Obsessive–compulsive disorder - Wikipedia

Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform ... Obsessive–compulsivedisorder FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Disorderthatinvolvesrepeatedthoughtsthatmakeapersonfeeldriventodosomething "OCD"redirectshere.NottobeconfusedwithObsessive–compulsivepersonalitydisorder.Forotheruses,seeOCD(disambiguation). Thisarticlemayrequirecopyeditingforgrammar,style,cohesion,tone,orspelling.Youcanassistbyeditingit.(November2021)(Learnhowandwhentoremovethistemplatemessage) MedicalconditionObsessive–compulsivedisorderFrequentandexcessivehandwashingoccursinsomepeoplewithOCD.SpecialtyPsychiatrySymptomsFeeltheneedtocheckthingsrepeatedly,performcertainroutinesrepeatedly,havecertainthoughtsrepeatedly[1]ComplicationsTics,anxietydisorder,suicide[2][3]UsualonsetBefore35years[1][2]CausesChangesinlivingsituation,suchasmoving,gettingmarriedordivorced,orstartinganewschoolorjob,deathofalovedoneorotheremotionaltrauma,historyofabuse,lowlevelsofserotonin,anaturalsubstanceinthebrainthatmaintainsmentalbalance,overactivityinareasthebrain,problemsatworkorschool,problemswithanimportantrelationship,lllness(ifyougettheflu,forexample,youmaystartacycleofobsessingaboutgermsandwashingcompulsively).[4]RiskfactorsChildabuse,stress[2]DiagnosticmethodBasedonthesymptoms[2]DifferentialdiagnosisAnxietydisorder,majordepressivedisorder,eatingdisorders,obsessive–compulsivepersonalitydisorder[2]TreatmentCounseling,selectiveserotoninreuptakeinhibitors,clomipramine[5][6]Frequency2.3%[7] Obsessive–compulsivedisorder(OCD)isamentalandbehavioraldisorderinwhichanindividualhasintrusivethoughtsand/orfeelstheneedtoperformcertainroutinesrepeatedlytotheextentwhereitinducesdistressorimpairsgeneralfunction.[8][1][2]Asindicatedbythedisorder'sname,theprimarysymptomsofOCDareobsessionsandcompulsions.Obsessionsarepersistentunwantedthoughts,mentalimages,orurgesthatgeneratefeelingsofanxiety,disgust,ordiscomfort.[9]Commonobsessionsincludefearofcontamination,obsessionwithsymmetry,andintrusivethoughtsaboutreligion,sex,andharm.[1][10]Compulsionsarerepeatedactionsorroutinesthatoccurinresponsetoobsessions.Commoncompulsionsincludeexcessivehandwashing,cleaning,arrangingthings,counting,seekingreassurance,andcheckingthings.[1][10][11]ManyadultswithOCDareawarethattheircompulsionsdonotmakesense,buttheyperformthemanywaytorelievethedistresscausedbyobsessions.[1][9][10][12]Compulsionsoccursooften,typicallytakingupatleastonehourperday,thattheyimpairone'squalityoflife.[1][10] ThecauseofOCDisunknown.[1]Thereappeartobesomegeneticcomponents,anditismorelikelyforbothidenticaltwinstobeaffectedthanbothfraternaltwins.Riskfactorsincludeahistoryofchildabuseorotherstress-inducingevents;somecaseshaveoccurredafterstreptococcalinfections.[1]Diagnosisisbasedonpresentedsymptomsandrequiresrulingoutotherdrug-relatedormedicalcauses;ratingscalessuchastheYale–BrownObsessiveCompulsiveScale(Y-BOCS)assessseverity.[2][13]Otherdisorderswithsimilarsymptomsincludegeneralizedanxietydisorder,majordepressivedisorder,eatingdisorders,ticdisorders,andobsessive–compulsivepersonalitydisorder.[2]Theconditionisalsoassociatedwithageneralincreaseinsuicidality.[14][15] TreatmentforOCDmayinvolvepsychotherapysuchascognitivebehavioraltherapy(CBT),pharmacotherapysuchasantidepressants,orsurgicalproceduressuchasdeepbrainstimulation(DBS).[5][6][16][17]CBTincreasesexposuretoobsessionsandpreventscompulsions,whilemetacognitivetherapyencouragesritualbehaviorstoaltertherelationshiptoone'sthoughtsaboutthem.[5][18]Selectiveserotoninreuptakeinhibitors(SSRIs)areacommonantidepressantusedtotreatOCD.SSRIsaremoreeffectivewhenusedinexcessoftherecommendeddepressiondosage;however,higherdosescanincreaseside-effectintensity.[19]CommonlyusedSSRIsincludesertraline,fluoxetine,fluvoxamine,paroxetine,citalopram,andescitalopram.[16]SomepatientsfailtoimproveaftertakingthemaximumtolerateddoseofmultipleSSRIsforatleasttwomonths;thesecasesqualifyastreatment-resistantandrequiresecond-linetreatmentsuchasclomipramineoratypicalantipsychoticaugmentation.[5][6][19][20]Surgerymaybeusedasafinalresortinthemostsevereortreatment-resistantcases,thoughmostproceduresareconsideredexperimentalduetothelimitedliteratureontheirsideeffects.[21]Withouttreatment,OCDoftenlastsdecades.[2] Obsessive–compulsivedisorderaffectsabout2.3%ofpeopleatsomepointintheirlives,whileratesduringanygivenyearareabout1.2%.[2][7]Itisunusualforsymptomstobeginafterage35,andaround50%ofpatientsexperiencedetrimentaleffectstodailylifebeforeage20.[1][2]Malesandfemalesareaffectedequally,andOCDoccursworldwide.[1][2]Thephraseobsessive–compulsiveissometimesusedinaninformalmannerunrelatedtoOCDtodescribesomeoneasexcessivelymeticulous,perfectionistic,absorbed,orotherwisefixated.[22] Contents 1Signsandsymptoms 1.1Obsessions 1.2Compulsions 1.3Insightandovervaluedideation 1.4Cognitiveperformance 1.5Children 1.6Associatedconditions 2Causes 2.1Drug-inducedOCD 2.2Genetics 2.3Brainstructureandfunctioning 2.4Autoimmune 2.5Environment 3Mechanisms 3.1Neuroimaging 3.2Cognitivemodels 3.3Neurobiological 4Diagnosis 4.1Differentialdiagnosis 5Management 5.1Therapy 5.2Medication 5.3Procedures 5.4Children 6Epidemiology 7Prognosis 8History 8.1Notablecases 9Societyandculture 9.1Art,entertainmentandmedia 10Research 11Otheranimals 12References 13Externallinks Signsandsymptoms OCDcanpresentwithawidevarietyofsymptoms.Certaingroupsofsymptomsusuallyoccurtogether;thesegroupsaresometimesviewedasdimensions,orclusters,whichmayreflectanunderlyingprocess.ThestandardassessmenttoolforOCD,theYale–BrownObsessiveCompulsiveScale(Y-BOCS),has13predefinedcategoriesofsymptoms.Thesesymptomsfitintothreetofivegroupings.[23]Ameta-analyticreviewofsymptomstructuresfoundafour-factorgroupingstructuretobemostreliable:asymmetryfactor,aforbiddenthoughtsfactor,acleaningfactor,andahoardingfactor.Thesymmetryfactorcorrelateshighlywithobsessionsrelatedtoordering,counting,andsymmetry,aswellasrepeatingcompulsions.Theforbiddenthoughtsfactorcorrelateshighlywithintrusiveanddistressingthoughtsofaviolent,religious,orsexualnature.Thecleaningfactorcorrelateshighlywithobsessionsaboutcontaminationandcompulsionsrelatedtocleaning.Thehoardingfactoronlyinvolveshoarding-relatedobsessionsandcompulsions,andwasidentifiedasbeingdistinctfromothersymptomgroupings.