Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Obsessive-Compulsive Disorder

  • Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD  more...
 
Updated: Apr 19, 2016
 

Practice Essentials

Obsessive-compulsive disorder (OCD) is characterized by distressing, intrusive obsessive thoughts and/or repetitive compulsive physical or mental acts. Once believed to be rare, OCD was found to have a lifetime prevalence of 2.5% in the Epidemiological Catchment Area study.[1]

Signs and symptoms

Common obsessions include the following:

  • Contamination
  • Safety
  • Doubting one's memory or perception
  • Scrupulosity (need to do the right thing, fear of committing a transgression, often religious)
  • Need for order or symmetry
  • Unwanted, intrusive sexual/aggressive thoughts

Common compulsions include the following:

  • Cleaning/washing
  • Checking (eg, locks, stove, iron, safety of children)
  • Counting/repeating actions a certain number of times or until it "feels right"
  • Arranging objects
  • Touching/tapping objects
  • Hoarding
  • Confessing/seeking reassurance
  • List making

Many patients with OCD have other psychiatric comorbid disorders, and may exhibit any of the following:

  • Mood and anxiety disorders
  • Somatoform disorders, especially hypochondriasis and body dysmorphic disorder
  • Eating disorders
  • Impulse control disorders, especially kleptomania and trichotillomania
  • Attention deficit–hyperactivity disorder (ADHD)
  • Obsessive-compulsive personality disorder
  • Tic disorder
  • Suicidal thoughts and behaviors

Skin findings in OCD patients may include the following:

  • Eczematous eruptions related to excessive washing
  • Hair loss related to trichotillomania or compulsive hair pulling
  • Excoriations related to neurodermatitis or compulsive skin picking

See Clinical Presentation for more detail.

Diagnosis

Once OCD is suspected, the following should be performed:

  • Define the range and severity of OCD symptoms; the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) [2] is a good tool for this purpose
  • Complete Mental Status Examination; look for comorbid symptoms and disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),[3] released in 2013, includes a new chapter for OCD and related disorders, including body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder. Previously, OCD was grouped together with anxiety disorders.

The American Psychiatric Association defines OCD as the presence of obsessions, compulsions, or both. Obsessions are defined by (1) and (2) as follows:

  1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and cause marked anxiety and distress
  2. The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action

Compulsions are defined by (1) and (2) as follows:

  1. Repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) in response to an obsession or according to rules that must be applied rigidly
  2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a way that could realistically neutralize or prevent whatever they are meant to address, or they are clearly excessive

See Workup for more detail.

Management

The mainstays of treatment of OCD are as follows:

  • Serotonergic antidepressant medications
  • Particular forms of behavior therapy (exposure and response prevention and some forms of cognitive-behavioral therapy [CBT])
  • Education and family interventions
  • Neurosurgery (anterior capsulotomy, or deep brain stimulation) [4] , in extremely refractory cases

First-line serotonergic antidepressants for OCD are selective serotonin reuptake inhibitors (SSRIs; (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, escitalopram) and clomipramine (Anafranil), a tricyclic antidepressant. SSRIs are generally preferred over clomipramine, as their adverse effect profiles are less prominent. Results of serotonergic antidepressant treatment are as follows:

  • Complete or near-complete remission of OCD symptoms is rare with monotherapy
  • Perhaps half of patients may experience symptom reductions of 30-50%
  • Many other patients fail to achieve even this degree of relief

Interventions for patients with treatment resistance include the following:

  • Change or increase in medication (eg, increase dose or prescribe a different SSRI or clomipramine)
  • More intensive CBT

Other interventions, which have not received US Food and Drug Administration (FDA) approval for use in OCD, include the following:

  • Addition of a norepinephrine reuptake inhibitor (eg, desipramine) to an SSRI or a trial of venlafaxine
  • Addition of a typical or atypical antipsychotic (eg, haloperidol, olanzapine, risperidone), especially in patients with a history of tics
  • Augmentation with buspirone
  • Augmentation with ondansetron [5]
  • Addition of inositol
  • Sole or augmented use of selected glutamatergic agents (eg, riluzole, glycine, memantine, ketamine) [6, 7, 8, 9, 10]
  • Deep brain stimulation [11, 12] or cingulotomy neurosurgery [13] for severe and intractable casesb

See Treatment and Medication for more detail.

