MENTAL HEALTH Stress & Anxiety • Obsessive-compulsive disorder • Post-traumatic stress disorder (PTSD) • Phobias • Panic attacks • Generalized anxiety disorder • Adjustment disorders • Social anxiety disorder (social phobia) • Oppositional defiant disorder (ODD)

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Do you wipe off the doorknobs in your home each time someone touches them? Or do you consistently go to great lengths to avoid walking on sidewalk cracks? Or, worried that you might cause a fire, do you repeatedly check to see that you've turned off the stove? Having feelings that you must perform rituals such as these over and over may indicate that you have obsessive-compulsive disorder.

If you have obsessive-compulsive disorder, your ritual behaviors may literally take over your life. You have distressing, unwanted thoughts or images that don't make sense to you. These thoughts or images keep coming back despite your efforts to resist them. You may strive to hide your condition from friends and co-workers for fear of being labeled crazy.

Doctors once believed that obsessive-compulsive disorder was a rare condition, but it's now known to be more common than other mental illnesses such as schizophrenia and bipolar disorder. More than 3 million Americans have obsessive-compulsive disorder.

Obsessive-compulsive disorder doesn't affect just adults. The disorder often begins during adolescence or early childhood. About one-third to one-half of adult cases begin in childhood.

Although there's no cure for obsessive-compulsive disorder, treatments can help you get the disorder under control.

Signs and symptoms of obsessive-compulsive disorder include:

Obsessions
These are recurrent, persistent, unwanted ideas, thoughts or impulses that you experience involuntarily and that appear to be senseless. They commonly intrude when you're trying to think of or do other things. Common obsessions include:

• Fear of dirt or contamination
• Concern with order, symmetry and exactness
• Constantly thinking about certain sounds, images, words or numbers
• Fear of harming a family member or friend
• Fear of thinking evil or sinful thoughts

Compulsions
These are repetitive behaviors that you're driven to perform regularly to combat your obsessions, even though to you — and to others — they may seem irrational. You may even make up "rules" to follow that help control the anxiety you feel when having obsessive thoughts. Typical compulsions include:

• Excessive hand washing
• Repeatedly checking that doors are locked and appliances are turned off
• Arranging items in a precise order
• Repeatedly counting to the same number
• Touching certain objects a precise number of times

When you perform these rituals, you may feel some relief from anxiety, but not for long. Soon your discomfort returns, and you feel compelled to repeat your behaviors.

If you have an obsessive-compulsive disorder, you probably know that your repetitive thoughts and behaviors are irrational and senseless, but you can't free yourself from them. You may be able to control unwanted behaviors for a while, but your resistance may weaken after months or years of struggle. Eventually, your rituals may take up more and more of your day, making it virtually impossible to lead a normal life.

There's a difference between being a perfectionist and having obsessive-compulsive disorder. Perhaps you get all of your work done a week ahead of schedule, you compete at sports like a pro, and you keep the floors in your house so clean you could eat off them. That doesn't mean you have obsessive-compulsive disorder. Instead, you may belong to a large group of people who are sometimes called compulsive. That just means you hold yourself to a very high standard of performance in all that you do. This behavior contributes to building your self-esteem and success. These are not the behaviors seen in people with obsessive-compulsive disorder. Behaviors associated with obsessive-compulsive disorder interfere with everyday functioning.

Doctors don't know the exact cause of obsessive-compulsive disorder. Some researchers theorize that its cause is biological, while others feel the disorder stems from learned behavior. Still others believe the cause of the disorder may be both biological and environmental factors. An insufficient level of serotonin, one of your brain's chemical messengers, may contribute to obsessive-compulsive disorder. Imaging studies that use positron emission tomography (PET) scans to compare the brains of people who have obsessive-compulsive disorder with the brains of those who don't, show differences in brain-activity patterns. In addition, people with obsessive-compulsive disorder who take medications that enhance the action of serotonin often show great improvement.

Your risk of developing an obsessive-compulsive disorder is slightly higher if your parents or other family members have obsessive-compulsive disorder. However, researchers haven't identified any genes responsible for obsessive-compulsive disorder. You may also have a biological predisposition to react strongly to stress. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of obsessive-compulsive disorder.

Shame and embarrassment may keep you from seeking treatment for obsessive-compulsive disorder. But even if your rituals are deeply ingrained, treatments can help. If you suspect you have obsessive-compulsive disorder, see your doctor or a mental health professional.

To diagnose obsessive-compulsive disorder, your doctor will ask you questions about your obsessions, compulsions and emotional well-being and may talk to your friends and relatives about your behavior. There's no specific laboratory test to diagnose obsessive-compulsive disorder.

Two forms of treatment are available for obsessive-compulsive disorder: a type of psychotherapy called cognitive behavior therapy and antidepressant medications.

Cognitive behavior therapy
This form of psychological treatment involves retraining your thought patterns and routines so that compulsive behaviors are no longer necessary. One approach in particular is called exposure and response prevention. The therapy involves gradually exposing you to a feared object or obsession and teaching you different ways to deal with it, rather than performing your anxiety-reducing ritual or compulsion. During the course of treatment, your symptoms gradually decrease in frequency and intensity. Learning the techniques and new thought patterns takes effort and practice, but it's worth it. Most people with obsessive-compulsive disorder show improvement of signs and symptoms with cognitive behavior therapy.

Cognitive behavior therapy may be especially helpful for children and adolescents with obsessive-compulsive disorder. A study published in the Oct. 27, 2004, issue of the Journal of the American Medical Association found that almost 40 percent of children receiving cognitive behavior therapy had a significant reduction in symptoms, while only about one in five children taking antidepressant medication alone did. However, the study found that the most effective treatment was combining cognitive behavior therapy with antidepressant medication. Almost 60 percent of the children in the study receiving the combination treatment reported remission of their symptoms.

It's important to find a therapist who is well trained in cognitive behavior therapy. Ask your doctor for a recommendation or contact the Obsessive-Compulsive Foundation at (203) 401-2070.

Cognitive behavior therapy isn't for everyone, though. As many as one in four people with obsessive-compulsive disorder refuses this treatment because it can be difficult.

Antidepressant medications
These medications also may help relieve the symptoms of obsessive-compulsive disorder:

• Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft). SSRIs work by enhancing the brain's ability to use serotonin, a chemical that helps brain cells send and receive messages. Doctors believe serotonin plays a crucial role in mood states.
• Tricyclic antidepressants such as clomipramine (Anafranil).

These steps may help you get the most from your medical care and overcome obsessive-compulsive disorder:

• Take your medications. Follow the correct schedule and dose.
• Follow your therapy schedule. Don't skip sessions.
• Involve your family. Provide them with materials that explain obsessive-compulsive disorder, and encourage them to join support groups. You can find support groups in your community or on the Internet.
• Learn as much as you can about your disorder. You can get more information from the National Institute of Mental Health by calling 1-888-ANXIETY, or (888) 269-4389.

If you live with someone with obsessive-compulsive disorder, these tips may help:

• Bring relevant books, tapes and other literature into your home. Encourage your loved one to read or listen to these presentations about obsessive-compulsive disorder. Often, your loved one already knows his or her behavior is irrational.
• Be patient about the pace of progress. The severity of obsessive-compulsive disorder varies, as do recovery times.
• Praise small successes. At first, decreasing hand washing time by 10 minutes a day may seem insignificant to some, but it may be a giant first step for a person with obsessive-compulsive disorder.
• Refuse to participate in the person's rituals. Explain that doing so would only make the condition worse.
• Don't become a baby sitter. Your loved one needs to know you trust him or her to be left alone at times — to not always be under your watchful eye.