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24.07.2013
Join tens of thousands of doctors, health professionals and patients who receive our newsletters. Obsessive-compulsive disorder (OCD) is a chronic, debilitating mental health condition characterized by distressing, intrusive obsessive thoughts and repetitive, compulsive physical or mental acts.
Hoarding disorder and excoriation were newly added to this category of disorders in the DSM-5, the Diagnostic and Statistical Manual used by clinicians and researchers to diagnose and classify mental disorders, which was published by The American Psychiatric Association (APA) in 2013.
OCD includes the following two characteristics: obsessions (undesirable, recurrent, intrusive, distressing thoughts and worries) and compulsions (repetitive or ritualized physical or mental behaviors). You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Obsessive-compulsive disorder (OCD) is characterized by distressing, intrusive obsessive thoughts and repetitive, compulsive physical or mental acts.
Common obsessions include contamination, losing control, perfectionism, harm, unwanted sexual thoughts and religious obsessions. Common compulsions include washing and cleaning, checking, repeating and mental compulsions.
OCD could be triggered by a combination of genetic, neurological, behavioral, cognitive and environmental factors.
Some people suffering OCD successfully hide their symptoms in fear of embarrassment or stigma.
Treatment of OCD usually comprises of a combination of cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRI). Obsessive-compulsive disorder (OCD) has a lifetime prevalence rate of 2.3% and manifests in compulsive urges to perform irrational or excessive avoidance behaviors. According to a 2001 World Health Organization (WHO) mental health report, it is estimated that, in the year 2000, OCD was among the top 20 causes of illness-related disability worldwide for people aged 15-44, and that OCD was the fourth most common mental illness after phobias, substance abuse, and major depression. The presence of obsessions or compulsions or often both, distinguish obsessive-compulsive disorder.
Constant hand-washing and washing and cleaning in a specific way are common OCD compulsions. Despite abundant research being carried out into obsessive-compulsive disorder, the exact cause has not been identified. OCD is, however, considered to have a neurobiological basis, with neuroimaging research showing that the brain functions differently in people with the disorder. Abnormalities, or an imbalance in the neurotransmitters, or brain chemicals, including serotonin, dopamine or glutamine are thought to be involved in OCD. In certain individuals, OCD could be triggered by a combination of genetic, neurological, behavioral, cognitive and environmental factors. Studies have shown that OCD runs in families and can be considered a "familial disorder."7 The disease may span generations with close relatives of people with OCD significantly more likely to develop OCD themselves. Although research indicates that genetic factors may contribute to OCD, no one gene has been identified as the "cause" of OCD.
Abnormalities in serotonin regulation have been observed in people with OCD, as have mutations in hSERT, the human serotonin transporter gene. In some people with OCD, a variant of the hSERT gene has been seen to encode for rapid uptake of serotonin, meaning that all the serotonin may be taken up by the transporters before the next nerve has heard the signal. A study funded by the National Institutes of Health (NIH) examined DNA and found that OCD and certain related psychiatric disorders may be associated with an uncommon mutation of the human serotonin transporter gene (hSERT). I425V - a mutation of hSERT that increases transport activity, capturing more serotonin and most likely reducing effects at the receiving neuron's receptors. Two long alleles of the 5-HTTLPR polymorphism - a variant associated with increased expression and function of the serotonin transporter resulting in similar cellular effects to the I425V mutation: an increase in transporter proteins leading to less serotonin being available for neuronal communication. When both mutations are present, there is significantly less serotonin available within the synapse than when either mutation occurs alone, resulting in greater biochemical effects and more severe symptoms. Mutations in this gene may decrease glutamate uptake, leading to persistent excitation of neurons in people with OCD. Some rapid onset cases of obsessive-compulsive disorder in children might be a consequence of Group A streptococcal infections, which cause inflammation and dysfunction in the basal ganglia.
In recent years, however, other pathogens, such as the bacteria responsible for Lyme disease, and H1N1 (the flu virus), have also been associated with rapid onset of OCD in children.
A paper published in 2014 in the journal Medical Hypotheses, proposed that episodic OCD is explained not by streptococcal infections but rather by alterations in gut microbiota resulting from the use of prophylactic antibiotics as treatment for the infections.
