Article covers description of OCD symptoms, how OCD can mimic other disorders, the genetics of OCD, and treatment of OCD.

Description of OCD Symptoms

"Imagine you are getting up in the morning. You know you will need to go to the bathroom, but the thought of accidentally touching the doorknob is frightening. There may be dangerous bacteria on it. Of course you cleaned the entire bathroom yesterday, including the usual series of disinfectant spraying, washing and rinsing. As usual it took a couple of hours to do it the right way. Even then you weren't sure whether you had missed an area, so you had to re-wash the floor. Naturally the doorknob was sprayed and rubbed three times with a bactericidal spray. Now the thought that you could have missed a spot on the doorknob makes you very nervous. Maybe you should have cleaned it another time? Carefully you put on your laundered slippers and think to yourself repeatedly, "The Lord will protect me from all germs; I will fear no evil", and cross the floor to the bathroom, careful to do it in exactly 10 steps. On some days you spend so much of your time checking, cleaning and arranging things, there is little time left for other matters."

This description might give you some sense of the tormented and anxious world that people with Obsessive Compulsive Disorder (OCD) live in. It is a world filled with dangers from outside and from within. Often elaborate rituals and thoughts are used to ward off feared events, but no amount of mental or physical activity seems adequate, so doubt and anxiety are often present.

(Read this description of what it's like living with OCD)

Obsessions are thoughts or images that seem to intrude into a person's mind. While he generally knows they are his own thoughts, he can't control them, and finds them very disturbing. They may take the form of fears of something terrible happening to himself, his friends or family, often as a result of his own actions or neglect.

Compulsions are behaviors that usually are repetitive and stereotyped. They may take the form of actions or thoughts. The compulsive behaviors are intended to reduce the anxiety engendered by obsessions. People who do not have OCD may perform behaviors in a ritualistic way, repeating, checking, or washing things out of habit or concern. Generally this is done without much if any worry. What distinguishes OCD as a psychiatric disorder is that the experience of obsessions, and the performance of rituals, reaches such an intensity or frequency that it causes significant psychological distress and interferes in a significant way with psychosocial functioning. The guideline of at least one hour spent on symptoms per day (American Psychiatric Association 1994; Goodman et al. 1989b) is often used as a measure of "significant interference." However, among patients who try to avoid situations that bring on anxiety and compulsions, the actual symptoms may not consume an hour. Yet the quantity of "time lost" from having to avoid objects or situations would clearly constitute interfering with functioning. Consider, for instance, a welfare mother who throws out more than $100 of groceries a week because of contamination fears. Although this behavior has a major effect on her functioning, it might not consume one hour per day.

Patients with OCD describe their experience as having thoughts (obsessions) that they associate with some danger. The sufferer generally recognizes that it is his own thought, rather than something imposed by someone else (as in some paranoid schizophrenic patients). However the disturbing thought cannot be dismissed, and simply nags at him. Something must then be done to relieve the danger and mitigate the fear. This leads to actions and thoughts that are intended to neutralize the danger. These are the compulsions. Because these behaviors seem to give the otherwise "helplessly anxious" person something to combat the danger, they are temporarily reassuring. However, since the "danger" is typically irrational or imaginary, it simply returns, thereby triggering another cycle of the briefly reassuring compulsions. From the standpoint of classic conditioning, this pattern of painful obsession followed by temporarily reassuring compulsion eventually produces an intensely ingrained habit. It is rare to see obsessions without compulsions.

The two most common obsessions are fears of contamination and fear of harming oneself or others. The two most common compulsions are checking and cleaning (Foa and Kozak 1995).

OCD Can Mimic Other Disorders

An OCD sufferer with an intense fear of contamination might avoid the object of his fear by staying home, and thus become housebound as in agoraphobia. The distinction becomes apparent when the reason for staying home is investigated.

Obsessive Compulsive Disorder may manifest with fears of contracting severe illnesses, such as cancer, venereal diseases or AIDS. These somatic obsessions may resemble hypochondria. Despite the similarities, the OCD patient will often have a typical history of various obsessions and compulsive symptoms that are not primarily somatic (e.g. fears of hitting someone, compulsions to count or check).

OCD can result in depression as well as avoidant behavior that resembles specific or social phobias. The degree of anxiety experienced in connection with the obsessions may be so pervasive that it can resemble generalized anxiety disorder.

Genetics of OCD

The prevalence of OCD in the United States is estimated to be 2-3%. Thus 5-7 million Americans have this illness. Studies of OCD patients and their families have established a 10% prevalence of OCD in first degree relatives (an additional 8% have a subclinical degree of OCD symptoms). The genetic connection seems to be higher if the onset of OCD is before age 14. In studies of twins, there is a 63% concordance rate for OCD in identical twins.