[24] SomeOCDsubtypeshavebeenassociatedwithimprovementinperformanceoncertaintasks,suchaspatternrecognition(washingsubtype)andspatialworkingmemory(obsessivethoughtsubtype).Subgroupshavealsobeendistinguishedbyneuroimagingfindingsandtreatmentresponse.Neuroimagingstudiesonthishavebeentoofew,andthesubtypesexaminedhavedifferedtoomuchtodrawanyconclusions.Ontheotherhand,subtype-dependenttreatmentresponsehasbeenstudied,andthehoardingsubtypehasconsistentlyrespondedleasttotreatment.[25] WhileOCDisconsideredahomogeneousdisorderfromaneuropsychologicalperspective,manyofthesymptomsmaybetheresultofcomorbiddisorders.Forexample,adultswithOCDhaveexhibitedmoresymptomsofattention–deficit/hyperactivitydisorder(ADHD)andautismspectrumdisorder(ASD)thanadultswithoutOCD.[26] Obsessions Mainarticle:Intrusivethought Seealso:Primarilyobsessionalobsessivecompulsivedisorder PeoplewithOCDmayfaceintrusivethoughts,suchasthoughtsaboutthedevil(shownisapaintedinterpretationofHell). Obsessionsarestress-inducingthoughtsthatrecurandpersist,despiteeffortstoignoreorconfrontthem.[27]PeoplewithOCDfrequentlyperformtasks,orcompulsions,toseekrelieffromobsession-relatedanxiety.Withinandamongindividuals,initialobsessionsvaryinclarityandvividness.Arelativelyvagueobsessioncouldinvolveageneralsenseofdisarrayortension,accompaniedbyabeliefthatlifecannotproceedasnormalwhiletheimbalanceremains.Amoreintenseobsessioncouldbeapreoccupationwiththethoughtorimageofaclosefamilymemberorfrienddying,orintrusionsrelatedtorelationshiprightness.[28][29]Otherobsessionsconcernthepossibilitythatsomeoneorsomethingotherthanoneself—suchasGod,thedevil,ordisease—willharmeitherthepatientorthepeopleorthingsthepatientcaresabout.OtherswithOCDmayexperiencethesensationofinvisibleprotrusionsemanatingfromtheirbodies,orfeelthatinanimateobjectsareensouled.[30] SomepeoplewithOCDexperiencesexualobsessionsthatmayinvolveintrusivethoughtsorimagesof"kissing,touching,fondling,oralsex,analsex,intercourse,incest,andrape"with"strangers,acquaintances,parents,children,familymembers,friends,coworkers,animals,andreligiousfigures,"andcanincludeheterosexualorhomosexualcontactwithpeopleofanyage.[31]Similartootherintrusivethoughtsorimages,somedisquietingsexualthoughtsarenormalattimes,butpeoplewithOCDmayattachextraordinarysignificancetosuchthoughts.Forexample,obsessivefearsaboutsexualorientationcanappeartotheaffectedindividual,andeventothosearoundthem,asacrisisofsexualidentity.[32][33]Furthermore,thedoubtthataccompaniesOCDleadstouncertaintyregardingwhetheronemightactonthetroublingthoughts,resultinginself-criticismorself-loathing.[31] MostpeoplewithOCDunderstandthattheirthoughtsdonotcorrespondwithreality;however,theyfeelthattheymustactasthoughtheseideasarecorrectorrealistic.Forexample,someonewhoengagesincompulsivehoardingmightbeinclinedtotreatinorganicmatterasifithadthesentienceorrightsoflivingorganisms,despiteacceptingthatsuchbehaviorisirrationalonanintellectuallevel.ThereisadebateastowhetherhoardingshouldbeconsideredwithotherOCDsymptoms.[34] Compulsions Mainarticle:Compulsivebehavior Skin-pickingdisorder SomepeoplewithOCDperformcompulsiveritualsbecausetheyinexplicablyfeelthattheymustdoso,whileothersactcompulsivelytomitigatetheanxietythatstemsfromobsessivethoughts.Theaffectedindividualmightfeelthattheseactionswilleitherpreventadreadedeventfromoccurring,orpushtheeventfromtheirthoughts.Inanycase,theirreasoningissoidiosyncraticordistortedthatitresultsinsignificantdistress,eitherpersonally,orforthosearoundtheaffectedindividual.Excessiveskinpicking,hairpulling,nailbiting,andotherbody-focusedrepetitivebehaviordisordersareallontheobsessive–compulsivespectrum.[2]SomeindividualswithOCDareawarethattheirbehaviorsarenotrational,buttheyfeelcompelledtofollowthroughwiththemtofendofffeelingsofpanicordread.[35]Furthermore,compulsionsoftenstemfrommemorydistrust,asymptomofOCDcharacterizedbyinsecurityinone'sskillsinperception,attention,andmemory,evenincaseswherethereisnoclearevidenceofadeficit.[36] Commoncompulsionsmayincludehandwashing,cleaning,checkingthings(suchaslocksondoors),repeatingactions(suchasrepeatedlyturningonandoffswitches),orderingitemsinacertainway,andrequestingreassurance.[37]Althoughsomeindividualsperformactionsrepeatedly,theydonotnecessarilyperformtheseactionscompulsively;forexample,morningornighttimeroutinesandreligiouspracticesarenotusuallycompulsions.Whetherbehaviorsqualifyascompulsionsormerehabitdependsonthecontextinwhichtheyareperformed.Forinstance,arrangingandorderingbooksforeighthoursadaywouldbeexpectedofsomeonewhoworksinalibrary,butthisroutinewouldseemabnormalinothersituations.Inotherwords,habitstendtobringefficiencytoone'slife,whilecompulsionstendtodisruptit.[38]Furthermore,compulsionsaredifferentfromtics(suchastouching,tapping,rubbing,orblinking)andstereotypedmovements(suchasheadbanging,bodyrocking,orself-biting),whichareusuallynotascomplexandnotprecipitatedbyobsessions.[39]Itcansometimesbedifficulttotellthedifferencebetweencompulsionsandcomplextics,andabout10–40%ofpeoplewithOCDalsohavealifetimeticdisorder.[2][40] PeoplewithOCDrelyoncompulsionsasanescapefromtheirobsessivethoughts;however,theyareawarethatreliefisonlytemporary,andthatintrusivethoughtswillreturn.Someaffectedindividualsusecompulsionstoavoidsituationsthatmaytriggerobsessions.Compulsionsmaybeactionsdirectlyrelatedtotheobsession,suchassomeoneobsessedwithcontaminationcompulsivelywashingtheirhands,buttheycanbeunrelatedaswell.[10]InadditiontoexperiencingtheanxietyandfearthattypicallyaccompaniesOCD,affectedindividualsmayspendhoursperformingcompulsionseveryday.Insuchsituations,itcanbecomedifficultforthepersontofulfilltheirwork,familial,orsocialroles.Thesebehaviorscanalsocauseadversephysicalsymptoms;forexample,peoplewhoobsessivelywashtheirhandswithantibacterialsoapandhotwatercanmaketheirskinredandrawwithdermatitis.[41] IndividualswithOCDoftenuserationalizationstoexplaintheirbehavior;however,theserationalizationsdonotapplytothebehavioralpattern,buttoeachindividualoccurrence.Forexample,someonecompulsivelycheckingthefrontdoormayarguethatthetimeandstressassociatedwithonecheckislessthanthetimeandstressassociatedwithbeingrobbed,andcheckingisconsequentlythebetteroption.Thisreasoningoftenoccursinacyclicalmanner,andcancontinueforaslongastheaffectedpersonneedsittoinordertofeelsafe.