Overview
Definition
A chronic mental health disorder characterized by the presence of intrusive, distressing thoughts (obsessions) and/or repetitive, time-consuming behaviors (compulsions) performed to reduce anxiety.
Epidemiology
Lifetime prevalence ~2%. Equal sex distribution in adulthood.
Etiology & Risk Factors
- Dysregulation of the cortico-striato-thalamo-cortical (CSTC) circuits
- Serotonin and glutamate imbalances
Clinical Symptoms
- Obsessions: Recurrent, intrusive thoughts, urges, or images causing marked anxiety (e.g., contamination fears, doubts, need for symmetry, aggressive/sexual thoughts)
- Compulsions: Repetitive physical behaviors or mental acts performed in response to obsessions to reduce distress (e.g., hand washing, checking locks, counting, repeating words)
- Symptoms are time-consuming (taking > 1 hour/day) and cause clinical distress
Clinical Approach
Diagnosis
- DSM-5 criteria: Presence of obsessions, compulsions, or both, which are time-consuming and impair functioning
Management
- Cognitive Behavioral Therapy incorporating Exposure and Response Prevention (ERP) - highly effective
- High-dose SSRIs (e.g., Fluoxetine, Sertraline, Fluvoxamine)
- Clomipramine (tricyclic antidepressant, highly effective second-line)
Complications
- Severe social and occupational impairment
- Major depressive disorder
- Skin damage (from excessive washing)