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Obsessive-compulsive disorder

Although much has been learned in recent decades about the mechanisms and management of all of the anxiety disorders, progress in the comprehension of OCD has been truly phenomenal.


On a worldwide basis, it is estimated that 2% of the general population suffers from OCD. The obsessive thinking and compulsive behaviors that characterize this disorder may also occur in other related diseases that have been termed spectrum disorders. These overlap OCD in three areas: neurologic disorders including Tourette's syndrome; Sydenham's chorea, torticollis, and autism; preoccupation with bodily sensations and appearance, as in body dysmorphic disorder, depersonalization, anorexia nervosa, and hypochondriasis; and impulsive disorders, such as sexual compulsions, trichotillomania, pathologic gambling, kleptomania, and self-injurious behavior. When the number of people with these disorders is included, the total population affected by the OCD spectrum may be as high as 10%.


Recognition and the beginning of appropriate treatment of this disease often is extremely delayed. In one study, there was an average of 17 years delay from the onset of the illness to the time of treatment. One reason for this is that, like GAD, OCD is a closet disease. Afflicted people recognize that their thoughts and actions are out of the ordinary, but they assume that either it is their own fault and they just need to overcome it, or they may be ashamed to tell anyone else. Another reason may be that, until recently, treatment, almost entirely by some form of psychotherapy, has been unsatisfactory.

One recent study cited by Hollander was designed to assess patients' perception of the most effective help they received from various therapies. Successful therapeutic techniques, as measured by patient questionnaires, were identified as behavior therapy (26%), reading about the disease (36%), and the use of serotonergic drugs (clomipramine, fluoxitine, fluvoxamine, sertraline, and paroxetine) (56%).

The generally accepted hypothesis about the mechanism of OCD is that it involves abnormal serotonergic function regulation. It is interesting to note that although both serotonergic and nonserotonergic antidepressants are effective in the treatment of depression, only the serotoninergic drugs are effective in treating OCD.


The mainstay of pharmacologic treatment of OCD is a 10- to 12-week trial of one of the potent serotonin reuptake inhibitors (SRI).


Behavior therapy also has been found to be extremely effective as an adjunctive therapy, and may have more long lasting benefits.

Primary care physicians have an opportunity to make an early diagnosis, which may improve the outcomes of treatment, and can save patients from many years of life-constricting misery. The key to early diagnosis is asking the right questions in a comfortable milieu, with a strong patient and physician relationship.