[citationneeded] Incognitivebehavioraltherapy,OCDpatientsareaskedtoovercomeintrusivethoughtsbynotindulginginanycompulsions.TheyaretaughtthatritualskeepOCDstrong,whilenotperformingthemcausesOCDtobecomeweaker.[42]Thispositionissupportedbythepatternofmemorydistrust;themoreoftencompulsionsarerepeated,themoreweakenedmemorytrustbecomes,andthiscyclecontinuesasmemorydistrustincreasescompulsionfrequency.[43]Forbody-focusedrepetitivebehaviors(BFRB)suchastrichotillomania(hairpulling),skinpicking,andonychophagia(nailbiting),behavioralinterventionssuchashabitreversaltraininganddecouplingarerecommendedforthetreatmentofcompulsivebehaviors.[44][45] OCDsometimesmanifestswithoutovertcompulsions,whichmaybetermed"primarilyobsessionalOCD."OCDwithoutovertcompulsionscould,byoneestimate,characterizeasmanyas50–60%ofOCDcases.[46] Insightandovervaluedideation TheDSM-5identifiesacontinuumforthelevelofinsightinOCD,rangingfromgoodinsight(theleastsevere)tonoinsight(themostsevere).Goodorfairinsightischaracterizedbytheacknowledgmentthatobsessive–compulsivebeliefsareormaynotbetrue,whilepoorinsight,inthemiddleofthecontinuum,ischaracterizedbythebeliefthatobsessive–compulsivebeliefsareprobablytrue.Theabsenceofinsightaltogether,inwhichtheindividualiscompletelyconvincedthattheirbeliefsaretrue,isalsoidentifiedasadelusionalthoughtpattern,andoccursinabout4%ofpeoplewithOCD.[47][48]WhencasesofOCDwithnoinsightbecomesevere,affectedindividualshaveanunshakablebeliefintherealityoftheirdelusions,whichcanmaketheircasesdifficulttodifferentiatefrompsychoticdisorders.[49] SomepeoplewithOCDexhibitwhatisknownasovervaluedideas,ideasthatareabnormalcomparedtoaffectedindividuals'respectivecultures,andmoretreatment-resistantthanmostnegativethoughtsandobsessions.[50]Aftersomediscussion,itispossibletoconvincetheindividualthattheirfearsareunfounded.ItmaybemoredifficulttopracticeERPtherapyonsuchpeople,astheymaybeunwillingtocooperate,atleastinitially.[citationneeded]Similartohowinsightisidentifiedonacontinuum,obsessive-compulsivebeliefsarecharacterizedonaspectrum,rangingfromobsessivedoubttodelusionalconviction.IntheUnitedStates,overvaluedideation(OVI)isconsideredmostakintopoorinsight—especiallywhenconsideringbeliefstrengthasoneofanidea'skeyidentifiers—butEuropeanqualificationshavehistoricallybeenbroader.Furthermore,severeandfrequentovervaluedideasareconsideredsimilartoidealizedvalues,whicharesorigidlyheldby,andsoimportanttoaffectedindividuals,thattheyendupbecomingadefiningidentity.[50]InadolescentOCDpatients,OVIisconsideredaseveresymptom.[51] Historically,OVIhasbeenthoughttobelinkedtopoorertreatmentoutcomeinpatientswithOCD,butitiscurrentlyconsideredapoorindicatorofprognosis.[51][52]TheOvervaluedIdeasScale(OVIS)hasbeendevelopedasareliablequantitativemethodofmeasuringlevelsofOVIinpatientswithOCD,andresearchhassuggestedthatovervaluedideasaremorestableforthosewithmoreextremeOVISscores.[53] Cognitiveperformance ThoughOCDwasoncebelievedtobeassociatedwithabove-averageintelligence,thisdoesnotappeartonecessarilybethecase.[54]A2013reviewreportedthatpeoplewithOCDmaysometimeshavemildbutwide-rangingcognitivedeficits,mostsignificantlythoseaffectingspatialmemoryandtoalesserextentwithverbalmemory,fluency,executivefunction,andprocessingspeed,whileauditoryattentionwasnotsignificantlyaffected.[55]PeoplewithOCDshowimpairmentinformulatinganorganizationalstrategyforcodinginformation,set-shifting,andmotorandcognitiveinhibition.[56] SpecificsubtypesofsymptomdimensionsinOCDhavebeenassociatedwithspecificcognitivedeficits.[57]Forexample,theresultsofonemeta-analysiscomparingwashingandcheckingsymptomsreportedthatwashersoutperformedcheckersoneightoutoftencognitivetests.[58]Thesymptomdimensionofcontaminationandcleaningmaybeassociatedwithhigherscoresontestsofinhibitionandverbalmemory.[59] Children Approximately1–2%ofchildrenareaffectedbyOCD.[60]Obsessive–compulsivedisordersymptomstendtodevelopmorefrequentlyinchildren10–14yearsofage,withmalesdisplayingsymptomsatanearlierage,andatamoreseverelevelthanfemales.[61]Inchildren,symptomscanbegroupedintoatleastfourtypes,includingsporadicandtic-relatedOCD.[23] Associatedconditions PeoplewithOCDmaybediagnosedwithotherconditionsaswellasOCD,suchasobsessive–compulsivepersonalitydisorder,majordepressivedisorder,bipolardisorder,generalizedanxietydisorder,anorexianervosa,socialanxietydisorder,bulimianervosa,Tourettesyndrome,transformationobsession,ASD,ADHD,dermatillomania,bodydysmorphicdisorder,andtrichotillomania.[62]Morethan50%ofpeoplewithOCDexperiencesuicidaltendencies,and15%haveattemptedsuicide.[13]Depression,anxiety,andpriorsuicideattemptsincreasetheriskoffuturesuicideattempts.[63] IndividualswithOCDhavealsobeenfoundtobeaffectedbydelayedsleepphasedisorderatasubstantiallyhigherratethanthegeneralpublic.[64]Moreover,severeOCDsymptomsareconsistentlyassociatedwithgreatersleepdisturbance.ReducedtotalsleeptimeandsleepefficiencyhavebeenobservedinpeoplewithOCD,withdelayedsleeponsetandoffset,andanincreasedprevalenceofdelayedsleepphasedisorder.[65] SomeresearchhasdemonstratedalinkbetweendrugaddictionandOCD.Forexample,thereisahigherriskofdrugaddictionamongthosewithanyanxietydisorder,likelyasawayofcopingwiththeheightenedlevelsofanxiety.However,drugaddictionamongpeoplewithOCDmayserveasatypeofcompulsivebehavior,andnotjustasacopingmechanism.DepressionisalsoextremelyprevalentamongpeoplewithOCD.OneexplanationforthehighdepressionrateamongOCDpopulationswaspositedbyMineka,Watson,andClark(1998),whoexplainedthatpeoplewithOCD,oranyotheranxietydisorder,mayfeeldepressedbecauseofan"outofcontrol"typeoffeeling.[66] SomeoneexhibitingOCDsignsdoesnotnecessarilyhaveOCD.Behaviorsthatpresentasobsessive–compulsivecanalsobefoundinanumberofotherconditions,includingobsessive–compulsivepersonalitydisorder(OCPD),autismspectrumdisorder(ASD),ordisordersinwhichperseverationisapossiblefeature(ADHD,PTSD,bodilydisorders,orstereotypedbehaviors).[67]SomecasesofOCDpresentsymptomstypicallyassociatedwithTourettesyndrome,suchascompulsionsthatmayappeartoresemblemotortics;thishasbeentermedtic-relatedOCDorTouretticOCD.[68][69] OCDfrequentlyoccurscomorbidlywithbothbipolardisorderandmajordepressivedisorder.Between60and80%ofthosewithOCDexperienceamajordepressiveepisodeintheirlifetime.Comorbidityrateshavebeenreportedatbetween19and90%,asaresultofmethodologicaldifferences.Between9–35%ofthosewithbipolardisorderalsohaveOCD,comparedto1–2%inthegeneralpopulation.About50%ofthosewithOCDexperiencecyclothymictraitsorhypomanicepisodes.OCDisalsoassociatedwithanxietydisorders.LifetimecomorbidityforOCDhasbeenreportedat22%forspecificphobia,18%forsocialanxietydisorder,12%forpanicdisorder,and30%forgeneralizedanxietydisorder.ThecomorbidityrateforOCDandADHDhasbeenreportedtobeashighas51%.