Next

Background

Obsessive-compulsive disorder (OCD) is a relatively common, if not always recognized, chronic disorder that is often associated with significant distress and impairment in functioning. Due to stigma and lack of recognition, individuals with OCD often must wait many years before they receive a correct diagnosis and indicated treatment.

OCD has a wide range of potential severity. Many patients with OCD experience moderate symptoms. In severe presentations, this disorder is quite disabling and is appropriately characterized as an example of severe and persistent mental illness.

Previously identified by the American Psychiatric Assocation as an anxiety disorder, OCD is now a separate diagnosis with its own chapter, "Obsessive-Compulsive and Related Disorders," in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The condition is characterized by distressing, intrusive, obsessive thoughts and/or repetitive, compulsive actions (which may be physical or mental acts) that are clinically significant.

The new chapter groups OCD with related disorders, including body dysmorphic disorder, and conditions formerly found in the "impulse control disorder (ICD) not elsewhere classified" section, including trichotillomania.

DSM-5 criteria for obsession

Obsessions are defined in the DSM-5 by (1) and (2) as follows:[3]

  • Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance as intrusive and inappropriate, and that cause marked anxiety and distress.
  • The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action.

DSM-5 criteria for compulsion

Compulsions are defined by (1) and (2) as follows:

  • Repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) performed in response to an obsession or according to rules that must be applied rigidly. The behaviors are not a result of the direct physiologic effects of a substance or a general medical condition.
  • The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a way that could realistically neutralize or prevent whatever they are meant to address or they are clearly excessive.

At some point during the course of the disorder, the person recognizes that the obsessions or compulsions are excessive or unreasonable (although this does not apply to children).

The obsessions or compulsions cause marked distress, are time consuming (take >1 hour per day), or significantly interfere with the person's normal routine, occupational or academic functioning, or usual social activities or relationships.

Obsessions and their related compulsions (the latter also referred to as rituals) often fall into 1 or more of several common categories, as seen in the table below.

Table. Categorizing Obsessions and Compulsions (Open Table in a new window)

Obsessions Commonly Associated Compulsions
Fear of contamination Washing, cleaning
Need for symmetry, precise arranging Ordering, arranging, balancing, straightening until "just right"
Unwanted sexual or aggressive thoughts or images Checking, praying, “undoing” actions, asking for reassurance
Doubts (eg, gas jets off, doors locked) Repeated checking behaviors
Concerns about throwing away something valuable Hoarding

Individuals often have obsessions and compulsions in several categories, and may have other obsessions (eg, scrupulosity, somatic obsessions, physical or mental repeating rituals). Often, the first pathologic obsession that an individual may experience is fear of contamination.

DSM-5 includes 2 new diagnoses in OCD: excoriation (skin-picking) disorder and hoarding disorder. Excoriation disorder is characterized by repetitive and compulsive picking of skin, resulting in tissue damage. Hoarding is a disorder in which sufferers have persistent difficulty discarding possessions regardless of their value.[14, 15]

OCD should not be confused with obsessive-compulsive personality disorder (OCPD). The diagnosis of OCPD refers to an individual who is preoccupied with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency; a pattern that typically emerges in early adulthood. They often display perfectionism, excessive devotion to work, rigidity, and/or miserliness (for further details, see DSM-5).[3]

Despite the similarities in labels, relatively few individuals with OCD also meet the criteria for OCPD and vice versa.

Previous
Next

Pathophysiology

The fact that obsessive-compulsive symptoms seem to often take very stereotypic forms has led some to hypothesize that the pathologic disturbance causing OCD may be disinhibiting and exaggerating some built-in behavioral potential that humans have that, under other ancestral circumstances, would have an adaptive function (eg, primate grooming rituals).

