Obsessive Compulsive Disorder (OCD)

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Prognosis

The average age of onset for OCD varies among men and women. Men may experience childhood onset, between ages 6 and 15, while women typically experience adult onset, between ages 20 and 30. Two-thirds of all adults with OCD had symptoms before age 15, 80% of whom also had symptoms of depression. Given the likelihood of early onset, it is alarming that the average age that a person seeks treatment is 27.

Although OCD usually develops gradually, psychosocial stressors like changes in living situations, relationship problems, or work problems can cause sudden onset. About 70% of people experience a chronic and lifelong course, with worsening and improving symptoms. About 5% have episodic symptoms with partial or complete remission between episodes.

Regardless of a person's age at onset, the content of obsessions does not determine prognosis. The factors associated with a good prognosis include the following:

• Milder symptoms
• Brief duration of symptoms
• Good functioning before full onset

Some people have only obsessions and do not behave compulsively. These people may attempt to suppress their disturbing, intrusive, or inappropriate thoughts by thinking healthy thoughts. This may lead to mental exhaustion, distraction, or concentration problems.

Complications common to OCD include anxiety (see also generalized anxiety disorder) with panic symptoms (see panic disorder), depression, and suicidal thoughts.

Roughly 80% of people who suffer from OCD experience depression. These people typically have a hard time maintaining relationships, do not marry as often as others, and have occupational and school problems. Though suicidal obsessions are common in OCD, less than 1% of people with OCD commit suicide. In fact, people with OCD rarely become completely incapacitated.

OCD is associated with other disorders that often involve excessive attention to the body and distorted perceptions of it. About 13% of people with OCD suffer from eating disorders like anorexia nervosa and bulimia nervosa. Slightly more, about 15%, suffer from trichotillomania, which is the irresistible urge to pull out one's own scalp, facial, or body hair.

Between 10% and 15% experience Tourette's syndrome, which causes involuntary muscle movements and tics, and repetitive uncontrollable speech that is often disruptive and profane. Tics are apparent in some people, especially during childhood, before OCD is diagnosed. Although its prevalence is not known, some people are affected by body dysmorphic disorder, in which they fear a certain body part is abnormal or misshapen, regardless of what others tell them.

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