A disorder characterized by recurrent, unwanted, intrusive ideas, images, or impulses that seem silly, weird, nasty, or horrible (obsessions), and by urges to do something that will lessen the discomfort due to obsessions (compulsions).

This disorder usually begins in adolescence or early adulthood but can occur in childhood. In addition, individuals that have close biological relatives with the disorder demonstrate a higher rate than would be found in the general population.

The typical person with obsessive-compulsive disorder feels compelled to perform repetitive, purposeful, intentional behaviors called rituals to balance their obsessions. Most persons with this disorder are aware that their obsessions do not reflect actual danger, and that the behaviors they exhibit to alleviate their concern are impractical and extremely excessive. The ability to maintain insight, although in some cases it may be minimal, is what most often makes the distinction between obsessive-compulsive and psychotic disorders.

To date, no laboratory findings have been indicated to diagnose this disorder. Observations made during physical examination of patients who actively perform obsessions may be manifested as medical conditions, e.g., skin problems from excessive hand washing.

The diagnostic criteria for obsessive-compulsive disorder include:

• Obsessions which are usually determined by:

  • Repeated and unrelenting inclinations, thoughts, or images that the patient experiences that at some time become disturbing, causing significant anxiety

  • The nature of the thoughts, inclinations, and impulses which are not simply excessive worry about actual real-life problems

  • Attempts by the person to disregard or hold back such thoughts, images etc., or counteract them with some other thinking or action

  • Awareness of the person that the obsessional thoughts, images etc. are a creation of his own mind.

• Compulsions which are usually determined by:

  • Recurring behaviors, e.g., hand washing or checking a clock, that a person seems determined to perform as secondary to an obsession or regulations that they feel must be strictly applied

  • Behaviors or mental actions intended to protect or reduce anguish in the person or protect him or her from some horrible occurrence. However, these behaviors or mental actions are either not realistically connected, or not related to what the person believes they are counteracting or protecting themselves from, and the behavior is clearly excessive.

• Additionally information pertaining to diagnosis:

  • During some point in the disorder, the person realizes that the obsessions and compulsions are extreme

  • The obsessions or compulsions take a significant amount of time, e.g., more than an hour a day, or substantially disrupt normal daily routines

  • If another disorder is present, e.g., hypochondria, the person's compulsions or obsessions are not restricted to a fixation with serious illness, as they are in this condition, but expand beyond it

  • The disorder cannot be attributed to effects from a substance, drug, or medical condition.

The therapy most often used is exposure therapy. The patients are exposed to the situation or object that initiates the obsession, and then the ritual they would carry out is deferred or not permitted to decrease the need for the ritual. It is desired that the patient learn that the ritual is needless. In addition, some authorities believe that the combination of exposure therapy and medications are the best treatment.

Exacerbation of symptoms is usually brought on by stress. Approximately 15% of patients realize a continuous decline in job-related experiences and social functioning. Five percent may experience symptoms in episodes with nominal or no symptoms in between.