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OCD is often a matter of degree

Copyright 2002 President Fellows Harvard College behalf HMS MediServices Phoby LizGreen HMS MediServices Anthony Leader Komaroff MD Harvard Health Publications

Copyright 2002 President and Fellows of Harvard College on behalf of HMS Media Services, Photo by Liza Green, HMS Media Services, Anthony Leader Komaroff, MD, Harvard Health Publications

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Updated: November 13, 2012 6:17AM

Dear Doctor K: The term OCD is used so casually these days. How can you identify someone who truly has obsessive-compulsive disorder?

Dear Reader:

The two defining symptoms of OCD are obsessive thoughts and compulsive rituals.

Obsessions are persistent, repeated, anxiety-provoking or distressing thoughts. They intrude into a person’s consciousness. Here are some common ones:

Fear of contamination: constant worry about having dirty hands or about catching or spreading germs.

Fears related to accidents or acts of violence: fear of becoming a victim of violence (an unlocked door that admits an intruder); fear of suffering accidental bodily harm (an oven is left on).

Fears concerning disorder or asymmetry: an irresistible need for order; anxiety about the smallest detail out of place.

Compulsive rituals are persistent, excessive, repetitive behaviors. The goal of the ritual is to reduce the anxiety caused by obsessive thoughts. Examples include:

Repeated washing or bathing;

Refusal to shake hands or touch doorknobs;

Repeated checking of locks or stoves;

Compulsive counting of objects;

Over-organizing work or household items;

Repeating specific words or prayers;

In OCD, the obsessions and compulsions are excessive and distressing. They are time-consuming. They may interfere with personal relationships, and performance at work or school.

The most effective treatment for OCD is a combination of psychotherapy and medication. Ongoing treatment may be necessary.

Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat OCD. They include sertraline (Zoloft) and citalopram (Celexa). Tricyclic antidepressants also may be effective, particularly clomipramine (Anafranil).

A number of psychotherapy techniques may be helpful. Cognitive behavioral therapy (CBT) can help a person with OCD recognize the unreasonableness of fearful, obsessive thinking. The therapist sometimes teaches specialized techniques that can help extinguish the compulsions.

So OCD is a matter of degree. If your obsessive thoughts or compulsive behaviors occur repeatedly throughout the day, and interfere with life at home or at work, you’ve got a problem — and several possible solutions.

Write to Dr. Komaroff at

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