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UC Davis Health System

UC Davis Health System

Checkup on Health: Help is available for obsessive-compulsive disorder

anxious man
OCD involves severe anxiety but also obsessions and compulsions. People with OCD usually know that their thoughts and actions are irrational, and are therefore reluctant to seek help, fearing that others will think they are crazy.

By Donald M. Hilty, M.D. 

Everyone is occasionally plagued by disturbing thoughts or finds comfort in small routines. But for some people, such thoughts turn into obsessions that they can’t get out of their mind, and small routines are performed so repetitively that they become compulsive acts. Such obsessions and compulsions may become an overwhelming part of  one’s life.

Obsessive-compulsive disorder or OCD is a recognized psychiatric disorder found in about 2 to 3 percent of the population. Obsessions are unpleasant ideas, thoughts or images that manifest themselves repeatedly. They may include fears of contamination by dirt or germs, or terrors that loved ones will be harmed, either by others or by one’s own hand. Sexual images, which are perceived as sinful or disgusting, are also common. Obsessions are usually extremely anxiety-provoking and are experienced as an intrusion beyond personal control.

Compulsions are behaviors that are performed over and over again in an attempt to relieve the anxiety generated from the mental obsessions. They may include frequent hand-washing or teeth-brushing to control germs or repeatedly checking that doors are locked, drawers are shut or appliances are turned off. Some people repetitively count small objects or place them in special arrangements.  Many people engage in mental routines that aren’t noticeable to others, such as repeating prayers, number sequences or certain phrases.

Such compulsive routines may occupy an hour or more of a person’s time each day, and may significantly interfere with work, social activities or other aspects of a normal life.

A medical problem, with a biological basis

Dr. HiltyAbout the author

Dr. Hilty is an adult psychiatrist at UC Davis Medical Center in Sacramento and medical director at the Sacramento County Mental Health Treatment Center.

OCD is usually diagnosed during young adulthood, although many report that the tendency was apparent since childhood. People with OCD usually know that their thoughts and actions are irrational, and are therefore reluctant to seek help, fearing that others will think they are crazy.

But OCD is a medical problem: a biological basis exists for it. A person’s thoughts and actions are not easily controlled, even when one knows they may be irrational. Brain scans of individuals with OCD have detected abnormalities in metabolic activity in certain areas of the brain associated with anxiety and maintaining habits. This abnormal brain activity tends to more normal patterns when a patient is being successfully treated.

OCD often runs in families and is likely to be genetically influenced. Interestingly, Tourette’s disorder, a quite different problem involving involuntarily tics and unusual mannerisms, tends to be found in the same families, strengthening the theory for a genetic basis for both problems.

Medications are effective against OCD

The important thing is to not be afraid to seek professional help, whether it is for the first time or during exacerbations of the problem. Doctors usually can help people with OCD cope with their problems and get on with a happy and productive life.

Medications that are effective against OCD act by increasing the availability of serotonin, a neurotransmitter closely tied to depression and anxiety disorders. Several different drugs are available, belonging to two different classes of drugs: tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). While the TCAs are associated with more side effects than the SSRIs and have become a second-line medication against depression, one TCA, clomipramine (Anafranil), is particularly effective in treating OCD. 

If a medication does not seem to be working, increasing the dosage may be helpful. Dosages of these medications tend to be higher for OCD than for those used against depression. If side effects are intolerable, switching to another medication or trying a combination can be tried.

One medication, sertraline (Zoloft) has been FDA-approved for treating OCD in childhood.

Behavior therapy also helpful

Cognitive-behavioral therapies can also reduce the symptoms of OCD and may be used in conjunction with or instead of medications. A typical behavioral approach is to gradually bring the person into contact with fears, either through actual or imaginary exposure. Compulsive comforting behaviors are prevented or postponed little by little until they are no longer needed.

Cognitive therapy helps one learn about the vicious cycles of emotion and thinking initiated by a negative thought, as well as how to train the mind to avoid such unproductive and anxious cycles. Cognitive-behavioral therapy should be undertaken only with a professional who has experience with treating such problems, as it may be extremely anxiety-provoking.

OCD is a difficult problem that is rarely completely cured. However, most sufferers can bring their symptoms under control with medications and/or cognitive-behavioral therapies. The important thing is to not be afraid to seek professional help, whether it is for the first time or during exacerbations of the problem. Doctors usually can help people with OCD cope with their problems and get on with a happy and productive life.