Obsessive Compulsive Disorder (OCD)

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Overview

Obsessive-compulsive disorder (OCD) can be a debilitating disorder with the following two anxiety-related essential features: obsessions (undesirable, recurrent, disturbing thoughts) and compulsions (repetitive or ritualized behaviors).

People with OCD experience unwanted obsessions, which cause anxiety. Severe anxiety produces feelings of dread, worry, fright, and apprehension (see generalized anxiety disorder [GAD]). Certain behaviors are performed compulsively in an attempt to lessen this anxiety. Although they realize their obsessions are excessive and their behavior is unreasonable, they feel powerless to control either. In fact, their symptoms can overwhelm them and result in severe impairment and dysfunction, which can begin at an early age.

Incidence and Prevalence
The National Institute for Mental Health reports that about 3% of people in the United States have OCD. Typical age of onset for boys is 6 to 15, while for women it is often later, between 20 and 30. Risk factors like genetic predisposition and environmental stress contribute to OCD. Also, OCD is more common among people of higher education, IQ, and socioeconomic status. Men and women, however, are affected equally. Though its course is chronic and usually lasts a lifetime, it is treatable with medication, behavioral therapy, and, in extremely rare cases, brain surgery.

Risk Factors

Risk factors for obsessive-compulsive disorder include the following:

• Genetics
• Postpartum periods
• Environmental stressors

Although there is no clear genetic evidence, obsessive-compulsive disorder tends to run in families. A person with OCD has a 25% chance of having a blood relative who has it. Like other mental illnesses, it is more prevalent among identical twins than fraternal. There is a 70% chance that identical twins with share it, and a 50% chance for fraternal twins. Currently, researchers do not understand OCD's genetic mechanisms, though they suspect multiple genes are involved.

Women with OCD may experience a worsening of symptoms during pregnancy and postpartum. A recent study suggests that fluctuating hormones may trigger symptoms during pregnancy. The same study reports OCD in 30% of women observed.

The arrival of a baby brings new responsibility, a new set of concerns, and changes in routine. While normal reaction to a newborn may include some anxiety, postpartum OCD features disturbing thoughts and excessive behavior regarding the baby's well-being. The following obsessions and compulsions are common:

These feelings and behaviors may occur immediately, but often begin 4 to 6 weeks after giving birth. Treatment is necessary to control symptoms and to ensure care of the baby.

Environmental stressors that can worsen OCD symptoms include the following:

• Abuse
• Changes in living situation
• Illness
• Occupational changes or problems
• Relationship concerns
• School-related problems

Causes

Biological factors involving brain structure and activation are associated with OCD. Abnormalities of the frontal lobes, basal ganglia, and cingulum are common in people with OCD. Basal ganglia are involved in routine behaviors, like grooming, and the frontal lobes in organizing behaviors and in planning. The cingulum consists of fibrous bands that assist in communicating the brain's behavioral and emotional messages. Support for its role in OCD is the fact that surgical severing of the cingulum has relieved and even cured people with the disorder.

The Serotonin Hypothesis
An abnormally low level of serotonin is perhaps the most well-established link between the brain and OCD. Serotonin is a chemical neurotransmitter that transmits information from one nerve to another throughout the brain. It is released by one synapse(nerve ending), crosses a gap, and is picked up by another synapse. After a message is sent, enzymes in the brain clean serotonin out of the synapses. Drugs used to treat OCD, known as selective serotonin reuptake inhibitors (SSRIs), increase and sustain serotonin levels and reduce or eliminate symptoms (see Treatment).

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