Obsessive-compulsive disorder (OCD) is
an anxiety disorder that usually begins in adolescence or early adulthood,
but may begin in childhood. When OCD starts in childhood, it is more common
in boys than in girls. The usual time of onset is later for females than
males, so the disorder is equally common among adult men and women. Without
treatment, OCD usually follows a chronic course, and some persons become
severely disabled by it. The October 27, 2004, issue of JAMA includes an article about treating OCD in children
Obsessive-compulsive disorder is characterized by the presence
of obsessions or compulsions or (as is often the case) both of them. The
obsessions or compulsions cause marked distress, are time-consuming, and
interfere with the person's normal functioning.
Obsessions—unwanted, recurrent thoughts, impulses,
or images that are experienced as intrusive and
The obsessions of OCD are not just worries about real-life
The person realizes that the obsessive thoughts are
from his or her own mind.
The person attempts to suppress or neutralize the
obsessions with actions or other thoughts.
Examples of typical obsessions include thoughts of
being contaminated by dirt or germs or thoughts of having hurt someone,
even though recognizing that such concerns are not realistic.
behaviors or "rituals" that the person feels driven to perform in a
The compulsive actions are done to reduce
distress or to prevent something bad from happening, even though there is
no realistic connection with preventing such an occurrence.
Typical compulsions include excessive cleaning (such as
hand washing), repetitive checking, and hoarding of useless items.
Mental acts such as praying, counting, or repeating
words silently can be compulsions for some persons.
The exact cause of OCD is not known.
There is evidence that OCD can run in families and may
have a genetic (inherited) component.
An imbalance of serotonin, a
chemical messenger in the brain, may be involved.
Selective serotonin reuptake
inhibitors (SSRIs) are medications that have been shown to
successfully reduce the symptoms of OCD and that are also used as
therapy (CBT) for OCD involves
helping patients to change their ideas or thought patterns related to
obsessive thoughts and compulsions.
Exposure and response
prevention is a behavioral therapy that may be included as part of
CBT. The patient is deliberately exposed to situations that tend to
stimulate his or her compulsions (for example, getting his or her hands
dirty). A trained therapist helps the patient to deal with the resulting
anxiety while encouraging him or her not to engage in the compulsion
(for example, excessive hand washing).
Anxiety Disorders Association of America
American Psychiatric Association
National Institute of Mental Health 866/615-6464 http://www.nimh.nih.gov
To find this and previous JAMA Patient Pages, go to the Patient Page
link on JAMA's Web site at
http://www.jama.com. A Patient Page on obsessive-compulsive
disorder was published in the November 25, 1998, issue.
Sources: Anxiety Disorders Association of
America, American Psychiatric Association, National Institute of Mental
The JAMA Patient Page is a public service of JAMA. The information and
recommendations appearing on this page are appropriate in most instances, but they
are not a substitute for medical diagnosis. For specific information
concerning your personal medical condition, JAMA
suggests that you consult your physician. This page may be photocopied
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TOPIC: ANXIETY DISORDERS
Parmet S, Glass TJ, Glass RM. Obsessive-Compulsive Disorder. JAMA. 2004;292(16):2040. doi:10.1001/jama.292.16.2040