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What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an illness that causes people to have distressing, intrusive, irrational thoughts, images or impulses (i.e., obsessions) and to perform repetitive behavioral or mental acts (i.e., compulsions) aimed at reducing distress or preventing some dreaded situation. Click here to see the DSM-IV Criteria for OCD.

Although everyone with OCD has obsessions and/or compulsions, the content varies from person to person. Typical obsessions include repetitive fears of causing harm or being harmed, fears of contamination and illness, fears of making mistakes, intrusive distressing sexual or religious imagery, or fears of losing things. Typical compulsions include repetitive washing and cleaning, excessive checking, excessive ordering and arranging, or extreme hoarding and saving. Some people with OCD have only one type of obsession or compulsion; others have several types of obsessions and compulsions.

OCD occurs in 1-3 percent of the population with its onset typically occurring in adolescence or young adulthood (although it can start in childhood). The course is often chronic.

When obsessions and compulsions cause marked distress, are time consuming (for example, take more than one hour a day), or interfere with functioning, treatment is recommended. Two treatments significantly reduce the symptoms of OCD: cognitive-behavioral therapy (CBT) using exposure and ritual prevention and pharmacotherapy with serotonin reuptake inhibitors (SRIs) clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).

How is OCD Treated?

The first-line treatments for OCD are medication with serotonin reuptake inhibitors (SRIs), therapy with Cognitive Behavioral Therapy (CBT), or their combination. Our center offers both types of treatment. We encourage patients to select the treatment that they feel most comfortable with.

  • Serotonin Reuptake Inhibitors (SRIs): Serotonin reuptake inhibitors (SRIs) are the most effective pharmaceutical treatment for OCD. SRIs are antidepressants that block the re-absorption of serotonin in the brain. Although SRIs are commonly prescribed for depression, studies have found that they can be effective for patients with OCD. The doses required for treating OCD are often higher than the doses required for treating depression (see table below). Common side effects of SRIs include: nausea, diarrhea, sexual dysfunction, and headaches. Not all patients respond to SRIs, and some who do still experience bothersome symptoms. For these patients, we recommend adding Cognitive-Behavioral Therapy (CBT).
  • Cognitive-Behavioral Therapy (CBT): Cognitive-Behavioral Therapy (CBT) that includes Exposure and Ritual Prevention (or Exposure and Response Prevention; EX/RP, ERP) has been shown to be the most effective psychotherapy for OCD. The goal of CBT is to change dysfucntional thoughts, emotions, and behaviors. To do this, the therapist helps the patient repeatedly approach situations that trigger OCD-related anxiety or distress (exposure), while refraining from performing compulsions or rituals (ritual prevention). By doing this, the patient learns that their anxiety and distress will go down, and that feared consequences will not occur, even if they don’t do their rituals. CBT with EX/RP (ERP) is typically completed in 17-25 ninety-minute sessions.

 

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