Obsessive-compulsive disorder (OCD) cost the United States $8.4 billion in 1990 in social and economic losses, nearly 6% of the total mental health bill of $148 billion. (1) Such a staggering statistic necessitates that individuals be accurately diagnosed and be given effective treatment for this debilitating condition.

Definition and Classification

OCD falls under the broad category of anxiety disorders, which encompasses conditions such as panic disorder, social phobia, and posttraumatic stress disorder (DSM-IV). A person with OCD usually has obsessions and compulsions (~90%), but sometimes may only have one or the other.

Obsessions are recurrent intrusive thoughts, impulses, or images that are perceived as inappropriate, grotesque, or forbidden. They are not simply excessive worries about real-life problems. The person usually recognizes that the obsessions are excessive or unreasonable and fears he or she will lose control or act upon such thoughts or impulses. One metaphor likens OCD symptoms to a case of mental hiccups that won’t go away.

Some common obsessions include:

* Fear of dirt or germs

* Disgust with bodily waste or fluids

* Concern with order, symmetry (balance) and exactness

* Worry that a task has been done poorly, even when the person knows this is not true

* Fear of thinking evil or sinful thoughts

* Thinking about certain sounds, images, words or numbers all the time

* Need for constant reassurance

* Fear of harming a family member or friend

Compulsions are repetitive behaviors (rituals) or mental acts that reduce the anxiety that accompanies an obsession. The person feels driven to perform them in response to their obsession, or according to rules that must be rigidly applied.

Some common compulsions include:

* Cleaning and grooming, such as washing hands, showering or brushing teeth over and over again

* Checking drawers, door locks and appliances to be sure they are shut, locked or turned off

* Repeating, such as going in and out of a door, sitting down and getting up from a chair, or touching certain objects several times

* Ordering and arranging items in certain ways

* Counting over and over to a certain number

* Saving newspapers, mail or containers when they are no longer needed

* Seeking constant reassurance and approval