Brain imaging techniques have allowed researchers to study the activity of specific areas of the brain, leading to the discovery that some parts of the brain are different in OCD sufferers compared with non-sufferers. The circuit between the above areas regulates primitive aspects of behavior such as aggression, sexuality and bodily excretions. Experts suggest that in people with OCD, the brain has difficulty turning off and ignoring urges from the circuit, which creates communication problems in these brain areas; the obsessions and compulsions continue, leading to repetition of the behavior, such as continual hand-washing. The specific nature of this problem is unclear, but likely involves the chemicals in the brain such as serotonin, dopamine and glutamate.
There is a possible link between low levels or imbalance of the neurotransmitter serotonin and the development of OCD. Once the connection between and object and the feeling of fear becomes established, people with OCD begin to avoid that object and the fear it generates, rather than confronting or tolerating the fear. For example, a person who has always been able to use a public restroom may, when under stress, make a connection between the toilet seat and a fear of catching an illness. These actions can offer temporary relief from the feeling of fear, but because the source of fear is never challenged or dealt with the behavior is reinforced over time. The behavioral theory outlined above focuses on how people with OCD make an association between an object and fear, whereas, the cognitive theory focuses on how people with OCD misinterpret their thoughts.
Most people have unwelcome or intrusive thoughts at some time or other, but for those with OCD the importance of those thoughts are exaggerated.
For example, a person who is caring for an infant and who is under intense pressure may have an intrusive thought of harming the infant. In the mind of the sufferer, a fleeting thought is changed to a dangerous intention, believing that they may be a threat to the child, which causes anxiety and negative emotion such as disgust, guilt and shame. OCD sufferers who fear their own thoughts attempt to neutralize negative feelings that arise from their thoughts by avoiding the situations that trigger the thoughts or engaging in rituals such as excessively self-cleaning or praying.
As long as the sufferer interprets these intrusive thoughts as cataclysmic and true, they will continue the avoidance and ritual behaviors. An international group of researchers known as the Obsessive-Compulsive Cognitions Working Group has suggested that people with OCD who attach exaggerated importance to intrusive thoughts may have developed false beliefs earlier in life. Intolerance of uncertainty - believing that one is able to and must know, without any doubt, that negative events will not occur.


Environmental stressors may be a trigger for OCD in people with a tendency toward developing the condition.
Overall, studies indicate that patients with OCD frequently report stressful and traumatic life events before the illness begins.6 These events may also exacerbate symptoms. Characterized by persistent thoughts or urges, obsessive-compulsive disorder forces individuals to perform repetitive actions to try to relieve anxiety about their uncontrollable thoughts. An investigation of the brain circuits behind compulsive behavior has revealed a surprisingly intimate connection with the circuits that control obesity. The cause or causes of obsessive-compulsive disorder remain unknown, but researchers from Johns Hopkins University School of Medicine in Baltimore, MD, say they have uncovered a genetic marker that may provide clues. Researchers from the University of Cambridge in the UK say compulsions from OCD may originate from misfiring of the brain's control system. This YouTube video, by The Mighty Site, is a 3 minute video diary of one sufferer of OCD, giving a glimpse of what it is like living with OCD.
On the next page, we look at the common symptoms of OCD, some of the common obsessions and how OCD can be diagnosed. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication, Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE, Archive of General Psychiatry, June 2005. What you need to know about obsessive compulsive disorder, OCD Foundation, Accessed 18 March 2014. A family study of obsessive-compulsive disorder, Nestadt G, Samuels J, Riddle M, Bienvenu OJ 3rd, Liang KY, LaBuda M, Walkup J, Grados M, Hoehn-Saric R, Archive of General Psychiatry, 57(4):358-63, April 2000. Guideline Watch (March 2013): Practical Guideline for the Treatment of Patients with Obsessive Compulsive Disorder, Lorrin M. Genetic and environmental influences on obsessive–compulsive behaviour across development: a longitudinal twin study, G.
New onset obsessive-compulsive symptoms in children and adolescents with severe traumatic brain injury, MA Grados et al., Depress Anxiety, published online 2008, abstract.
