Affects less than 1% of youth, and 2-3% of adults. Onset is usually during childhood and adolesence
usually one of three underlying themes:
recurrent thoughts, impulses or images that intrude and cause marked anxiety or distress. Patients make efforts to ignore or suppress.
Repetitive, purposeful, intentional behaviours (checking) or mental acts (counting) driven to do things or rules to prevent dreaded event. These are drive by obsessions and typically according to certain rules design to respond to obsessions. Compulsions include:
can be ego dystonic (unnatural) or ego syntonic (connected with who you are)
can be either obsessions or compulsions
Three psychological dysfunctions seem to be related to OCD:
Genetics
There are direct neurological correlates to OCD
As you fight one, a new one can come in. but kicking the new one's butt is easier to stop.
"A new one slides in"
mild OCDs can be treated by behaviour therapy
moderate-severe OCD: SSRI/clomipramine (serotonergic TCA) plus behaviour therapy
if tics, trichotillomania, delusional symptoms present, add pimozide, haloperidol, lithium
psychotropics work 50:50; takes months to kick in
fixed dose RCTs - 12 weeks of fluoxetine (20 mg, 40 mg, 60 mg) = 52%, 54%, 58%