Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder characterized by recurrent, persistent, unwanted, and unpleasant thoughts (obsessions) and repetitive, purposeful ritualistic behaviors that the person feels driven to perform (compulsions). A cardinal feature of this disorder is an awareness of the irrationality or excess of the obsessions and compulsions accompanied by an inability to control them.
Typical compulsions include an irresistible urge to wash your hands repeatedly, clean, check doors to confirm they’re locked, return repeatedly to appliances to make sure they’re off, touch, repeat, count, arrange, or save items. Typical obsessions include over concern about dirt and contamination, fear of acting on violent or aggressive impulses, feeling overly responsible for the safety of others, abhorrent religious (blasphemous) and sexual intrusions, and inordinate concern with arrangement or symmetry. Obsessions may accompany compulsions, or compulsions may occur alone.
The difference between obsessive-compulsive disorder and milder forms of obsession or compulsion seen in otherwise healthy people is that for the sufferer the obsessions or compulsions cause marked distress, are time-consuming, and significantly interfere with the person’s normal routine, occupational functioning, usual social activities, and relationships with others.
Onset in adolescence occurs in about a third of cases. In another third symptoms appear in early adulthood, and in the last third they start later in life. If not treated appropriately, the disorder is often chronic, with waxing and waning of symptoms.
An effective mode of psychotherapy is behavioral therapy, in which the patients are gradually exposed to their feared or triggering situation but are prevented from performing accompanying compulsions. This approach, which focuses on treating the symptoms rather than trying to understand their origin, seems to be more effective in treating the ritualistic behavior (compulsions) than the pervasive thoughts (obsessions). Obsessive-compulsive disorder often eases with medications that affect the brain’s serotonergic system, such as clorimipramine (Anafranil), fluvoxamine (Luvox), and fluoxetine (Prozac). TMS is being used to reduce the obsessions and anxiety that occurs with OCD. A recent area of focus is the supplementary motor area using a slow pulse stimulation.
Dr. Phil featured OCD during an episode airing October 2012. The link below shows videos of neuroradiologic studies showing target areas for TMS. The treatment “Bob” received is TMS.
*At this time, TMS is not FDA-aproved for the treatment of OCD, which would be considered an off-label application.