The role of comorbidity in the crisis of the current psychiatric classification system, Massimiliano Aragona, Philosophy, Psychiatry, & Psychology, published March 2009, abstract.
Drug treatment of obsessive-compulsive disorder, Michael Kellner, Dialogues in Clinical Neuroscience, published 2010. For any corrections of factual information, or to contact our editorial team, please see our contact page.
Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. In popular culture, hand washing is synonymous with OCD but the obsessions can take lots of different forms.
People with OCD aren't being difficult or anal about seemingly small things— they have incredibly high levels of anxiety which they can't naturally control.
People who are affected have little or no control over their obsessive thoughts, but they often know their fear of killing someone or being contaminated is irrational. And the very fact that they understand that it's irrational is part of why it's so exhausting and upsetting to the sufferer. Nobody actually knows exactly where OCD comes from, but it's not just a case of having a "high maintenance" personality. OCD may be more common in people with a history of having experienced emotional, physical or sexual abuse, neglect, social isolation, teasing or bullying. Sometimes you can't totally cure it, but there are effective treatments, including medication which increases serotonin in the brain.
Culture writer with a particular love of hard-hitting documentaries and constructed reality.
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This is basically compulsive biting of the nail and is a body focused repetitive behavior that causes destruction of the individual’s own fingernails as well as the skin around the cuticles and nails. This behavior is normally unconscious and individuals with this compulsion behavior can have great difficulty stopping due to the fact that they are not even aware of their actions. The reason for nail biting that is compulsive is possibly a blending of environmental as well as biological factors. Nail biting which is compulsive is usually seen in those individuals who suffer with obsessive-compulsive disorder as well as body dysmmorphic disorder. Usually there are numerous reasons why individuals with this behavior continue it and normally it may be much more than only a difficulty of will-power. Whenever individuals are stressed many feel the need for soothing themselves and find biting nails makes them feel better.
In contrast, whenever individuals are inactive or bored, nail-biting helps to keep an individual awake or alert rather than otherwise becoming distracted or bored. Some nail-biters can spend tremendous time examining and grooming their nails for irregularities and then trying to fix these problems. The very first-line of management for obsessive-compulsive disorder is normally anti-depressant drugs, especially serotonin re-uptake inhibitors or SRIs. The dosages for anti-obsessional abilities are normally higher than what is required for anti-depressant properties.
Most individuals who attempt SRIs will be “treatment responders,” most studies have shown that the reduction of symptoms inclines to be meek at best. This website is for informational purposes only and Is not a substitute for medical advice, diagnosis or treatment.
New research from Sunnybrook reveals physical activity’s power to improve symptoms of bipolar disorder and OCDFay Ganz is 56 and has bipolar disorder. For the first 20 years of her illness, Fay weathered severe manic episodes followed by bouts of deep depression. OCD is thought to affect up to one million people in the UK, and an estimated three million in the USA.
About the authors: Professor Kevin Gournay was Professor of Mental Health at the Institute of Psychiatry, London.
Come and see us at The Wellness Show, Australia's largest health and wellness expo, this Friday, Saturday and Sunday, Moore Park Sydney - April 1 -3. This site requires JavaScript to function properly.Please enable JavaScript in your web browser. The obsessions or compulsions cause marked distress, are time-consuming and interfere with a person's normal functioning.


Two genes, SLC1A1 (the neuronal glutamate transporter gene) and hSERT (the serotonin transporter gene), have been proposed as factors in the development of OCD. They also discovered a second variation in the gene in some people with severe OCD symptoms. As such, clinicians have altered the acronym to PANS - Pediatric Acute-Onset Neuropsychiatric Syndrome. Despite this revelation, it is not known exactly how these differences relate to the development of OCD. When activated, the circuit causes an urge to come to a person's attention and cause a particular appropriate behavior, such as hand-washing after visiting the bathroom.
It contains billions of nerve cells, called neurons and it is essential they communicate and cooperate for the body to function normally. This person may begin to avoid using public restrooms or, if forced to use a public restroom, will perform elaborate cleaning rituals, such as cleaning the seat, door handles or following a detailed washing procedure. The fear associated with a specific object or situation may spread to similar objects such as public sinks and showers. Most people can shrug off and disregard the thought, but a person suffering from OCD may exaggerate the importance of the thought and respond as though it signifies a threat.