[70] Causes Mainarticle:Causeofobsessive-compulsivedisorder ThecauseofOCDisunknown.[1]Bothenvironmentalandgeneticfactorsarebelievedtoplayarole.Riskfactorsincludeahistoryofchildabuseorotherstress-inducingevents.[2] Drug-inducedOCD Somemedicationsandotherdrugs,suchasmethamphetamineorcocaine,caninduceobsessive-compulsivedisorder(OCD)inpeoplewithoutprevioussymptoms.[71] Someatypicalantipsychotics(second-generationantipsychotics)suchasolanzapine(Zyprexa)andclozapine(Clozaril)caninduceOCDinpeople,particularlyindividualswithschizophrenia.[72][73][74][75] Genetics ThereappeartobesomegeneticcomponentsofOCDcausation,withidenticaltwinsmoreoftenaffectedthanfraternaltwins.[2]Furthermore,individualswithOCDaremorelikelytohavefirst-degreefamilymembersexhibitingthesamedisordersthanmatchedcontrols.IncasesinwhichOCDdevelopsduringchildhood,thereisamuchstrongerfamiliallinkinthedisorderthanwithcasesinwhichOCDdevelopslaterinadulthood.Ingeneral,geneticfactorsaccountfor45–65%ofthevariabilityinOCDsymptomsinchildrendiagnosedwiththedisorder.[76]A2007studyfoundevidencesupportingthepossibilityofaheritableriskforOCD.[77] AmutationhasbeenfoundinthehumanserotonintransportergenehSERTinunrelatedfamilieswithOCD.[78] AsystematicreviewfoundthatwhileneitherallelewasassociatedwithOCDoverall,inCaucasians,theLallelewasassociatedwithOCD.[79]Anothermeta-analysisobservedanincreasedriskinthosewiththehomozygousSallele,butfoundtheLSgenotypetobeinverselyassociatedwithOCD.[80] Agenome-wideassociationstudyfoundOCDtobelinkedwithSNPsnearBTBD3,andtwoSNPsinDLGAP1inatrio-basedanalysis,butnoSNPreachedsignificancewhenanalyzedwithcase-controldata.[81] Onemeta-analysisfoundasmallbutsignificantassociationbetweenapolymorphisminSLC1A1andOCD.[82] TherelationshipbetweenOCDandCOMThasbeeninconsistent,withonemeta-analysisreportingasignificantassociation,albeitonlyinmen,andanothermetaanalysisreportingnoassociation.[83][84] Ithasbeenpostulatedbyevolutionarypsychologiststhatmoderateversionsofcompulsivebehaviormayhavehadevolutionaryadvantages.Exampleswouldbemoderateconstantcheckingofhygiene,thehearth,ortheenvironmentforenemies.Similarly,hoardingmayhavehadevolutionaryadvantages.Inthisview,OCDmaybetheextremestatisticaltailofsuchbehaviors,possiblytheresultofahighnumberofpredisposinggenes.[85] Brainstructureandfunctioning ImagingstudieshaveshowndifferencesinthefrontalcortexandsubcorticalstructuresofthebraininpatientswithOCD.ThereappearstobeaconnectionbetweentheOCDsymptomsandabnormalitiesincertainareasofthebrain,butthatconnectionisnotclear.[86]SomepeoplewithOCDhaveareasofunusuallyhighactivityintheirbrain,orlowlevelsofthechemicalserotonin,[87]whichisaneurotransmitterthatsomenervecellsusetocommunicatewitheachother,[88]andisthoughttobeinvolvedinregulatingmanyfunctions,influencingemotions,mood,memory,andsleep.[89] Autoimmune AcontroversialhypothesisisthatsomecasesofrapidonsetofOCDinchildrenandadolescentsmaybecausedbyasyndromeconnectedtoGroupAstreptococcalinfections,knownaspediatricautoimmuneneuropsychiatricdisordersassociatedwithstreptococcalinfections(PANDAS).[90][91][92]OCDandticdisordersarehypothesizedtoariseinasubsetofchildrenasaresultofapost-streptococcalautoimmuneprocess.[93][94][95]ThePANDAShypothesisisunconfirmedandunsupportedbydata,andtwonewcategorieshavebeenproposed:PANS(pediatricacute-onsetneuropsychiatricsyndrome)andCANS(childhoodacuteneuropsychiatricsyndrome).[94][95]TheCANS/PANShypothesesincludedifferentpossiblemechanismsunderlyingacute-onsetneuropsychiatricconditions,butdonotexcludeGABHSinfectionsasacauseinasubsetofindividuals.[94][95]PANDAS,PANS,andCANSarethefocusofclinicalandlaboratoryresearch,butremainunproven.[93][94][95]WhetherPANDASisadistinctentitydifferingfromothercasesofticdisordersorOCDisdebated.[96][97][98][99] Areviewofstudiesexamininganti-basalgangliaantibodiesinOCDfoundanincreasedriskofhavinganti-basalgangliaantibodiesinthosewithOCDversusthegeneralpopulation.[100] Environment OCDmaybemorecommoninpeoplewhohavebeenbullied,abused,orneglected,anditsometimesstartsafterasignificantlifeevent,suchaschildbirthorbereavement.[87]Ithasbeenreportedinsomestudiesthatthereisaconnectionbetweenchildhoodtraumaandobsessive-compulsivesymptoms.Moreresearchisneededtounderstandthisrelationshipbetter.[86] Mechanisms Mainarticle:Biologyofobsessive–compulsivedisorder Neuroimaging SomepartsofthebrainshowingabnormalactivityinOCD Functionalneuroimagingduringsymptomprovocationhasobservedabnormalactivityintheorbitofrontalcortex,leftdorsolateralprefrontalcortex,rightpremotorcortex,leftsuperiortemporalgyrus,globuspallidusexternus,hippocampus,andrightuncus.Weakerfociofabnormalactivitywerefoundintheleftcaudate,posteriorcingulatecortex,andsuperiorparietallobule.[101]However,anoldermeta-analysisoffunctionalneuroimaginginOCDreportedthattheonlyconsistentfunctionalneuroimagingfindingwasincreasedactivityintheorbitalgyrusandheadofthecaudatenucleus,whileACCactivationabnormalitiesweretooinconsistent.[102]Ameta-analysiscomparingaffectiveandnonaffectivetasksobserveddifferenceswithcontrolsinregionsimplicatedinsalience,habit,goal-directedbehavior,self-referentialthinking,andcognitivecontrol.Fornonaffectivetasks,hyperactivitywasobservedintheinsula,ACC,andheadofthecaudate/putamen,whilehypoactivitywasobservedinthemedialprefrontalcortex(mPFC)andposteriorcaudate.Affectivetaskswereobservedtorelatetoincreasedactivationintheprecuneusandposteriorcingulatecortex(PCC),whiledecreasedactivationwasfoundinthepallidum,ventralanteriorthalamus,andposteriorcaudate.[103]Theinvolvementofthecortico-striato-thalamo-corticalloopinOCD,aswellasthehighratesofcomorbiditybetweenOCDandADHD,haveledsometodrawalinkintheirmechanism.Observedsimilaritiesincludedysfunctionoftheanteriorcingulatecortexandprefrontalcortex,aswellasshareddeficitsinexecutivefunctions.[104]TheinvolvementoftheorbitofrontalcortexanddorsolateralprefrontalcortexinOCDissharedwithbipolardisorder,andmayexplainthehighdegreeofcomorbidity.[105]DecreasedvolumesofthedorsolateralprefrontalcortexrelatedtoexecutivefunctionhasalsobeenobservedinOCD.