Previous
Next

Etiology

The exact process that underlies the development OCD has not been established. Research and treatment trials suggest that abnormalities in serotonin (5-HT) neurotransmission in the brain are meaningfully involved in this disorder. This is strongly supported by the efficacy of serotonin reuptake inhibitors (SRIs) in the treatment of OCD.[16, 17]

Evidence also suggests abnormalities in dopaminergic transmission in at least some cases of OCD. In some cohorts, Tourette disorder (also known as Tourette syndrome) and multiple chronic tics genetically co-vary with OCD in an autosomal dominant pattern. OCD symptoms in this group of patients show a preferential response to a combination of serotonin specific reuptake inhibitors (SSRIs) and antipsychotics.[18]

Functional imaging studies in OCD have demonstrated some reproducible patterns of abnormality. Specifically, magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning have shown increases in blood flow and metabolic activity in the orbitofrontal cortex, limbic structures, caudate, and thalamus, with a trend toward right-sided predominance. In some studies, these areas of overactivity have been shown to normalize following successful treatment with either SSRIs or cognitive-behavioral therapy (CBT).[19]

These findings suggest the hypothesis that the symptoms of OCD are driven by impaired intracortical inhibition of specific orbitofrontal-subcortical circuitry that mediates strong emotions and the autonomic responses to those emotions. Cingulotomy, a neurosurgical intervention sometimes used for severe and treatment-resistant OCD, interrupts this circuit (see Treatment and Management).

Similar abnormalities of inhibition are observed in Tourette disorder, with a postulated abnormal modulation of basal ganglia activation.

Attention has also been focused on glutamatergic abnormalities and possible glutamatergic treatments for OCD.[20, 21] Although modulated by serotonin and other neurotransmitters, the synapses in the cortico-striato-thalamo-cortical circuits thought to be centrally involved in the pathology of OCD principally employ the neurotransmitters glutamate and gamma-aminobutyric acid (GABA).

Genetic influence in OCD

Twin studies have supported strong heritability for OCD, with a genetic influence of 45-65% in studies in children and 27-47% in adults.[22] Monozygotic twins may be strikingly concordant for OCD (80-87%), compared with 47-50% concordance in dizygotic twins.[23] Several genetic studies have supported linkages to a variety of serotonergic, dopaminergic, and glutamatergic genes.[24, 25, 26, 27, 28]

Other genes putatively linked to OCD have included those coding for catechol-O-methyltransferase (COMT), monoamine oxidase-A (MAO-A), brain-derived neurotrophic factor (BDNF), myelin oligodendrocyte glycoprotein (MOG), GABA-type B-receptor 1, and the mu opioid receptor, but these must be considered provisional associations at this time. In some cohorts, OCD, attention deficit hyperactivity disorder (ADHD), and Tourette disorder/tic disorders co-vary in an autosomal dominant fashion with variable penetrance.

Infectious disease and OCD

Case reports have been published of OCD with and without tics arising in children and young adults following acute group A streptococcal infections. Fewer reports cite herpes simplex virus as the apparent precipitating infectious event.

It has been hypothesized that these infections trigger a CNS autoimmune response that results in neuropsychiatric symptoms (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections [PANDAS]). A number of the poststreptococcal cases have reportedly improved following treatment with antibiotics.

Other neurologic conditions

Rare reports exist of OCD presenting as a manifestation of neurologic insults, such as brain trauma, stimulant abuse, and carbon monoxide poisoning.

Stress and OCD

OCD symptoms can worsen with stress; however, stress does not appear to be an etiologic factor.

Parenting and OCD

As previously mentioned, parenting style or upbringing does not appear to be a causative factor in OCD.

Previous
Next

Epidemiology

Incidence of OCD in the United States

Once believed to be rare, OCD was found to have a lifetime prevalence of 2.5% in the Epidemiological Catchment Area study.[1] Current estimates of lifetime prevalence are generally in the range of 1.7-4%. Discovery of effective treatments and education of patients and health care providers have significantly increased the identification of individuals with OCD. The incidence of OCD is higher in dermatology patients and cosmetic surgery patients.

Race-, age-, and sex-related demographics

OCD appears to have a similar prevalence in different races and ethnicities, although specific pathologic preoccupations may vary with culture and religion (eg, concerns about blaspheming are more common in religious Catholics and Orthodox Jews).

The overall prevalence of OCD is equal in males and females, although the disorder more commonly presents in males in childhood or adolescence and tends to present in females in their twenties. Childhood-onset OCD is more common in males. Males are more likely to have a comorbid tic disorder.

It is not uncommon for women to experience the onset of OCD during a pregnancy, although those who already have OCD will not necessarily experience worsening of their symptoms during pregnancy.

