OCD Facts*All facts obtained through DynaMed Database or ocdeducationstation.org

Definition• obsessions are recurrent and persistent

thoughts, impulses or images experienced as intrusive and inappropriate

• compulsions are feelings of being driven to perform repetitive behaviors or mental acts in response to obsession or according to rules that must be applied rigidly

Common Obsessions and CompulsionsObsessions Compulsions

• contamination• safety• fear of committing sin• need for order• sexual/aggressive

thoughts

• cleaning• checking• counting/repeating• arranging• touching objects• hoarding• seeking reassurance• making lists

Who is most affected?• OCD more common in women than men in most

countries

• Onset• onset peak age 13-15 years,• female onset peak age 20-24 years

• Many adults diagnosed with obsessivecompulsive disorder report symptoms began in childhood

• (Weissman, M. et al., 1994)

Prevalence• Many research reports cite OCD as the fourth most common mental

illness after phobias, substance abuse, and major depression.

• Lifetime prevalence of OCD in young people:o worldwide, is approximately 1-2% o (lifetime prevalence of OCD refers to the percentage of individuals in a

given statistical population who, at some point in their lives, have experienced a case of OCD). 

• Another figure commonly referred to in the OCD research is that at any one given point in time, OCD affects approximately 1 in 100 children. 

• Overall, OCD has been found to be one of the most common psychiatric illnesses affecting children and adolescents.

• http://www.nimh.nih.gov/statistics/1ocd_adult.shtml

Celebrities with OCD• http://

www.rethink-anxiety-disorders.com/famous-people-with-ocd.html

Causes• Direct cause uncertain

• Evidence points to genetic component to susceptibility to OCD…particularly involving genes that that work to tone down glutamate.

• (Arnold, et al., 2006)

• Abnormalities (as seen in fMRI studies) in the prefrontal cortex….esp. areas that control activity from the amygdala (emotional processor)o See Abstract – OCD causes - Biological

Diagnosis• Some factors: • presence of obsessions or compulsions that

o are time-consuming (take > 1 hour/day)o cause distress or impairment o are recognized by the patient as excessive or unreasonableo not due to medication, drug abuse or medical conditiono if another Axis I disorder present, the content of obsessions or

compulsions not restricted to it

• Use of Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

• Irregularity on PET scans (esp. in prefrontal cortex)

Treatment - Counseling

• Behavior therapy most studied is exposure and response prevention (ERP)

• ERP appears more effective than progressive muscle relaxation

• ERP appears more effective than clomipramine alone or pill placebo

• clinician-guided behavior therapy more effective than computer-guided behavior therapy which is more effective than relaxation

• cognitive-behavioral therapy (CBT) appears effective compared to no therapy, sertraline alone or pill placebo

• cognitive therapy and behavioral therapy appear to have similar efficacy over 4-16 weeks (level 2 [mid-level] evidence)

Behavior Therapy• effective exposure and response prevention (also

called exposure and ritual prevention, ERP, EX/RP)o exposure may include

• in vivo exposure - gradual, prolonged confrontation with anxiety provoking stimuli

• imagined exposureo continue exposure until anxiety decreases (habituation)o response prevention - abstinence from rituals as opposed to active

blockingo duration of therapy 1-3 months

Predictors of better outcome with behavioral therapy

• early adherence to exposure homework• employment• living with family• no previous treatment• having fear of contamination• overt ritualistic behavior• absence of depression

Cognitive Behavioral Therapy

(CBT)• May include:

o psychoeducation, cognitive training, mapping OCD target symptoms and exposure and response therapy (EX/RP)

• therapy is more intense, involving individual or group sessions with trained therapists, homework, and monitoring procedures

• Cognitive-behavioral group therapy appears highly effective compared to no therapyo 47 patients with OCD (DSM-IV criteria) randomized to 12 weekly sessions of cognitive-

behavioral group therapy vs. waiting list controlo 70% treatment vs. 4% control patients had improvement (p < 0.001, NNT 2)

• Also works better with SSRIs

o ***See Abstract – OCD Treatment – Group treatment and SSRIs

CBT (cont.)• cognitive therapy and behavioral therapy

appear to have similar efficacy over 4-16 weeks on 6 randomized trials

• exposure and response prevention reported to result in higher recovery rates (45% vs. 13%) than cognitive behavioral therapy at 3 months after treatment based on follow-up of 62 patients in one of these trials

o See Abstract: OCD treatment – CBT vs. Beh therapy

Prognosis• typically chronic course with waxing and waning

of symptoms

• patients who respond to medications may experience significant improvement in symptoms but are rarely cured of illness

• ***See Abstract – OCD Prognosis