OCD
Obsessive–compulsive disorder (OCD) is a mental disorder in which an individual has intrusive thoughts (an obsession) and feels the need to perform certain behaviors (compulsions) repeatedly to relieve the distress caused by the obsession, to the extent where it impairs general function. OCD has been described since antiquity and has affected numerous notable historical and contemporary figures; understandings of it were historically rooted in religion and beliefs about demonic possession.
Obsessions are persistent unwanted thoughts, mental images, or urges that generate feelings of anxiety, disgust, or discomfort. Some common obsessions include fear of contamination, obsession with symmetry, the fear of acting blasphemously, sexual obsessions, and the fear of possibly harming others or themselves. Compulsions are repetitive actions performed in response to obsessions to reduce anxiety, such as washing, checking, counting, reassurance seeking, and situational avoidance.
Compulsions occur often and typically take up at least one hour per day, impairing one's quality of life. Compulsions temporarily relieve distress but reinforce obsessions over time. Many adults with OCD recognize their rituals as irrational yet continue them to reduce anxiety. For this reason, thoughts and behaviors in OCD are usually considered egodystonic (inconsistent with one's ideal self-image).
The causes of OCD are multifactorial and not fully understood, involving genetic predisposition, environmental stressors such as childhood trauma, abnormalities in brain structure and neurotransmitter function, certain medications or drugs, potential autoimmune processes in some children, and possibly evolutionary factors influencing compulsive behaviors. Diagnosis is based on clinical presentation; rating scales such as the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) assess severity. OCD involves abnormalities in cortico-striato-thalamo-cortical circuits and dysregulation of serotonin, dopamine, and glutamate. OCD is associated with a general increase in suicidality. The term obsessive–compulsive or OCD is often used informally to describe someone overly meticulous or fixated, but OCD can present in many ways, and not all sufferers focus on cleanliness or symmetry.
OCD is chronic and long-lasting with periods of severe symptoms followed by periods of improvement. Treatment can improve ability to function and quality of life, and is usually reflected by improved Y-BOCS scores. First-line treatment for OCD typically consists of either exposure and response prevention or pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs), or both in combination. Some patients fail to improve after treatment with SSRIs alone; these cases qualify as treatment-resistant and can require second-line treatment such as clomipramine or augmentation with an atypical antipsychotic. Treatment-resistant obsessive–compulsive disorder is also managed with transcranial magnetic stimulation, electroconvulsive therapy, or, as a last resort, surgical options like deep brain stimulation.
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