Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviours (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.

You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behaviour — the vicious cycle of OCD.

OCD often centres around certain themes — for example, an excessive fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they're sore and chapped.

Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realise that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social, school or work functioning.

**Obsession symptoms**

OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behaviour or ritual. These obsessions typically intrude when you're trying to think of or do other things.

Obsessions often have themes to them, such as: - Fear of contamination or dirt - Doubting and having difficulty tolerating uncertainty - Needing things orderly and symmetrical - Aggressive or horrific thoughts about losing control and harming yourself or others - Unwanted thoughts, including aggression, or sexual or religious subjects

Examples of obsession signs and symptoms include: - Fear of being contaminated by touching objects others have touched - Doubts that you've locked the door or turned off the stove - Intense stress when objects aren't orderly or facing a certain way - Images of driving your car into a crowd of people - Thoughts about shouting obscenities or acting inappropriately in public - Unpleasant sexual images - Avoidance of situations that can trigger obsessions, such as shaking hands

**Compulsion symptoms**

OCD compulsions are repetitive behaviours that you feel driven to perform. These repetitive behaviours or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they're intended to fix.

As with obsessions, compulsions typically have themes, such as: - Washing and cleaning - Checking - Counting - Orderliness - Following a strict routine - Demanding reassurance

Examples of compulsion signs and symptoms include: - Hand-washing until your skin becomes raw - Checking doors repeatedly to make sure they're locked - Checking the stove repeatedly to make sure it's off - Counting in certain patterns - Silently repeating a prayer, word or phrase - Arranging your canned goods to face the same way

Obsessive-compulsive disorder treatment may not result in a cure, but it can help bring symptoms under control so that they don't rule your daily life. Depending on the severity of OCD, some people may need long-term, ongoing or more intensive treatment.

The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these.

**Psychotherapy**

Cognitive behavioural therapy (CBT), a type of psychotherapy, is effective for many people with OCD. Exposure and response prevention (ERP), a component of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn ways to resist the urge to do your compulsive rituals. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.

**Medications**

Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first.

Antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD include: - Clomipramine (Anafranil) for adults and children 10 years and older - Fluoxetine (Prozac) for adults and children 7 years and older - Fluvoxamine for adults and children 8 years and older - Paroxetine (Paxil, Pexeva) for adults only - Sertraline (Zoloft) for adults and children 6 years and older

**Other treatment**

Sometimes, psychotherapy and medications aren't effective enough to control OCD symptoms. In treatment-resistant cases, other options may be offered: - **Radiofrequency brain lesioning.** An effective and safe technique for the treatment of severe OCD. The procedure is essentially painless and it is done under local anesthesia.

- **Deep brain stimulation (DBS).** DBS is approved by the FDA to treat OCD in adults age 18 years and older who don't respond to traditional treatment approaches. DBS involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that may help regulate abnormal impulses.

- **Transcranial magnetic stimulation (TMS).** The FDA approved a specific device (BrainsWay Deep Transcranial Magnetic Stimulation) to treat OCD in adults ages 22 to 68 years, when traditional treatment approaches have not been effective. TMS is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of OCD. During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet delivers a magnetic pulse that stimulates nerve cells in your brain.