Obsessive-Compulsive Disorder

1. Either obsessions or compulsions:
   Obsessions as defined by (1), (2), (3), and (4):
   1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
   2. the thoughts, impulses, or images are not simply excessive worries about real-life problems
   3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
   4. the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

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

   1. repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform 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 realistic way with what they are designed to neutralize or prevent or are clearly excessive
2. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.
3. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.
4. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).
5. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Treatment

• The Expert Consensus Guideline Series on OCD (very extensive desription of treatment options)
• A Guide for Patients and Families(short version for laypersons of the above)

OCD and SSRIs
The introduction of the SSRIs (selective serotonin reuptake inhibitors) over the past decade has provided exciting new opportunities for the treatment of obsessive-compulsive disorder (OCD). The serotonin hypothesis, based on the preferential response of OCD to the serotonin reuptake inhibitor, clomipramine, paved the way for research into the efficacy of the SSRIs in the treatment of this disorder. Large, controlled, multicenter studies have found clomipramine and the SSRIs, fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), and paroxetine (Paxil), to be effective and safe in the treatment of OCD. Meta-analytic studies have reported that clomipramine is superior to the SSRIs; however, direct head-to-head comparisons suggest equal efficacy. As SSRIs have a more favorable side-effect profile they may be preferable as first-line treatment of OCD. Improvement following adequate OCD drug treatment is frequently partial whereupon augmentation strategies may become necessary. High rates of relapse have been reported on discontinuation of SRI treatment. Long-term maintenance treatment has been found to be effective in sustaining initial therapeutic gains and bringing about further improvement.

Read the full Research Report--->SSRIs in the Treatment of OCD

• Depressed Mood
• Somatic or Sexual Dysfunction
• Guilt or Obsession
• Addiction
• Anxious or Fearful or Dependent Personality

Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which one needs to be ruled out to establish a precise diagnosis.

• Anxiety Disorder Due to a General Medical Condition;
• Substance-Induced Anxiety Disorder;
• Body Dysmorphic Disorder;
• Specific Phobia;
• Social Phobia;
• Trichotillomania;
• Major Depressive Episode;
• Generalized Anxiety Disorder;
• Hypochondriasis;
• Delusional Disorder;
• Psychotic Disorder Not Otherwise Specified;
• Schizophrenia;
• Tic Disorder; Stereotypic Movement Disorder;
• Eating Disorders;
• Paraphilias;
• Pathological Gambling;
• Alcohol Dependence;
• Alcohol Abuse;
• Obsessive-Compulsive Personality Disorder;
• Superstitions;
• Repetitive checking behaviors.