Obsessive Compulsive Personality Disorder

Obsessive thoughts and compulsive behaviors represent recurring efforts to control overwhelming anxiety, guilt, or unacceptable impulses that persistently enter the consciousness. The word obsession refers to a recurrent idea, thought, impulse, or image that is intrusive and inappropriate and causes marked anxiety or distress.

A compulsion is a ritualistic, repetitive, and involuntary defensive behavior. Performing a compulsive behavior reduces the patient's anxiety and increases the probability that the behavior will recur. Compulsions are often associated with obsessions.

Patients with obsessive-compulsive disorder are prone to abuse psychoactive substances, such as alcohol and anxiolytics, in an attempt to relieve their anxiety. In addition, other anxiety disorders and major depression often coexist with obsessive-compulsive disorder.

Obsessive-compulsive disorder is typically a chronic condition with remissions and flareups. Mild forms of the disorder are relatively common in the population at large.

Causes

Signs and symptoms

The psychiatric history of a patient with this disorder may reveal the presence of obsessive thoughts, words, or mental images that persistently and involuntarily invade the consciousness.

Some common obsessions include thoughts of violence (such as stabbing, shooting, maiming, or hitting), thoughts of contamination (images of dirt, germs, or feces), repetitive doubts and worries about a tragic event, and repeating or counting images, words, or objects in the environment. The patient recognizes that the obsessions are a product of his own mind and that they interfere with normal daily activities.

The patient's history also may reveal the presence of compulsions, irrational and recurring impulses to repeat a certain behavior. Common compulsions include repetitive touching, sometimes combined with counting; doing and undoing (for instance, opening and closing doors or rearranging things); washing (especially hands); and checking (to be sure no tragedy has occurred since the last time he checked). The patient's anxiety often is so strong that he will avoid the situation or the object that evokes the impulse.

When the obsessive-compulsive phenomena are mental, observation may reveal no behavioral abnormalities. However, compulsive acts may be observed, although feelings of shame, nervousness, or embarrassment may prompt the patient to try limiting these acts to his own private time.

You'll need to evaluate the impact of obsessive-compulsive phenomena on the patient's normal routine. He'll typically report moderate to severe impairment of social and occupational functioning.

Diagnosis

There is no diagnostic test for OCD. Your doctor will listen to a history of your symptoms and ask you questions. He or she will want to know what types of obsessions and compulsions you have, and whether they interfere with your everyday life and relationships in any way. You may have OCD if you have thoughts you can't ignore or make go away; you feel the need to check things over and over, such as whether a door is locked or a light switched off; you need to clean objects or your hands repeatedly; your obsessions or compulsions make you feel anxious; and these feelings interfere with your normal activities. It is important to answer the doctor's questions openly and honestly. He or she will also ask about any medications you are taking to be sure they are not causing your symptoms. People with OCD often avoid seeking treatment because they are embarrassed by the condition. While brain imaging studies are not used to diagnose OCD, when researchers have compared positron emission tomography (PET) scans of people with and without OCD, they found different patterns of brain activity in people with OCD. 

Treatment

Obsessive-compulsive disorder is tenacious, but with treatment, improvement occurs in 60% to 70% of patients. Current treatment usually involves a comedication and cognitive behavioral therapy. Other types of psychotherapy may also be helpful.

Effective medications include clomipramine, a tricyclic antidepressant; selective serotonin reuptake inhibitors, such as fluoxetine, paroxetine, sertraline, and fluvoxamine; and the benzodiazepine clonazepam.

Behavioral therapies-aversion therapy, thought stopping, thought switching, flooding, implosion therapy, and response prevention - have also been effective.

Prevention

Preventive measures to reduce the incidence of OCD in adolescents are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the adolescent's normal growth and development, and improve the quality of life experienced by children or adolescents with anxiety disorders.