OCD Recovery Center (Obsessive Compulsive Disorder): OCD: OCD Overview

OCD - An Overview

Obsession, or compulsions that are a significant source of distress, or interfere with social, or role functioning.
First described in psychiatric literature by Esquirol in 1838. Regarded initially as manifestations of depression
Tend to fall into one of several major categories: checking rituals, cleaning rituals, obsessional slowness, obsessive thoughts, and mixed rituals.
Generally 24-33% of OCD persons have fluctuating course; 11-14% have a phasic course and 40% achieve complete emission.

Common OCD symptoms: withdrawal, repetitive behaviors, difficulty making decisions, simple tasks taking longer than usual, fatigability, lateness, overly concerned with details, sleep difficulties.
Common OCD signs: recurrent and persistent obsessions; time consuming, repetitive behaviors in response to obsessive material.
Generally 3 types of OCD: unremitting and chronic, phasic with periods of complete remission, episodic with incomplete remission permitting normal social functioning.
Prevalence in general population of 3.0% with 1:1 sex ratio and 20 as the mean age of onset of symptoms (17.5 years for males and 20.8 for females. Slight tendency for OCD individuals to be first-born. Discrepancy between verbal and performance intelligence with preference for the former. Childhood onset correlated with higher familial incidence, but otherwise does not differ from adult onset.

Various surveys and checklists available including: Yale-Brown Obsessive Compulsive Scale, Leyton Obsessional Inventory, Maudsley Obsessive-Compulsive Inventory, Obsessive-Compulsive Disorder Subscale of the Comprehensive Psychopathological Rating Scale, NIMH Global Obsessive-Compulsive Rating Scale. Rorschach and MMPI Profiles researched (the latter with 2, 7, 8 configurations). 83% of OCD patients found to have dianosable Axis II personality disorder.

Genetic: Most studies find parents of OCD patients possess obsessional traits. Reoccurrence risk for first degree relatives between 20% and 25%.
Neurostructural: Various areas of brain researched including frontal lobes, cingulate gyri, septohippocampal system, hypothalamuc, and basal ganglia. Most likely present theory based on neuroimaging studies suggests a striatal substructure dysfunction. Cerebral disorders seem in some cases to be correlated with OCD.
Neurochemical: Most drugs which affect anxiety, depression, or psychosis are not effective. Current theories favor synaptic reuptake of serotonin.
Learning: Individual learns that anxiety can be reduced by obsession and compulsions. Response becomes conditioned and is reinforced intermittently.

Co-morbidity common and most prevalent in: Gilles de la Tourette syndrome and motor tic disorders, depression, anxiety disorders and phobias, eating and substance abuse disorders.

General: 70% improve with combined behavioral and neurochemical treatment; waxing and waning course most common.
Neurobiological: Electroconvulsive therapy not effective; some forms of psychosurgery utilized (anterior cingulotomy, subcaudate tractotomy, limbic leukotomy, anterior capsulotomy); pharmacological interventions highly effective particularly those which inhibit serotonergic re-uptake including cyclic antidepressants (clomipramine/"Anafranil"; fluxetine/"Prozac"; fluvoxamine), monoamine oxidase inhibitors (phenelzine sulfate/"Nardin"; tranylcypromine/"Parnate"), possibly in combination with various augmenting agents.
Psychological: Behavior therapy treatment of choice focusing on exposure and response prevention, thought stoppage, systematic desensitization, imaginal flooding, participant modeling.
Psychoeducational: patient must learn to understand disorder; supportive involvement of primary family and others; Multifamily Psychoeducational Support Group; increase self-acceptance and reduce perfectionism; develop internal yardstick for (long-term) progress; learn waxing/waning cycles; keep it simple; develop flexible family routines; follow medication regime; develop reasonable expectations; reduce environmental and intrapsychic stress.

Primary Source: Jenike, M., Baer, L., Minichiello, W. (1990) Obsessive Compulsive Disorders: Theory and Management. St. Louis: Mosby-Year Book, Inc.