[106] PeoplewithOCDevinceincreasedgreymattervolumesinbilaterallenticularnuclei,extendingtothecaudatenuclei,withdecreasedgreymattervolumesinbilateraldorsalmedialfrontal/anteriorcingulategyri.[107][105]Thesefindingscontrastwiththoseinpeoplewithotheranxietydisorders,whoevincedecreased(ratherthanincreased)greymattervolumesinbilaterallenticular/caudatenuclei,aswellasdecreasedgreymattervolumesinbilateraldorsalmedialfrontal/anteriorcingulategyri.[105]IncreasedwhitemattervolumeanddecreasedfractionalanisotropyinanteriormidlinetractshasbeenobservedinOCD,possiblyindicatingincreasedfibercrossings.[108] Cognitivemodels GenerallytwocategoriesofmodelsforOCDhavebeenpostulated,thefirstinvolvingdeficitsinexecutivefunction,andthesecondinvolvingdeficitsinmodulatorycontrol.ThefirstcategoryofexecutivedysfunctionisbasedontheobservedstructuralandfunctionalabnormalitiesinthedlPFC,striatumandthalamus.ThesecondcategoryinvolvingdysfunctionalmodulatorycontrolprimarilyreliesonobservedfunctionalandstructuraldifferencesintheACC,mPFC,andOFC.[109][110] OneproposedmodelsuggeststhatdysfunctionintheOFCleadstoimpropervaluationofbehaviorsanddecreasedbehavioralcontrol,whiletheobservedalterationsinamygdalaactivationsleadstoexaggeratedfearsandrepresentationsofnegativestimuli.[111] DuetotheheterogeneityofOCDsymptoms,studiesdifferentiatingvarioussymptomshavebeenperformed.Symptom-specificneuroimagingabnormalitiesincludethehyperactivityofcaudateandACCincheckingrituals,whilefindingincreasedactivityofcorticalandcerebellarregionsincontamination-relatedsymptoms.Neuroimagingdifferentiatingcontentofintrusivethoughtshasfounddifferencesbetweenaggressiveasopposedtotaboothoughts,findingincreasedconnectivityoftheamygdala,ventralstriatum,andventromedialprefrontalcortexinaggressivesymptoms,whileobservingincreasedconnectivitybetweentheventralstriatumandinsulainsexualorreligiousintrusivethoughts.[112] Anothermodelproposesthataffectivedysregulationlinksexcessiverelianceonhabit-basedactionselection[113]withcompulsions.ThisissupportedbytheobservationthatthosewithOCDdemonstratedecreasedactivationoftheventralstriatumwhenanticipatingmonetaryreward,aswellasincreasedfunctionalconnectivitybetweentheVSandtheOFC.Furthermore,thosewithOCDdemonstratereducedperformanceinPavlovianfear-extinctiontasks,hyperresponsivenessintheamygdalatofearfulstimuli,andhyporesponsivenessintheamygdalawhenexposedtopositivelyvalancedstimuli.Stimulationofthenucleusaccumbenshasalsobeenobservedtoeffectivelyalleviatebothobsessionsandcompulsions,supportingtheroleofaffectivedysregulationingeneratingboth.[111] Neurobiological FromtheobservationoftheefficacyofantidepressantsinOCD,aserotoninhypothesisofOCDhasbeenformulated.Studiesofperipheralmarkersofserotonin,aswellaschallengeswithproserotonergiccompoundshaveyieldedinconsistentresults,includingevidencepointingtowardsbasalhyperactivityofserotonergicsystems.[114]Serotoninreceptorandtransporterbindingstudieshaveyieldedconflictingresults,includinghigherandlowerserotoninreceptor5-HT2AandserotonintransporterbindingpotentialsthatwerenormalizedbytreatmentwithSSRIs.Despiteinconsistenciesinthetypesofabnormalitiesfound,evidencepointstowardsdysfunctionofserotonergicsystemsinOCD.[115]OrbitofrontalcortexoveractivityisattenuatedinpeoplewhohavesuccessfullyrespondedtoSSRImedication,aresultbelievedtobecausedbyincreasedstimulationofserotoninreceptors5-HT2Aand5-HT2C.[116] AcomplexrelationshipbetweendopamineandOCDhasbeenobserved.Althoughantipsychotics,whichactbyantagonizingdopaminereceptorsmayimprovesomecasesofOCD,theyfrequentlyexacerbateothers.Antipsychotics,inthelowdosesusedtotreatOCD,mayactuallyincreasethereleaseofdopamineintheprefrontalcortex,throughinhibitingautoreceptors.Furthercomplicatingthingsistheefficacyofamphetamines,decreaseddopaminetransporteractivityobservedinOCD,[117]andlowlevelsofD2bindinginthestriatum.[118]Furthermore,increaseddopaminereleaseinthenucleusaccumbensafterdeepbrainstimulationcorrelateswithimprovementinsymptoms,pointingtoreduceddopaminereleaseinthestriatumplayingaroleingeneratingsymptoms.[119] AbnormalitiesinglutamatergicneurotransmissionhaveimplicatedinOCD.Findingssuchasincreasedcerebrospinalglutamate,lessconsistentabnormalitiesobservedinneuroimagingstudies,andtheefficacyofsomeglutamatergicdrugs,suchastheglutamate-inhibitingriluzole,haveimplicatedglutamateinOCD.[118]OCDhasbeenassociatedwithreducedN-AcetylasparticacidinthemPFC,whichisthoughttoreflectneurondensityorfunctionality,althoughtheexactinterpretationhasnotbeenestablished.[120] Diagnosis Formaldiagnosismaybeperformedbyapsychologist,psychiatrist,clinicalsocialworker,orotherlicensedmentalhealthprofessional.TobediagnosedwithOCD,apersonmusthaveobsessions,compulsions,orboth,accordingtotheDiagnosticandStatisticalManualofMentalDisorders(DSM).TheQuickReferencetothe2000editionoftheDSMstatesthatseveralfeaturescharacterizeclinicallysignificantobsessionsandcompulsions,andthatsuchobsessionsarerecurrentandpersistentthoughts,impulses,orimagesthatareexperiencedasintrusive,andthatcausemarkedanxietyordistress.Thesethoughts,impulses,orimagesareofadegreeortypethatliesoutsidethenormalrangeofworriesaboutconventionalproblems.[121]Apersonmayattempttoignoreorsuppresssuchobsessions,ortoneutralizethemwithsomeotherthoughtoraction,andwilltendtorecognizetheobsessionsasidiosyncraticorirrational. Compulsionsbecomeclinicallysignificantwhenapersonfeelsdriventoperformtheminresponsetoanobsession,oraccordingtorulesthatmustbeappliedrigidly,andwhenthepersonconsequentlyfeelsorcausessignificantdistress.Therefore,whilemanypeoplewhodonothaveOCDmayperformactionsoftenassociatedwithOCD(suchasorderingitemsinapantrybyheight),thedistinctionwithclinicallysignificantOCDliesinthefactthatthepersonwithOCDmustperformtheseactionstoavoidsignificantpsychologicaldistress.Thesebehaviorsormentalactsareaimedatpreventingorreducingdistressorpreventingsomedreadedeventorsituation;however,theseactivitiesarenotlogicallyorpracticallyconnectedtotheissue,or,theyareexcessive.Inaddition,atsomepointduringthecourseofthedisorder,theindividualmustrealizethathisorherobsessionsorcompulsionsareunreasonableorexcessive.[citationneeded] Moreover,theobsessionsorcompulsionsmustbetime-consuming,oftentakingupmorethanonehourperday,orcauseimpairmentinsocial,occupational,orscholasticfunctioning.