Content area
Full Text
OBSESSIVE COMPULSIVE DISORDER (OCD) is characterized by persistent, intrusive thoughts (obsessions), and repetitive intentional behaviors (compulsions). These symptoms persist despite individuals' attempts to eliminate them and are accompanied by marked and often overwhelming anxiety. Typical obsessions are unrealistic concerns with cleanliness, order, and harm avoidance. In extreme cases, symptoms occupy every waking moment. Compulsions are typically excessive hand washing, counting, checking and rituals that can disrupt all routine activities. Many patients function despite OCD, but in many others the illness leads to profound impairment. OCD ranked as the 10th leading cause of disability among all medical and psychiatric illnesses in industrialized countries.1
Treatment can reduce symptoms and improve quality of life.2 The illness often goes unrecognized and untreated in medical practice. While the one-year US population prevalence of OCD was 2.4%,3 in a large HMO only 0.095% of patients were treated for OCD.4 While awareness of OCD in the general population is increasing, gradually lessening stigma, its symptoms can be intensely embarrassing and patients may not volunteer them. Functional impairment due to OCD was greater than that in diabetes and hypertension.5 Moreover, undetected OCD can worsen outcomes of other illnesses. The diagnosis of OCD is clinical. It rests on the identification of obsessive thoughts and compulsive behaviors (including covert mental rituals) and the resulting distress, time consumed, and interference with function (including how much normal work and social activities are avoided for fear they might trigger OCD symptoms).6
FAMILY/GENETIC FACTORS
While not formally part of diagnostic criteria, a family history of OCD may increase confidence in an uncertain diagnosis. The risk of OCD was 12% in first-degree relatives of OCD probands vs. 3% in relatives of psychiatrically-healthy controls. The risk was highest (18%) in people whose siblings developed OCD before they were 18 years old.9 We are collaborating in the first large-scale family-genetic study of OCD funded by the National institutes of Health (NIH) to learn more about 1) core features of OCD (e.g., symptom subtypes) which are most familial and so are most likely to be genetically influenced, and 2) which chromosomal regions and candidate genes are associated with OCD.
BRAIN CIRCUITRY AND OCD
Hypotheses of OCD pathophysiology focus on cortico-striato-pallido-thalamic (CSPT) circuitry.10,11 Although a primary pathological process underlying core OCD symptoms has...