Treatment of Obsessive/compulsive Disorder

By Lawrence J Cohen | Drug Topics, April 1997 | Go to article overview

Treatment of Obsessive/compulsive Disorder


Lawrence J Cohen, Drug Topics


Obsessive-compulsive disorder (OCD) is a psychiatric disorder in which a person becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome.

It is not unusual for some patients to wait for years before seeking treatment. Although the consequences of untreated OCD are not known, OCD does produce significant work and social disability. In fact, if OCD becomes severe enough, it can destroy a person's capacity to function in the home, at work, or at school. Other psychiatric disorders such as anxiety and mood disorders may prompt patients to seek treatment. A study conducted by the National Institutes of Mental Health, the Epidemiologic Catchment Area study (ECA), indicated that approximately 50% of patients with OCD also had another psychiatric disorder (e.g., major depression, anxiety disorder, panic disorder, or schizophrenia).

Although symptoms of OCD have been recognized for centuries, it has only in recent years become a focus area of extensive research. Since the mid-1990s, the Food & Drug Administration has approved five drugs: clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline for the treatment of OCD. Although OCD is officially classified as an anxiety disorder, in many cases it is considered a separate disorder because of its unique presentation and treatment approach.

OCD is perhaps the most disabling anxiety disorder and rarely remits without pharmacologic intervention. Even with pharmacotherapy and intensive psychotherapy, many patients suffer disabling symptoms with a lifetime of disability.

The ECA study provided the mental health community with data concerning prevalence of psychiatric disorders based on a survey conducted in five communities from 1980 to 1984. After conducting more than 18,500 interviews, researchers were surprised to find that OCD was approximately 50 times more common than previously reported. ECA data revealed a lifetime prevalence of 2.5% in adults and 1% in children, with a one-year prevalence rate of 1.5% to 2.1%. OCD is the fourth most common psychiatric disorder following phobias, substance abuse, and major depression.

In most cases, OCD begins in late adolescence or early adulthood, although it can present earlier. The incidence of OCD is higher in females than males. However, males seem to become symptomatic earlier in life. The onset of symptoms is gradual, and symptoms seem to wax and wane throughout life.

In order to meet the diagnostic criteria for Obsessive-Compulsive Disorder, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV), requires the presence of obsessions and/or compulsions that are severe enough to cause marked distress, to be time consuming (activity requires > 1 hour per day), and to cause significant impairment in social or occupational functioning. Frequently, those afflicted with OCD recognize that their obsessions or compulsions are excessive or unreasonable, but they feel they can do nothing about them.

Obsessions are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. The most common obsessions are repeated thoughts about contamination (e.g., becoming contaminated by shaking hands), repeated doubts (e.g., wondering whether one has left a door unlocked), a need to have things in a particular order (e.g., intense distress when objects are disordered or asymmetrical), aggressive or horrific impulses (e.g., to hurt one's child or to shout an obscenity in church), and sexual imagery (e.g., a recurrent pornographic image).

The thoughts, impulses, or images are not simply excessive worries about real-life problems (e.g., concerns about current ongoing difficulties in life, such as financial, work, or school problems) and are unlikely to be related to a reallife problem.

The individual with obsessions usually attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action (e. …

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