Obsessive-compulsive disorder is a common psychiatric condition with a prevalence of up to 1% of adults, in which the patient engages in repetitive actions (compulsions, e.g. hand washing) or trains of thought (obsessions, e.g. counting rituals), which he knows are irrational but which, if he stops, lead to incapacitating anxiety. Obsessive-compulsive disorder is relatively common; however, its actual incidence has only recently become clear. The neurotransmitter serotonin appears to have a central role in this disorder. Males and females are affected equally, with onset usually occurring in late adolescence.
Symptoms include intrusive thoughts that lead the patient to perform repetitive rituals that interfere with daily living. Although these thoughts and rituals typically distress patients, they seldom volunteer their symptoms. Successful diagnosis often requires specific questioning by the physician. Treatment is directed at symptom reduction; however, complete remission of symptoms is unusual. Pharmacologic therapy usually includes clomipramine or antidepressant treatment with selective serotonin reuptake inhibitors, but in dosage ranges higher than those typically used in the treatment of depression. Behavior therapy has also been proved effective, both alone and in conjunction with pharmacologic therapy.
Obsessions are defined as distressing ideas, images or impulses that repeatedly intrude into the patient's awareness. These thoughts are typically experienced as inappropriate, anxiety-arousing and contrary to the patient's will or desires (i.e., ego dystonic). Typical obsessional themes include thoughts of contamination by dirt or germs, worries that the doors are unlocked or the stove has been left on, or intrusive images of family members being hurt or killed.
Compulsions, on the other hand, are repetitive behaviors or rituals that the patient performs to counteract the anxiety and distress produced by obsessive thoughts. Consequently, a direct relationship between the compulsive behavior and the obsession that triggers it typically exists. Patients are often aware that their compulsive behavior is excessive or irrational but, nonetheless, feel driven to perform it................
