is excessively devoted to work and productivity to the exclusion of leisure activities and friendships is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values is unable to discard worn-out or worthless objects even when they have no sentimental value is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes shows rigidity and stubbornness

The most clinically useful and detailed symptoms checklist is included in the Yale-Brown Obsessive-Compulsive Scale (Mataix-Cols, do Rosario-Campos, & Leckman, 2005). The most common theme of obsessions are contamination themes, and the related compulsive behavior is washing, usually compulsive handwashing. Along with contamination themes, problems with aggressive obsessions, sexual obsessions, the need for symmetry and order, obsessions about harm to oneself or others, and the need to confess exist. When overt, observable compulsive behaviors are relatively easy to observe to make the diagnosis, covert behaviors are harder to assess and evaluate.

Risk Factors

No single definitive cause for OCD exists (Foa et al., 2005; Kordon et al., 2005). One of these messengers, serotonin, functions to prevent people from repeating the same behaviors over and over again. Those with OCD may lack sufficient serotonin concentrations. Many people with OCD function better when they take medications designed to increase serotonin uptake in the brain.

Diagnosis

Diagnosis of OCD is not exclusionary (First et al., 1995). Other anxiety disorders, tic disorders, and disruptive behavior disorders are common comorbidities with OCD. OCD is considered a neuropsychiatric disorder. Relatively few OCD behaviors exist, and they are experienced in much the same manner by patients, regardless of their interpersonal histories.

If OCD is suspected, referral to a mental health professional is indicated. A complete family history is essential, especially any history of relatives who may have OCD or Tourette syndrome, as is a history of any infection that may have preceded the onset of symptoms. Of structured interviews and psychological tests used, the Yale-Brown Obsessive-Compulsive Scale is considered the instrument of choice in making the definitive diagnosis (Mataix-Cols et al., 2005).

Treatment

Successful treatment of OCD involves both the use of selective serotonin reuptake inhibitors (SSRIs) and structured psychotherapy designed to provide the patient with the skills to master the obsessive thoughts and accompanying compulsive behaviors. Cognitive behavioral therapy routinely is described as the psychotherapeutic treatment of choice for adults, children, and adolescents who have been diagnosed with OCD (First et al., 1995). Treatment relies heavily on exposing the individual to the problem situations and then preventing the compulsive response. The resulting anxiety then is managed by training children to use strategies that help them work with their anxiety in a more effective and less disruptive way.

Anxiety management techniques may include relaxation training, distraction, or imagery. Often, OCD is personified as something that makes the child perform an action. Thus, children learn to assess situations and ask themselves if they really want to do something, as opposed to the perception that the OCD is making them do something. With cognitive behavioral therapy, the initial goals are specific to one or two behaviors. However, as the patient becomes successful in coping with these situations, generalization usually occurs to other symptoms that have not been targeted. Usually, the patient reports an overall reduction in obsessive thoughts, general anxiety, and the need to perform certain actions.