Obsessions are recurrent, distressing thoughts that a person experiences without the ability to control the frequency and intensity of these intrusive thoughts. These thoughts cause marked anxiety and distress (panic symptoms) when they occur and occupy a marked amount of the patient’s day. A common example concerns the possibility of contamination or having a disturbing aggressive thought. A compulsion is a behavior or action that the patient believes he or she cannot stop doing or put off without experiencing a tremendous amount of anxiety. An example would be excessive washing of a part of the body or checking to make sure that one did the right thing or did not make a mistake. Obsessions and compulsions often occur together; frequently, the compulsion is a way to reduce the panic-like symptoms that follow an obsessive thought. These obsessions and compulsions cause marked distress to the individual and are time consuming, taking over one hour a day. Obsessive compulsive disorder (OCD) was initially reported to occur in up to 2.6% of the adult population. There is considerable comorbidity in anxiety disorders, and as many as 15% of anxiety disorder patients may meet criteria for OCD.

Patients with obsessive compulsive disorder (OCD) experience these thoughts as ridiculous, absurd, repugnant, and quite illogical; the thoughts may even be quite foreign to the person’s core values and beliefs. Given these characteristics, one begins to understand why many patients do not report these symptoms or seek treatment for fear of ridicule and embarrassment.

Many patients experience an early onset of symptoms, with 30% of patients developing the disorder by adolescence. Strong evidence exists for a definite neuroanatomical abnormality, with hyperactivity found in the basal ganglia, claudate nucleus and orbital frontal cortex. Concomitant neurological syndromes such as Tourette’s add further evidence for a biological etiology for obsessive compulsive disorder (OCD). Comorbid psychiatric disorders such as depression and alcoholism have a high likelihood of occurring in individuals with untreated OCD. Common obsessions and compulsions that manifest in obsessive compulsive disorder (OCD) are shown in TABLE 2.

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