Obsessive-compulsive disorder

Obsessions and/or compulsions that cause marked distress, are time consuming (take more than 1 hour per day), or interfere substantially with the person's normal routine, occupational or academic functioning, or usual social activities or relationships.

If the content of the obsessions or compulsions is limited to the scope of another psychiatric disorder, such as an obsession with food in the context of an eating disorder, then an additional diagnosis of OCD should not be made.

The Yale-Brown Obsessive-Compulsive Scale is useful in grading severity initially and following trials of therapy.

Patients tend to seek treatment from 3 to 4 doctors and spend on average around 9 years in treatment before a correct diagnosis is made. The average amount of time that lapses between onset of symptoms and appropriate treatment is 17 years.

Cognitive behavioural therapy in the form of exposure and response prevention, alone or in combination with a selective serotonin-reuptake inhibitor (SSRI) or clomipramine, is a first-line therapy.

While controlled trials with SSRIs have demonstrated a selective efficacy in OCD, up to 40% to 60% of patients do not have a satisfactory outcome.

Obsessive-compulsive disorder (OCD) is a frequently debilitating and often severe anxiety disorder that affects approximately 2% of the population. OCD is characterised by: (a) obsessions, defined as unwanted, disturbing, and intrusive thoughts, images, or impulses that are generally seen by the patient as excessive, irrational, and ego-alien; and (b) compulsions, defined as repetitive behaviours and mental acts that neutralise obsessions and reduce emotional distress. OCD causes significant distress and impairment in daily functioning and can have a substantial effect on the sufferer's quality of life.[1]Eisen JL, Mancebo MA, Pinto A, et al. Impact of obsessive-compulsive disorder on quality of life. Compr Psychiatry. 2006;47:270-275. http://www.ncbi.nlm.nih.gov/pubmed/16769301?tool=bestpractice.com