[121]ItishelpfultoquantifytheseverityofsymptomsandimpairmentbeforeandduringtreatmentforOCD.Inadditiontotheperson'sestimateofthetimespenteachdayharboringobsessive-compulsivethoughtsorbehaviors,concretetoolscanbeusedtogaugetheperson'scondition.Thismaybedonewithratingscales,suchastheYale–BrownObsessiveCompulsiveScale(Y-BOCS;expertrating)[122]ortheobsessive-compulsiveinventory(OCI-R;self-rating).[123]Withmeasurementssuchasthese,psychiatricconsultationcanbemoreappropriatelydetermined,asithasbeenstandardized.[13] OCDissometimesplacedinagroupofdisorderscalledtheobsessive–compulsivespectrum.[124] Differentialdiagnosis OCDisoftenconfusedwiththeseparateconditionobsessive–compulsivepersonalitydisorder(OCPD).OCDisegodystonic,meaningthatthedisorderisincompatiblewiththeindividual'sself-concept.[125][126]Asegodystonicdisordersgoagainstaperson'sself-concept,theytendtocausemuchdistress.OCPD,ontheotherhand,isegosyntonic,markedbytheperson'sacceptancethatthecharacteristicsandbehaviorsdisplayedasaresultarecompatiblewiththeirself-image,orareotherwiseappropriate,correct,orreasonable. Asaresult,peoplewithOCDareoftenawarethattheirbehaviorisnotrational,andareunhappyabouttheirobsessions,butneverthelessfeelcompelledbythem.[127]Bycontrast,peoplewithOCPDarenotawareofanythingabnormal;theywillreadilyexplainwhytheiractionsarerational.Itisusuallyimpossibletoconvincethemotherwise,andtheytendtoderivepleasurefromtheirobsessionsorcompulsions.[127] Management Cognitivebehavioraltherapy(CBT)andpsychotropicmedicationsarethefirst-linetreatmentsforOCD.[1][128]Otherformsofpsychotherapy,suchaspsychodynamicsandpsychoanalysis,mayhelpinmanagingsomeaspectsofthedisorder.However,in2007,theAmericanPsychiatricAssociation(APA)notedalackofcontrolledstudiesshowingtheirefficacy,"indealingwiththecoresymptomsofOCD."[129] Therapy Oneexposureandritualpreventionactivitywouldbetocheckthelockonlyonceandthenleave. ThespecifictechniqueusedinCognitiveBehavioralTherapy(CBT)iscalledexposureandresponseprevention(ERP),whichinvolvesteachingthepersontodeliberatelycomeintocontactwithsituationsthattriggerobsessivethoughtsandfears(exposure),withoutcarryingouttheusualcompulsiveactsassociatedwiththeobsession(responseprevention).Thistechniquecausespatientstograduallylearntotoleratethediscomfortandanxietyassociatedwithnotperformingtheircompulsions.Formanypatients,ERPistheadd-ontreatmentofchoicewhenselectiveserotoninreuptakeinhibitors(SSRIs)orserotonin-norepinephrinereuptakeinhibitors(SNRIs)medicationdoesnoteffectivelytreatOCDsymptoms,orviceversa,forindividualswhobegintreatmentwithpsychotherapy.[86] Forexample,apatientmightbeaskedtotouchsomethingverymildlycontaminated(exposure),andwashtheirhandsonlyonceafterward(responseprevention).Anotherexamplemightentailaskingthepatienttoleavethehouseandcheckthelockonlyonce(exposure),withoutgoingbacktocheckagain(responseprevention).Aftersucceedingatonestageoftreatment,thepatient'slevelofdiscomfortintheexposurephasecanbeincreased.Whenthistherapyissuccessful,thepatientwillquicklyhabituatetoananxiety-producingsituation,discoveringaconsiderabledropinanxietylevel.[130] ERPhasastrongevidencebase,andisconsideredthemosteffectivetreatmentforOCD.[130]However,thisclaimwasdoubtedbysomeresearchersin2000,whocriticizedthequalityofmanystudies.[131]A2007CochranereviewalsofoundthatpsychologicalinterventionsderivedfromCBTmodelsweremoreeffectivethantreatmentasusual,consistingofnotreatment,awaitinglist,ornon-CBTinterventions.[132]Forbody-focusedrepetitivebehaviors(BFRB),behavioralinterventionssuchashabit-reversaltraininganddecouplingarerecommended.[44][45] PsychotherapyincombinationwithpsychiatricmedicationmaybemoreeffectivethaneitheroptionaloneforindividualswithsevereOCD.[133][134][135] Medication AblisterpackofclomipramineunderthebrandnameAnafranil ThemedicationsmostfrequentlyusedtotreatOCDareantidepressantsincludingselectiveserotoninreuptakeinhibitors(SSRIs)andserotonin-norepinephrinereuptakeinhibitors(SNRIs).Clomipramine,amedicationbelongingtotheclassoftricyclicantidepressants,appearstoworkaswellasSSRIs,buthasahigherrateofsideeffects.[5] SSRIshelppeoplewithOCDbyinhibitingthereabsorptionofserotoninbythenervecellsaftertheycarrymessagesfromneuronstosynapse;thus,moreserotoninisavailabletopassfurthermessagesbetweennearbynervecells.[89] SSRIsareasecond-linetreatmentofadultOCDwithmildfunctionalimpairment,andasfirst-linetreatmentforthosewithmoderateorsevereimpairment.Inchildren,SSRIscanbeconsideredasasecond-linetherapyinthosewithmoderatetosevereimpairment,withclosemonitoringforpsychiatricadverseeffects.[128]PatientstreatedwithSSRIsareabouttwiceaslikelytorespondtotreatmentasarethosetreatedwithplacebo,sothistreatmentisqualifiedasefficacious.[136][137]Efficacyhasbeendemonstratedbothinshort-term(6–24weeks)treatmenttrials,andindiscontinuationtrialswithdurationsof28–52weeks.[138][139][140] In2006,theNationalInstituteofClinicalandHealthExcellence(NICE)guidelinesrecommendedaugmentativesecond-generation(atypical)antipsychoticsfortreatment-resistantOCD.[6]Atypicalantipsychoticsarenotusefulwhenusedalone,andnoevidencesupportstheuseoffirst-generationantipsychotics.[20][141]ForOCDtreatmentspecifically,thereistentativeevidenceforrisperidone,andinsufficientevidenceforolanzapine.Quetiapineisnobetterthanplacebowithregardtoprimaryoutcomes,butsmalleffectswerefoundintermsofYBOCSscore.Theefficacyofquetiapineandolanzapinearelimitedbyaninsufficientnumberofstudies.[142]A2014reviewarticlefoundtwostudiesthatindicatedthataripiprazolewas"effectiveintheshort-term",andfoundthat"[t]herewasasmalleffect-sizeforrisperidoneoranti-psychoticsingeneralintheshort-term";however,thestudyauthorsfound"noevidencefortheeffectivenessofquetiapineorolanzapineincomparisontoplacebo."[6]WhilequetiapinemaybeusefulwhenusedinadditiontoanSSRI/SNRIintreatment-resistantOCD,thesedrugsareoftenpoorlytolerated,andhavemetabolicsideeffectsthatlimittheiruse.AguidelinebytheAmericanPsychologicalAssociationsuggestedthatdextroamphetaminemaybeconsideredbyitselfaftermorewell-supportedtreatmentshavebeenattempted.[143] Procedures Electroconvulsivetherapy(ECT)hasbeenfoundtohaveeffectivenessinsomesevereandrefractorycases.[144] Surgerymaybeusedasalastresortinpeoplewhodonotimprovewithothertreatments.Inthisprocedure,asurgicallesionismadeinanareaofthebrain(thecingulatecortex).Inonestudy,30%ofparticipantsbenefittedsignificantlyfromthisprocedure.