Dogs can also suffer from this disorder and researchers say they may be able to serve as a simplified model of the human condition, after finding certain genetic links.
The researchers say the discovery offers new insights into the development and treatment of both compulsive behavior and eating disorders. Find out about the origins, the branches of psychology and how psychologists study the mind.
Some sufferers will have OCD linked to cleanliness and contamination, but others suffer from obsessional thoughts about illness, harming others, numbers, patterns, sexuality and morality. However, knowing the anxiety is irrational doesn't stop the thoughts dictating their lives.
Of course, lots of us have obsessive tendencies but we're able to block out the thoughts after some time and get on with our day, often just by distracting ourselves. Today, she happily balances volunteer work in mental health care, renovations to her Toronto home and daily power walks with friends, but the road to wellness has been a long and rocky. She feels fine today, happily balancing volunteer work in mental health care, renovations to her Toronto home and daily power walks with friends, but it has been a long and rocky road to wellness. Listed among the top 10 most debilitating illnesses by the World Health Organisation, OCD can have a devastating effect on work, social life and personal relationships.
These transporters soak up the surplus serotonin that remains after transmission of a nerve signal toward the next nerve cell in line. After this behavior, the urge diminishes, so, for example, the person will stop washing hands and move on to something else.
One OCD sufferer might be obsessed with the idea of ingesting germs while someone else might be obsessed with the thought that they've killed someone by accident. Professional treatment can be hard to access, and in addition many people are too ashamed of their problem to seek help. Special chemicals, called neurotransmitters, assist in moving these electrical messages from neuron to neuron.
Coping with Obsessive Compulsive Disorder offers expert advice and a thorough self-help programme based on solid scientific evidence. I was going to be the best daughter, the best employee, the best friend, the best girlfriend.
Until I started becoming psychotic,” she says.Later in her illness, Fay’s mania often led her away from her husband and children. I really feel good.”Psychiatrists in Sunnybrook’s Brain Sciences Research Program treat mood and anxiety disorders from adolescence to old age. Exercise, which is part of the new trend toward self-management, is an increasingly recognized treatment tool in illnesses such as depression, bipolar disorder and obsessive-compulsive disorder (OCD). Zaretsky.Research reveals that exercise increases production of a protein called brain-derived neurotrophic factor (BDNF), which encourages the growth of new neurons. Zaretsky calls it brain fertilizer.“Exercise is now viewed in those with severe mental illness not just as recreation, but also as brain rehab. That’s relatively new,” he says.Aerobic exercise and its effect on adolescents with bipolar disorder are being studied by Dr.
Benjamin Goldstein, director of Sunnybrook’s Centre for Youth Bipolar Disorder, together with his colleague Dr. In the study, adolescents with bipolar disorder completed a concentration task in a magnetic resonance imaging (MRI) scanner before and after 20 minutes of stationary cycling. Brain scans revealed they were able to complete the task with less brain effort after exercising. Importantly, obesity and blood vessel functioning impacted the effects of exercise, suggesting brain-body connections that can inform personalized treatment approaches. Goldstein.New research at Sunnybrook has also found that exercise is helpful as an add-on therapy in OCD.
The World Health Organization lists OCD among the top 10 causes of medical morbidity worldwide. Known treatments, such as medication and cognitive behavioural therapy, tend to only reduce symptoms by 25 per cent and 50 per cent, respectively. Richter and colleagues at the centre did a pilot study of exercise to see if OCD patients benefited.
Exercise led to a decrease in obsessions, such as incessant worries about germs or bad things happening, and compulsions, such as checking and cleaning. Sunnybrook is now leading a multisite, national trial testing exercise in 400 to 500 patients with OCD.“I think it’s extraordinarily exciting,” says Dr. If you exercise, not only do you increase your cardiovascular health and feel better and lower your risk for type 2 diabetes, on top of that you may improve your mood, and we believe improve symptoms of OCD, too. How do you beat that?” This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook.



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