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Obsessive-Compulsive Disorder: What It Is and How It's Treated
Am Fam Physician. 1998 Apr 1;57(7):1632-1634.See related article on obsessive-compulsive disorder.
What is obsessive-compulsive disorder?
Obsessive-compulsive disorder is surprisingly common and affects about two or three people out of every 100. It has two main symptoms: obsessions and compulsions. Obsessions are upsetting thoughts, pictures or urges that keep coming into your mind even though you don't want them to. For example, some people keep thinking they have been infected by germs or that they have forgotten to turn off the stove, or that a loved one has gotten hurt. These obsessive thoughts usually feel troubling or inappropriate or strange. If you have obsessive thoughts you may feel like they are something you can't control.
Because obsessions cause people to get anxious, most people try to reduce the anxiety that the obsessions create. They develop habits, called compulsions. If, for example, you have obsessive thoughts about being dirty, you may develop a compulsive habit of washing your hands again and again. When you do this, it reduces your anxiety and worry about being dirty. Or, for example, if you have repeated thoughts about a family member being in a car accident, you may find yourself repeating a “good luck” phrase a certain number of times or at certain times of the day. Doing this eases your anxiety. You may feel driven to perform these rituals (habits) and acts over and over, even though a part of you knows that these habits make no sense.
If I have obsessive-compulsive disorder, does that mean I'm crazy?
No. This is a common fear for people with obsessive-compulsive disorder. When you have strange or upsetting thoughts you can't seem to control, or perform rituals over and over, it's easy to feel like you're losing control. Usually most people with obsessive-compulsive disorder are quite in touch with reality and are able to think sensibly—that's what makes their condition so upsetting to them.
What causes obsessive-compulsive disorder?
There's no simple way to explain what causes this disorder. Most likely, it's a combination of both physical and mental factors. Physically, a chemical in your brain (called serotonin) may play a role. Serotonin is a neurotransmitter (one of the chemical messengers in your brain that helps your brain cells “talk” with each other). People with obsessive-compulsive disorder may not have enough serotonin in their brain. That's why medicines that increase the amount of serotonin in your brain can decrease the symptoms of obsessive-compulsive disorder.
Mental or psychological factors also play a role in obsessive-compulsive disorder. Compulsive rituals actually strengthen the disorder because, although the rituals aren't “fun” or pleasant, they do reduce the anxiety caused by the obsessive thoughts. And, of course, any ritual that helps decrease anxiety is likely to be repeated. Whenever you perform a compulsive ritual, you avoid having to actually face the thing that you're afraid of. For example, if you wash over and over, you don't have to face the dirt or germs. If you repeatedly check door locks, you don't have to face the fear that the doors may be unlocked. This helps to maintain your obsessive-compulsive disorder because to overcome a fear, you must face that fear.
How is obsessive-compulsive disorder treated?
There are two main ways to treat obsessive-compulsive disorders; one is medical and the other is psychological. Medical treatment usually involves taking a medicine that has anti-obsessive and anti-compulsive effects. Don't be surprised if you hear that the medicine you're taking is also an antidepressant, because most of the medicines used for treating obsessive-compulsive disorders are also used to treat depression. Your doctor will prescribe the medicine and help you find the dosage that works the best for you. You may have some side effects from the medicine (like dry mouth or diarrhea), but your doctor can help you manage them. Because obsessive-compulsive disorder is long lasting, you should expect to take the medicine for a year or longer.
The other treatment approach is called “Exposure Response Prevention” (ERP). In this treatment you can be “desensitized” to the things that usually make you do your compulsive rituals. This is done by gradually exposing you to the things that trigger your compulsive behavior (the “exposure” part) while you try to stop doing your usual rituals (the “response prevention” part). So you might be asked to touch a “dirty” doorknob and then make yourself not wash your hands. You would repeat this until touching the doorknob no longer makes you feel worried. This treatment is usually given by a special psychologist or psychiatrist. It may take 10 weeks or longer.
How well do the treatments work?
Both types of treatment work very well. With both treatments, you can expect some relief from the obsessive thoughts and the compulsive behaviors. Keep in mind, though, that not everyone gets complete relief from symptoms. Instead, you may find that your obsessions and compulsions are weaker and don't happen as often, but they may not completely go away.
Which treatment method is best?
There are good things about each method. Taking medicine for obsessive compulsive disorder is easy. All you have to do is be sure to take the medicine just as your doctor tells you to. However, some people don't like the idea of taking medicine for a long time. Some people have side effects from the medicine. ERP is faster and may be more long lasting. But it also takes a lot of work on your part. It may make you uncomfortable to face the things that bother you. You should talk about treatment options with your doctor. Together you can decide which approach is best for you. Your doctor may even want you to use both approaches at the same time.
Are there any support groups for obsessive-compulsive disorder?
Yes. The Obsessive-Compulsive Foundation sponsors self-help groups many parts of the country. These groups are often led by people who have obsessive-compulsive disorder themselves. Group members support each other and learn about treatments for obsessive-compulsive disorder. The foundation also provides support for family and friends of people with obsessive-compulsive disorder. A list of these groups is available from the foundation at the following address:
P.O. Box 70
Milford, CT 06460-0070
Telephone: (203) 878-5669 or
(203) 874-3843 (for recorded information).
You can also find information on the Internet at: http://ocfoundation.org/.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 1998 by the American Academy of Family Physicians.
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