Obsessive-compulsive disorder
Obsessive thoughts and compulsive behaviors represent recurring efforts to control overwhelming anxiety, guilt, or unacceptable impulses that persistently enter the consciousness. The word obsession refers to a recurrent idea, thought, impulse, or image that is intrusive and inappropriate and causes marked anxiety or distress.
A compulsion is a ritualistic, repetitive, and involuntary defensive behavior. Performing a compulsive behavior reduces the patient’s anxiety and increases the probability that the behavior will recur. Compulsions are commonly associated with obsessions.
Patients with obsessive-compulsive disorder are prone to abuse psychoactive substances, such as alcohol and anxiolytics, in an attempt to relieve their anxiety. In addition, other anxiety disorders and major depression commonly coexist with obsessive-compulsive disorder.
Obsessive-compulsive disorder is typically a chronic condition with remissions and flare-ups. Mild forms of the disorder are relatively common in the population at large.
Causes
The cause of obsessive-compulsive disorder is unknown. Some studies suggest the possibility of brain lesions, but the most useful research and clinical studies base an explanation on psychological theories. Several studies show brain abnormalities, such as decreased caudal size and decreased white matter, but results are inconsistent and remain under investigation. In addition, major depression, organic brain syndrome, and schizophrenia may contribute to the onset of obsessive-compulsive disorder.
Signs and symptoms
The psychiatric history of a patient with this disorder may reveal the presence of obsessive thoughts, words, or mental images that persistently and involuntarily invade the consciousness.
Some common obsessions include thoughts of violence (such as stabbing, shooting, maiming, or hitting), thoughts of contamination (images of dirt, germs, or feces), repetitive doubts and worries about a tragic event, and repeating or counting images, words, or objects in the environment. The patient recognizes that the obsessions are a product of his own mind and that they interfere with normal daily activities.
The patient’s history also may reveal the presence of compulsions, irrational and recurring impulses to repeat a certain behavior. Common compulsions include repetitive touching, sometimes combined with counting; doing and undoing (for instance, opening and closing doors or rearranging things); washing (especially hands); and checking (to be sure no tragedy has occurred
since the last time he checked). The patient’s anxiety is often so strong that he’ll avoid the situation or the object that evokes the impulse.
since the last time he checked). The patient’s anxiety is often so strong that he’ll avoid the situation or the object that evokes the impulse.
Diagnosing obsessive-compulsive disorder
The diagnosis of obsessive-compulsive disorder is made when the patient’s signs and symptoms meet the established criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision.
Obsessions or compulsions
Obsessions are defined as all of the following:
Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
The thoughts, impulses, or images aren’t simply excessive worries about real-life problems.
The person attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action.
The person recognizes that the obsessions are the products of his mind and not externally imposed.
Compulsions are defined as all of the following:
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