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Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a psychiatric disorder, specifically, an anxiety disorder. OCD is manifested in a variety of forms, but is most commonly characterized by a subject's obsessive drive to perform a particular task or set of tasks, compulsions commonly termed rituals. more...

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OCD should also be distinguished from the similarly named but notably different obsessive-compulsive personality disorder, which psychiatric guidelines define as a personality characteristic rather than an anxiety disorder.

The phrase "obsessive-compulsive" has worked its way into the wider English lexicon, and is often used in an offhand sense to describe someone who is meticulous or absorbed in a cause. Such casual references should not be confused with obsessive-compulsive disorder; see clinomorphism. It is also important to distinguish OCD from other types of anxiety, including the routine tension and stress that appear throughout life. A person who shows signs of infatuation or fixation with a subject/object, or displays traits such as perfectionism, is not necessarily stricken with OCD, a specific and well-defined disorder.

Symptoms and prevalence

Modern research has revealed that OCD is much more common than previously thought. An estimated two to three percent of the population of the United States is thought to have OCD or display OCD-like symptoms. Because of the condition's personal nature, and the lingering stigma that surrounds it, there may be many unaccounted-for OCD sufferers, and the actual percentages could be even higher.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsessions. To others, these tasks may appear simple and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways for fear of dire consequences and to stop the stress build up. Examples of these tasks: repeatedly checking that one's parked car has been locked before leaving it; turning lights on and off a set number of times before exiting a room; repeatedly washing hands at regular intervals throughout the day.

OCD rituals are often bound up with intricate detail — detail that may seem arbitrary to outsiders. Smokers with OCD, for instance, may argue with themselves that quitting cigarettes is possible only on the 13th or 27th of a month, and only when they are in possession of four cigarettes at noon.

Obsessions are thoughts and ideas that the sufferer cannot stop thinking about. Common OCD obsessions include fears of acquiring disease, getting hurt, or causing harm to someone. Obsessions are typically automatic, frequent, distressing, and difficult to control or put an end to by themselves. People with OCD who obsess over hurting themselves or others are actually less likely to do so than the average person.

Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. For an OCD sufferer who obsesses about germs or contamination, for example, these compulsions often involve repeated cleansing or meticulous avoidance of trash and mess. Most of the time the actions become so regular that it is not a noticeable problem. Common compulsions include excessive washing and cleaning; checking; hoarding; repetitive actions such as touching, counting, arranging and ordering; and other ritualistic behaviors that the person feels will lessen the chances of provoking an obsession. Compulsions can be observable — washing, for instance — but they can also be mental rituals such as repeating words or phrases, or counting.

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Obsessive-compulsive disorder in children
From Pediatrics for Parents, 12/1/04

Many children have bedtime rituals that are comforting and help prepare them for sleep. Unfortunately, one in every 200 children suffers from obsessive-compulsive disorder (OCD) which can result in rituals which involve immense anxiety. These rituals are actually compulsions, repetitive behaviors that are responses to obsessions.

For example, fear of germs may drive children to excessive hand washing or teeth brushing. These obsessions and compulsions are often embarrassing and hidden from parents.

According to Melissa Martinez, M.D., assistant professor of clinical psychiatry at the The University of Texas, "An obsession is a recurrent or persistent idea, thought or image, or impulse that intrudes in the child's life and is inappropriate." These obsessions cannot be simply ignored or suppressed.

It is important that parents recognize the signs of OCD. Dr. Martinez says, "The key hallmark of OCD behaviors is that they are excessive and unreasonable. They are distressing, time-consuming and interfere with the child's day-to-day functioning." Behaviors of concern include checking door locks excessively, repeating words, endless counting, and ordering or arranging. Compulsions related to foods are common. A child with OCD may lose sleep due to performing rituals and may also experience stress-related headaches or upset stomachs.

The average onset age of OCD is ten years, and one-half to one-third of adults who suffer from OCD say that they were afflicted by the disorder in childhood. There is evidence that childhood-onset OCD may be different from OCD which appears in adulthood. Children who develop OCD are much more likely to have blood relatives with this disorder. A family history of tic or anxiety disorders increases the child's risk of developing OCD.

There is no proven cause of OCD, but it is believed to involve insufficient levels of serotonin (a neurotransmitter in the brain). Drugs that increase the brain concentration of serotonin often help improve the symptoms. There is no laboratory test for OCD. The diagnosis is based on an assessment of the symptoms.

Dr. Martinez recommends a combination of cognitive behavioral therapy, family therapy and medication. More information on OCD can be found at www.ocfoundation.org.

COPYRIGHT 2004 Pediatrics for Parents, Inc.
COPYRIGHT 2005 Gale Group

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