[145]Deepbrainstimulationandvagusnervestimulationarepossiblesurgicaloptionsthatdonotrequiredestructionofbraintissue.IntheUnitedStates,theFoodandDrugAdministrationapproveddeep-brainstimulationforthetreatmentofOCDunderahumanitariandeviceexemption,requiringthattheprocedurebeperformedonlyinahospitalwithspecialqualificationstodoso.[146] IntheUnitedStates,psychosurgeryforOCDisatreatmentoflastresort,andwillnotbeperformeduntilthepersonhasfailedseveralattemptsatmedication(atthefulldosage)withaugmentation,andmanymonthsofintensivecognitive–behavioraltherapywithexposureandritual/responseprevention.[147]Likewise,intheUnitedKingdom,psychosurgerycannotbeperformedunlessacourseoftreatmentfromasuitablyqualifiedcognitive–behavioraltherapisthasbeencarriedout. Children TherapeutictreatmentmaybeeffectiveinreducingritualbehaviorsofOCDforchildrenandadolescents.[148]SimilartothetreatmentofadultswithOCD,CognitiveBehavioralTherapystandsasaneffectiveandvalidatedfirstlineoftreatmentofOCDinchildren.[149]Familyinvolvement,intheformofbehavioralobservationsandreports,isakeycomponenttothesuccessofsuchtreatments.[150]Parentalinterventionsalsoprovidepositivereinforcementforachildwhoexhibitsappropriatebehaviorsasalternativestocompulsiveresponses.Inarecentmeta-analysisofevidenced-basedtreatmentofOCDinchildren,family-focusedindividualCBTwaslabeledas"probablyefficacious,"establishingitasoneoftheleadingpsychosocialtreatmentsforyouthwithOCD.[149]Afteroneortwoyearsoftherapy,inwhichachildlearnsthenatureoftheirobsessionandacquiresstrategiesforcoping,theymayacquirealargercircleoffriends,exhibitlessshyness,andbecomelessself-critical.[151] AlthoughtheknowncausesofOCDinyoungeragegroupsrangefrombrainabnormalitiestopsychologicalpreoccupations,lifestresssuchasbullyingandtraumaticfamilialdeathsmayalsocontributetochildhoodcasesofOCD,andacknowledgingthesestressorscanplayaroleintreatingthedisorder.[152] Epidemiology Age-standardizeddisability-adjustedlifeyearestimatedratesforobsessive-compulsivedisorderper100,000 inhabitantsin2004.  nodata  <45  45–52.5  52.5–60  60–67.5  67.5–75  75–82.5  82.5–90  90–97.5  97.5–105  105–112.5  112.5–120  >120 Obsessive–compulsivedisorderaffectsabout2.3%ofpeopleatsomepointintheirlife,withtheyearlyrateabout1.2%.[7]OCDoccursworldwide.[2]Itisunusualforsymptomstobeginaftertheageof35andhalfofpeopledevelopproblemsbefore20.[1][2]Malesandfemalesareaffectedaboutequally.[1] Prognosis QualityoflifeisreducedacrossalldomainsinOCD.WhilepsychologicalorpharmacologicaltreatmentcanleadtoareductionofOCDsymptomsandanincreaseinreportedqualityoflife,symptomsmaypersistatmoderatelevelsevenfollowingadequatetreatmentcourses,andcompletelysymptom-freeperiodsareuncommon.[153][154]InpediatricOCD,around40%stillhavethedisorderinadulthood,andaround40%qualifyforremission.[155] History Plutarch,anancientGreekphilosopherandhistorian,describesanancientRomanmanpossiblysufferingfromscrupulosity,whichcouldbeasymptomofOCDorOCPD.Thismanisdescribedas"turningpaleunderhiscrownofflowers,"prayingwitha"falteringvoice,"andscattering"incensewithtremblinghands."[156][157][158] Inthe7thcenturyAD,JohnClimacusrecordsaninstanceofayoungmonkplaguedbyconstantandoverwhelming"temptationstoblasphemy"consultinganoldermonk,whotoldhim:"Myson,Itakeuponmyselfallthesinswhichthesetemptationshaveledyou,ormayleadyou,tocommit.AllIrequireofyouisthatforthefutureyoupaynoattentiontothemwhatsoever."[159]: 212 TheCloudofUnknowing,aChristianmysticaltextfromthelate14thcentury,recommendsdealingwithrecurringobsessionsbyattemptingtoignorethem,and,ifthatfails,to"cowerunderthemlikeapoorwretchandacowardovercomeinbattle,andreckonittobeawasteofyourtimeforyoutostriveanylongeragainstthem",atechniquenowknownasemotionalflooding.[159]: 213  Fromthe14thtothe16thcenturyinEurope,itwasbelievedthatpeoplewhoexperiencedblasphemous,sexualorotherobsessivethoughtswerepossessedbythedevil.[125][159]: 213 Basedonthisreasoning,treatmentinvolvedbanishingthe"evil"fromthe"possessed"personthroughexorcism.[160][161]Thevastmajorityofpeoplewhothoughtthattheywerepossessedbythedevildidnothavehallucinationsorother"spectacularsymptoms"but"complainedofanxiety,religiousfears,andevilthoughts."[159]: 213 In1584,awomanfromKent,England,namedMrs.Davie,describedbyajusticeofthepeaceas"agoodwife,"wasnearlyburnedatthestakeaftersheconfessedthatsheexperiencedconstant,unwantedurgestomurderherfamily.[159]: 213  TheEnglishtermobsessive–compulsivearoseasatranslationofGermanZwangsvorstellung(obsession)usedinthefirstconceptionsofOCDbyCarlWestphal.Westphal'sdescriptionwentontoinfluencePierreJanet,whofurtherdocumentedfeaturesofOCD.[48]Intheearly1910s,SigmundFreudattributedobsessive–compulsivebehaviortounconsciousconflictsthatmanifestassymptoms.[160]Freuddescribestheclinicalhistoryofatypicalcaseof"touchingphobia"asstartinginearlychildhood,whenthepersonhasastrongdesiretotouchanitem.Inresponse,thepersondevelopsan"externalprohibition"againstthistypeoftouching.However,this"prohibitiondoesnotsucceedinabolishing"thedesiretotouch;allitcandoisrepressthedesireand"forceitintotheunconscious."[162]FreudianpsychoanalysisremainedthedominanttreatmentforOCDuntilthemid-1980s,eventhoughmedicinalandtherapeutictreatmentswereknownandavailable,becauseitwaswidelythoughtthatthesetreatmentswouldbedetrimentaltotheeffectivenessofthepsychotherapy.[159]: 210–211 Inthemid-1980s,thisapproachchanged,andpractitionersbegantreatingOCDprimarilywithmedicineandpracticaltherapyratherthanthroughpsychoanalysis.[159]: 210  Notablecases JohnBunyan(1628–1688),theauthorofThePilgrim'sProgress,displayedsymptomsofOCD(whichhadnotyetbeennamed).Duringthemostsevereperiodofhiscondition,hewouldmutterthesamephraseoverandoveragaintohimselfwhilerockingbackandforth.[159]: 53–54 HelaterdescribedhisobsessionsinhisautobiographyGraceAboundingtotheChiefofSinners,stating,"Thesethingsmayseemridiculoustoothers,evenasridiculousastheywereinthemselves,buttometheywerethemosttormentingcogitations."[159]: 53–54 Hewrotetwopamphletsadvisingthosewithsimilaranxieties.[159]: 217–218 Inoneofthem,hewarnsagainstindulgingincompulsions:"Havecareofputtingoffyourtroubleofspiritinthewrongway:bypromisingtoreformyourselfandleadanewlife,byyourperformancesorduties".[159]: 217–218  Britishpoet,essayistandlexicographerSamuelJohnson(1709–1784)alsohadOCD.Hehadelaborateritualsforcrossingthethresholdsofdoorways,andrepeatedlywalkedupanddownstaircasescountingthesteps.