Women commonly experience worsening of their OCD symptoms during the premenstrual time of their periods. Women who are pregnant or breastfeeding should collaborate with their physicians in making decisions about starting or continuing OCD medications.Age preference in OCD

Symptoms of OCD usually begin in individuals aged 10-24 years.

Previous
Next

Prognosis

OCD is a chronic disorder with a wide range of potential severities. Without treatment, symptoms may wax and wane in intensity, but they rarely remit spontaneously.

Overall, close to 70% of patients entering treatment experience a significant improvement in their symptoms. However, OCD remains a chronic illness, with symptoms that may wax and wane during the life of the patient.

Roughly 15% of patients can show a progressive worsening of symptoms or deterioration in functioning over time.

Approximately 5% of patients have a complete remission of symptoms between episodes of exacerbation.

Pharmacologic treatment is often prescribed on a continuing basis; if a successfully treated individual discontinues his/her medication regimen, relapse is not uncommon. However, patients who successfully complete a course of CBT (perhaps as few as 12-20 sessions) may experience enduring relief even after the treatment, although some evidence shows that having CBT continue in some extended but less frequent fashion may further decrease the risk of relapse.

A certain percentage of patients may have disabling, treatment-resistant symptoms. These patients may require multiple medication trials and/or referral to a research center. A small subgroup of these patients may be candidates for neurosurgical intervention.

Previous
Next

Patient Education

Education about the nature and treatment of OCD is essential. As with many psychiatric disorders, patients and their families often have misconceptions about the illness and its management. Information should be provided about the neuropsychiatric source of the symptoms, as opposed to having families unnecessarily blame themselves for causing the disorder.

A helpful book on OCD, written for the general public, is Dr Judith Rapoport's The Boy Who Couldn't Stop Washing,[29] which discusses the recognition of OCD in individuals and the identification of effective treatments for the disease.

Patients and their families should be provided with information on support groups and should have opportunities to discuss the impact the illness has had on their self-experience and on their relationships.

The Obsessive-Compulsive Foundation is a self-help and family organization founded in 1986 that offers information and resources regarding OCD and related disorders (including contact information for various types of affiliated support groups, contact information listing psychiatrists and therapists who are experienced in the treatment of OCD, research opportunities, and book reviews).

Some other organizations offer more specialized resources, (eg, the San Francisco Bay Area Internet Guide for Extreme Hoarding Behavior, the Madison Institute of Medicine's Obsessive Compulsive Information Center, which provides information and a monthly newsletter for individuals with OCD symptoms of scrupulosity about religious/moral issues).

A more complete listing of OCD resources appears as an appendix in the APA Practice Guideline for OCD.[30]

Several self-help books are also available, including Dr Edna Foa and Dr Reid Wilson's book,[31] which can add CBT-style self-treatment to the educational experience they provide.

Useful Web sites include the following:

Previous
 
 
Contributor Information and Disclosures
Author

William M Greenberg, MD Medical Director, Mental Health Association of Rockland County; Professor, St George's University School of Medicine; Private Practice

William M Greenberg, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Acknowledgements

Mohammed A Memon, MD Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. Karno M, Golding JM, Sorenson SB, Burnam MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988 Dec. 45(12):1094-9. [Medline].

  2. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989 Nov. 46(11):1006-11. [Medline].

  3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.

  4. Pepper J, Hariz M, Zrinzo L. Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature. J Neurosurg. 2015 May. 122 (5):1028-37. [Medline].

  5. Andrade C. Ondansetron augmentation of serotonin reuptake inhibitors as a treatment strategy in obsessive-compulsive disorder. J Clin Psychiatry. 2015 Jan. 76 (1):e72-5. [Medline].

  6. Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G, et al. Riluzole augmentation in treatment-resistant obsessive-compulsive disorder: an open-label trial. Biol Psychiatry. 2005 Sep 1. 58(5):424-8. [Medline].

  7. Greenberg WM, Benedict MM, Doerfer J, Perrin M, Panek L, Cleveland WL, et al. Adjunctive glycine in the treatment of obsessive-compulsive disorder in adults. J Psychiatr Res. 2009 Mar. 43(6):664-70. [Medline].

