Anxiety & Panic Disorders Health Center

Understanding Obsessive-Compulsive Disorder -- Diagnosis and Treatment

How Do I Know If I Have OCD?

A person with obsessive-compulsive disorder (or OCD) may experience:

• Concern about contamination or serious illness
• Too much concern with keeping everything arranged in an exact way
• Horrible images
• Sexual or religious thoughts felt to be unacceptable
• Excessive fear of your house burning or flooding, of causing a car wreck, of spreading an illness, of losing something, of being responsible for another person getting hurt
• Fear of harming another person or a member of one's family
• Doing things over and over again
• Avoiding colors or numbers associated with bad thoughts or dreaded events
• Frequently feeling the need to confess something you did or to ask to be reassured that you did something the right way

If these experiences take up a lot of time, distress you, or interfere with your normal activities -- or if you find you have trouble controlling them -- you should see a mental health professional.

There are also rating scales, such as the as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), that not only can quantify the initial degree and severity of OCD, but also demonstrate progress of treatment by repeating the scoring after several months of treatment.

What Are the Treatments for OCD?

Not every person with OCD responds to the same treatment. Treatment options include drug treatment as well as behavioral treatments. People with OCD should discuss treatment strategies with their therapists. For most people, a combination of these treatments works best.  

Recent studies show that drugs that affect a specific brain chemical -- serotonin -- are particularly helpful in OCD. These include a class of drugs originally developed as antidepressants: the selective serotonin reuptake inhibitors, or SSRIs. SSRIs approved by the FDA for treatment of OCD include Prozac, Zoloft, Luvox, and Paxil. Other SSRIs may also be used. 

While these drugs offer at least a little help for most people with OCD, they aren't a cure. When a person stops taking them, OCD symptoms often come back. Other medications, particularly atypical antipsychotics such as risperidone, aripiprazole or quetiapine, may be used to supplement the SSRIs to help control symptoms.

Anafranil (clomipramine), also approved by the FDA for the treatment of OCD, is a tricyclic agent (TCA), an older class of antidepressants. Drugs that are FDA-approved first-line treatments for OCD include Luvox (fluvoxamine), Anafranil (clomipramine), fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). 

Traditional psychotherapy aims to help a person develop insight into his or her problems. The specific type of psychotherapy that has been best-studied to treat OCD is called cognitive therapy, which involves restructuring thought patterns about obsessions and compulsions.  Behavioral treatments for OCD also include exposure therapy with response prevention, in which patients are gradually exposed in a controlled environment to situations that cause anxiety. Techniques are learned to reduce anxiety and resist urges to act on compulsions.