Dr. M.J. Bazos, MD. Patient Handout

About Your Diagnosis
Obsessive compulsive disorder (OCD) is a fascinating and occasionally very disabling syndrome characterized by two components: obsessions and compulsions. The obsessions are unwanted, frequently occurring thoughts that the person has no control over and is unable to block. Obsessions can also be thoughts or impulses that you may be unable to dismiss, despite finding them very disturbing. Compulsions are behaviors. They are often repetitive behaviors that are intended to decrease anxiety. To diagnose OCD, these intrusive thoughts and compulsive behaviors must lead to some problem in your social or work life. The underlying problem with OCD is usually anxiety, and OCD occurs slightly more frequently in women than in men.

Living With Your Diagnosis
OCD usually begins in the late teens to early 20s. In most cases, the disease, once diagnosed, is fairly persistent without treatment. The obsessions, or abnormal thoughts, can be in many forms. Some common obsessions include aggressive obsessions, such as seeing violent images, the fear that you might harm others, that you might harm yourself, the fear of doing something embarrassing, the fear of acting on other impulses, such as robbing a bank, the fear of being responsible for things going wrong, and the fear that something terrible might happen. There are also contamination obsessions, which are disgusts with body waste, with dirt or germs, an excessive concern with environmental contaminants, and a concern that you will become ill beyond a reasonable expectation of that happening. Sexual obsessions include the fear that sexual activity might involve children, animals, incest, or homosexuality. There are also hoarding or collecting obsessions and religious obsessions. As can be seen, many of these obsessions involve socially unacceptable behaviors, which leads to feelings of guilt and increases the feeling of anxiety in patients who have them. There are also many different kinds of compulsions. These include cleaning or handwashing compulsions, where individuals may wash their hands 50–60 times a day; counting compulsions; and checking compulsions, where individuals may get
up during the night several times to make sure that appliances have been turned off, the door has been locked, and the windows have been closed. Even though individuals may not want to carry out these compulsive behaviors, they often are unable to control them. Some individuals may return to their home several times to make sure the door was locked and feel some relief of anxiety upon doing so. There are also repeating rituals and ordering or arranging compulsions, whereby individuals must have clothes, shoes, or dishes, for example, in a certain order, pointing a certain direction, to get some relief from their anxiety. These compulsive behaviors
can occupy a large part of an individual’s day and make other more productive activity less likely. The diagnosis of OCD is usually easy to make and is based on the feelings of distress associated with the behaviors mentioned above. It is important to keep in mind that some individuals, by the nature of their personality, are perfectionists and like things ordered and arranged in a specific way. However, they are able to function well at their jobs and in their social relationships. These patients would not meet the criteria for OCD. It is those individuals who feel that their obsessions and compulsions are taking up the majority of their time, and are disturbed by this, who merit treatment. Often family members or a co-worker point out to the individual the obsessiveness of his behavior. Individuals who have OCD usually are aware of their behavior and would like to stop it, but are unable to do so.

The treatment of OCD involves both medication and social intervention. Clomipramine, an older drug, or more likely one of the newer serotonin antidepressants such as Prozac, Zoloft, or Luvox are used to treat OCD. These drugs have been very effective in treating both the obsessions and compulsions associated with this condition. Side effects of clomipramine include blurred vision, racing heartbeat, dry mouth, and constipation, whereas side effects of the serotonin drugs include jitteriness or agitation, insomnia, weight loss, anorexia, and gastrointestinal distress. The goals of any treatment are to reduce the frequency and intensity of symptoms as much as possible, and to minimize the amount of interference the symptoms cause in the patient’s life. It is important to note that few patients experience a cure or complete remission of symptoms, but symptoms are usually much worse during times of psychological and psychosocial stress. Behavior therapy is designed at decreasing the compulsive aspect of the condition. Compulsions such as handwashing are often very responsive to behavior therapy, where the patient makes a conscious effort to decrease the frequency of a compulsive behavior. The intent behind behavioral treatment of OCD is to convince the patient that although compulsion behavior decreases anxiety, this anxiety reduction is only short-term. However, if the individual resists the anxiety and urge to engage in the ritual behavior, the anxiety will eventually decrease on its own and the need to perform the ritual will eventually disappear. Because many patients are extremely distressed by the behavior, they may become impatient with behavioral therapy alone, and a combination of medications and behavior treatment may have to be used.

The DOs
• As with any anxiety condition, exercise can often be very helpful in decreasing feelings of nervousness and providing an outlet for them.

The DON’Ts
• Because of the strong anxiety component to OCD, drugs that produce stimulation or nervousness should be avoided. These, of course, include such illicit drugs as phencyclidine (PCP) and cocaine.
• The intake of foods and beverages that are high in caffeine should also be avoided.

When to Call Your Doctor
•If the anxiety associated with OCD increases to a point where you are having physical symptoms.
• If you begin having suicidal or homicidal thoughts.
• If the obsessive thoughts that you are having become increasingly bizarre. There is a potential for psychosis with this condition.