[163][159]: 54–55 Hewouldtoucheverypostonthestreetashewalkedpast,onlystepinthemiddlesofpavingstones,andrepeatedlyperformtasksasthoughtheyhadnotbeendoneproperlythefirsttime.[159]: 55  TheAmericanaviatorandfilmmakerHowardHughesisknowntohavehadOCD.[164]FriendsofHugheshavealsomentionedhisobsessionwithminorflawsinclothing.[165]ThiswasconveyedinTheAviator(2004),afilmbiographyofHughes.[166] Englishsinger-songwriterGeorgeEzrahasopenlyspokenabouthislife-longstrugglewithOCD,particularly"PureOCD."[167] WorldrenownedSwedishclimateactivistGretaThunbergisalsoknowntohaveOCDamongothermentalhealthconditions.[168] AmericanactorJamesSpaderisalsoknowntohaveOCD.[169] Societyandculture Thisribbonrepresentstrichotillomaniaandotherbody-focusedrepetitivebehaviors.ConceptfortheribbonwasstartedbyJenneSchrader.ColorswerevotedonbytheTrichotillomaniaFacebookcommunity,andmadeofficialbytheTrichotillomaniaLearningCenterinAugust2013. Art,entertainmentandmedia MoviesandtelevisionshowsmayportrayidealizedorincompleterepresentationsofdisorderssuchasOCD.Compassionateandaccurateliteraryandon-screendepictionsmayhelpcounteractthepotentialstigmaassociatedwithanOCDdiagnosis,andleadtoincreasedpublicawareness,understandingandsympathyforsuchdisorders.[170][171] InthefilmAsGoodasItGets(1997),actorJackNicholsonportraysamanwithOCDwhoperformsritualisticbehaviorsthatdisrupthislife.[172] ThefilmMatchstickMen(2003),directedbyRidleyScott,portraysaconmannamedRoy(NicolasCage)withOCDwhoopensandclosesdoorsthreetimeswhilecountingaloudbeforehecanwalkthroughthem.[173] InthetelevisionseriesMonk(2002–2009),thetitularcharacterAdrianMonkfearsbothhumancontactanddirt.[174][175] InTurtlesAlltheWayDown(2017),ayoungadultnovelbyauthorJohnGreen,teenagemaincharacterAzaHolmesstruggleswithOCDthatmanifestsasafearofthehumanmicrobiome.Throughoutthestory,Azarepeatedlyopensanunhealedcallusonherfingertodrainoutwhatshebelievesarepathogens.ThenovelisbasedonGreen'sownexperienceswithOCD.HeexplainedthatTurtlesAlltheWayDownisintendedtoshowhow"mostpeoplewithchronicmentalillnessesalsolivelong,fulfillinglives".[176] TheBritishTVseriesPure(2019)starsCharlyCliveasa24-year-oldMarniewhoisplaguedbydisturbingsexualthoughts,asakindofprimarilyobsessionalobsessivecompulsivedisorder.[177]TheseriesisbasedonabookofthesamenamebyRoseCartwright. Research ThenaturallyoccurringsugarinositolhasbeensuggestedasatreatmentforOCD.[178] μ-Opioids,suchashydrocodoneandtramadol,mayimproveOCDsymptoms.[179]AdministrationofopiatetreatmentmaybecontraindicatedinindividualsconcurrentlytakingCYP2D6inhibitorssuchasfluoxetineandparoxetine.[180] Muchcurrentresearchisdevotedtothetherapeuticpotentialoftheagentsthataffectthereleaseoftheneurotransmitterglutamateorthebindingtoitsreceptors.Theseincluderiluzole,memantine,gabapentin,N-acetylcysteine,topiramateandlamotrigine.[181] Otheranimals Seealso:Animalpsychopathology§ Obsessivecompulsivedisorder(OCD) References ^abcdefghijklmnoTheNationalInstituteofMentalHealth(NIMH)(January2016)."WhatisObsessive-CompulsiveDisorder(OCD)?".U.S.NationalInstitutesofHealth(NIH).Archivedfromtheoriginalon23July2016.Retrieved24July2016. ^abcdefghijklmnopqrDiagnosticandstatisticalmanualofmentaldisorders :DSM-5(5 ed.).Washington:AmericanPsychiatricPublishing.2013.pp. 237–242.ISBN 978-0-89042-555-8. 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Obsessive–compulsivedisorderatCurlie NationalInstituteOfMentalHealth AmericanPsychiatricAssociation APADivision12treatmentpageforobsessive-compulsivedisorder Davis,LennardJ.(2008).Obsession:AHistory.UniversityofChicagoPress.ISBN 978-0-226-13782-7. vteMentaldisorders (Classification)AdultpersonalityandbehaviorSexual Ego-dystonicsexualorientation Paraphilia Fetishism Voyeurism Sexualmaturationdisorder Sexualrelationshipdisorder Other Factitiousdisorder Munchausensyndrome Genderdysphoria Intermittentexplosivedisorder Dermatillomania Kleptomania Pyromania Trichotillomania Personalitydisorder ChildhoodandlearningEmotionalandbehavioral ADHD Conductdisorder ODD Emotionalandbehavioraldisorders Separationanxietydisorder Movementdisorders Stereotypic Socialfunctioning DAD RAD Selectivemutism Speech Cluttering Stuttering Ticdisorder Tourettesyndrome Intellectualdisability X-linkedintellectualdisability Lujan–Frynssyndrome Psychologicaldevelopment(developmentaldisabilities) Pervasive Specific 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Serotonin–norepinephrinereuptakeinhibitors Venlafaxine Desvenlafaxine Duloxetine Serotonin–norepinephrine–dopaminereuptakeinhibitors Nefazodone Monoamineoxidaseinhibitors Phenelzine Tranylcypromine Tricyclicantidepressants Clomipramine Serotonergicpsychedelics Lysergicaciddiethylamide Psilocin Atypicalantipsychotics Aripiprazole Quetiapine Muopioidergics Hydrocodone Morphine Tramadol Anticholinergics Diphenhydramine NMDAglutamatergics Riluzole NK-1tachykininergics Aprepitant Other Nicotine Memantine Tautomycin Behavioral Acceptanceandcommitmenttherapy Cognitivebehavioraltherapy(Exposureandresponseprevention) Inference-basedtherapy Metacognitivetherapy Notablepeople EdnaB.Foa WayneK.Goodman StanleyRachman AdamS.Radomsky JeffreyM.Schwartz JonathanAbramowitz SusanSwedo EmilyColas VicMeyer DanielA.Geller DavidShannahoff-Khalsa GaryRoyGeffken ChristopherPittenger PopularcultureLiteratureFictional MatchstickMen Plyushkin Xenocide Nonfiction EverythinginItsPlace JustChecking Media AsGoodasItGets TheAviator MatchstickMen AdrianMonk Pure "$pringfield" StraightUp Related Obsessive–compulsivepersonalitydisorder Obsessionaljealousy PANDAS PrimarilyObsessionalOCD Relationshipobsessive–compulsivedisorder Socialanxietydisorder Tourettesyndrome vteOCDpharmacotherapiesAntidepressants SSRIs(citalopram,escitalopram,fluoxetine,fluvoxamine,paroxetine,sertraline) TCAs(clomipramine) Others Atypicalantipsychotics(aripiprazole,olanzapine,quetiapine,risperidone) Authoritycontrol:Nationallibraries France(data) Germany Israel UnitedStates Latvia Japan CzechRepublic ClassificationDICD-10:F42ICD-9-CM:300.3OMIM:164230MeSH:D009771DiseasesDB:33766ExternalresourcesMedlinePlus:000929eMedicine:article/287681 Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Obsessive–compulsive_disorder&oldid=1092817367" 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