  8. Haghighi M, Jahangard L, Mohammad-Beigi H, Bajoghli H, Hafezian H, Rahimi A, et al. In a double-blind, randomized and placebo-controlled trial, adjuvant memantine improved symptoms in inpatients suffering from refractory obsessive-compulsive disorders (OCD). Psychopharmacology (Berl). 2013 Mar 23. [Medline].

  9. Ghaleiha A, Entezari N, Modabbernia A, Najand B, Askari N, Tabrizi M, et al. Memantine add-on in moderate to severe obsessive-compulsive disorder: randomized double-blind placebo-controlled study. J Psychiatr Res. 2013 Feb. 47(2):175-80. [Medline].

  10. Rodriguez CI, Kegeles LS, Levinson A, Feng T, Marcus SM, Vermes D, et al. Randomized Controlled Crossover Trial of Ketamine in Obsessive-Compulsive Disorder: Proof-of-Concept. Neuropsychopharmacology. 2013 Jun 19. [Medline].

  11. Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology. 2006 Nov. 31(11):2384-93. [Medline].

  12. Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008 Nov 13. 359(20):2121-34. [Medline].

  13. Jung HH, Kim CH, Chang JH, Park YG, Chung SS, Chang JW. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: Long-term follow-up results. Stereotact Funct Neurosurg. 2006. 84(4):184-9. [Medline].

  14. Stetka B, Correll, C. A Guide to DSM-5: Hoarding, Skin-Picking, and Rethinking OCD. Available. Medscape Medical News. Available at http://www.medscape.com/viewarticle/803884_7. Accessed: July 1, 2013.

  15. APA. Obsessive-Compulsive and Related Disorders. Available at http://www.dsm5.org/Documents/Obsessive%20Compulsive%20Disorders%20Fact%20Sheet.pdf.. Accessed: July 1, 2013.

  16. Greist JH, Jefferson JW, Kobak KA, Katzelnick DJ, Serlin RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. A meta-analysis. Arch Gen Psychiatry. 1995 Jan. 52(1):53-60. [Medline].

  17. Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Henk HJ. Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis. Psychopharmacology (Berl). 1998 Apr. 136(3):205-16. [Medline].

  18. Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry. 2006 Jul. 11(7):622-32. [Medline].

  19. Baxter LR Jr, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, et al. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. 1992 Sep. 49(9):681-9. [Medline].

  20. Pittenger C, Krystal JH, Coric V. Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder. NeuroRx. 2006 Jan. 3(1):69-81. [Medline].

  21. Wu K, Hanna GL, Rosenberg DR, Arnold PD. The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder. Pharmacol Biochem Behav. 2012 Feb. 100(4):726-35. [Medline]. [Full Text].

  22. van Grootheest DS, Cath DC, Beekman AT, Boomsma DI. Twin studies on obsessive-compulsive disorder: a review. Twin Res Hum Genet. 2005 Oct. 8(5):450-8. [Medline].

  23. Carey G, Gottesman I. Twin and family studies of anxiety, phobic, and obsessive disorders. Klein DF, Rabkin JG. Anxiety: New Research and Changing Concepts. New York: Raven Press; 2000.

  24. Arnold PD, Rosenberg DR, Mundo E, Tharmalingam S, Kennedy JL, Richter MA. Association of a glutamate (NMDA) subunit receptor gene (GRIN2B) with obessive-compulsive disorder: a preliminary study. Psychopharmacology. August 2004. 174:530-538.

  25. Arnold PD, Sicard T, Burroughs E, Richter MA, Kennedy JL. Glutamate transporter gene SLC1A1 associated with obsessive-compulsive disorder. Arch Gen Psychiatry. 2006 Jul. 63(7):769-76. [Medline].

  26. Denys D, Van Nieuwerburgh F, Deforce D, Westenberg H. Association between the dopamine D2 receptor TaqI A2 allele and low activity COMT allele with obsessive-compulsive disorder in males. Eur Neuropsychopharmacol. 2006 Aug. 16(6):446-50. [Medline].

  27. Dickel DE, Veenstra-VanderWeele J, Cox NJ, Wu X, Fischer DJ, Van Etten-Lee M, et al. Association testing of the positional and functional candidate gene SLC1A1/EAAC1 in early-onset obsessive-compulsive disorder. Arch Gen Psychiatry. 2006 Jul. 63(7):778-85. [Medline].

