Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is characterized by recurrent, intrusive, undesired thoughts (known as obsessions) and/or uncontrollable repetitive acts (known as compulsions). Obsessions and compulsions are time-consuming (> 1 hour in a day), and cause significant distress in a patient’s daily life. The prevalence is 2-3%, with a mean onset in the second decade.

Obsessions cause grief and anxiety. These thoughts are unreasonable and are not worries about real-life problems. Carrying out compulsions may temporarily relieve the anxiety caused by obsessions. Compulsions can include physical acts (e.g. frequent hand-washing, repeatedly checking the stove or door lock, arranging objects in a specific order) or mental acts (e.g. counting, repeating certain phrases).

Treatment options include cognitive behavioral therapy and pharmacotherapy, and combining the two may be best. SSRIs may need to be titrated to higher doses than those used to treat other disorders. Clomipramine is also effective, but has many side effects. Antipsychotics may be helpful as a third-line agent in treatment-resistant cases.