  28. Lin PY. Meta-analysis of the association of serotonin transporter gene polymorphism with obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Apr 13. 31(3):683-9. [Medline].

  29. Rapoport JL. The Boy Who Couldn't Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder. paperback. New York: Penguin Putnam; 2001.

  30. [Guideline] American Psychiatric Association Work Group on Obsessive-Compulsive Disorder. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. July 2007. 164(suppl):1-56. [Full Text].

  31. Foa EB, Wilson R. Stop Obsessing!: How to Overcome Your Obsessions and Compulsions. Revis ed. New York: Bantam Dell; 2001.

  32. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders - Patient Edition (SCID-I/P, 11/2002 revision). New York: Biometrics Research Department, New York State Psychiatric Institute; November 2002.

  33. Berlin HA, Koran LM, Jenike MA, et al. Double-blind, placebo-controlled trial of topiramate augmentation in treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry. 2011 May. 72(5):716-21. [Medline].

  34. Simpson HB, Wetterneck CT, Cahill SP, Steinglass JE, Franklin ME, Leonard RC, et al. Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders. Cogn Behav Ther. 2013 Mar. 42(1):64-76. [Medline].

  35. Grayson J. Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living With Uncertainty. New York: Berkley Publishing Group; 2004.

  36. Celexa (citalopram hydrobromide) [package insert]. St. Louis, Missouri: Forest Pharmaceuticals, Inc. August, 2011. Available at [Full Text].

  37. US Food and Drug Administration. Celexa (citalopram hydrobromide): Drug safety communication – abnormal heart rhythms associated with high doses. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm269481.htm. Accessed: August 24, 2011.

  38. Komossa K, Depping AM, Meyer M, Kissling W, Leucht S. Second-generation antipsychotics for obsessive compulsive disorder. Cochrane Database Syst Rev. 2010 Dec 8. 12:CD008141. [Medline].

  39. FDA Public Health Advisory: Suicidality in Children and Adolescents Being Treated With Antidepressant Medications. FDA Website. October 15, 2004. 1-3. [Full Text].

  40. FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressant Medications. FDA Website. May 2, 2007. 1-3. [Full Text].

  41. A Message From APA President Dilip Jeste, M.D., on DSM-5. Available at http://www.psychnews.org/files/DSM-message.pdf. Accessed: December 1, 2012.

  42. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

  43. Bartz JA, Hollander E. Is obsessive-compulsive disorder an anxiety disorder?. Prog Neuropsychopharmacol Biol Psychiatry. 2006 May. 30(3):338-52. [Medline].

  44. Bienvenu OJ, Samuels JF, Wuyek LA, Liang KY, Wang Y, Grados MA, et al. Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychol Med. 2012 Jan. 42(1):1-13. [Medline].

  45. Brooks M. Adjunctive CBT First Choice for Refractory OCD. Medscape Medical News. Sep 11 2013. [Full Text].

  46. Castle DJ, Phillips KA. Obsessive-compulsive spectrum of disorders: a defensible construct?. Aust N Z J Psychiatry. 2006 Feb. 40(2):114-20. [Medline]. [Full Text].

  47. Dell'Osso B, Altamura AC, Allen A, Marazziti D, Hollander E. Epidemiologic and clinical updates on impulse control disorders: a critical review. Eur Arch Psychiatry Clin Neurosci. 2006 Dec. 256(8):464-75. [Medline]. [Full Text].

  48. Melville NA. CBT beats adjunctive antipsychotic for refractory OCD. Medscape Medical News. April 11, 2013. [Full Text].

  49. Simpson HB, Foa EB, Liebowitz MR, et al. Cognitive-Behavioral Therapy vs Risperidone for Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. Sep 11 2013. [Medline].

 
Previous
Next
 
Table. Categorizing Obsessions and Compulsions
Obsessions Commonly Associated Compulsions
Fear of contamination Washing, cleaning
Need for symmetry, precise arranging Ordering, arranging, balancing, straightening until "just right"
Unwanted sexual or aggressive thoughts or images Checking, praying, “undoing” actions, asking for reassurance
Doubts (eg, gas jets off, doors locked) Repeated checking behaviors
Concerns about throwing away something valuable Hoarding
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.