Obsessions and Compulsions
People sometimes over think somethings,
sometimes. However some people really
really really over think a lot of things a lot of
the time. If it is disabling, it is part of
obsessive compulsive disorder, O.C.D.
The other part of OCD is compulsions.
Compulsions are an intense need to perform
some type of ritual or custom as part of
routine activities of daily living. Like having
to tap a tube of toothpaste three times
before putting it away. Or having to recheck
the stove to be sure it is off over and over
again. If these rituals are not typical
for that persons culture and they interfere
with your life significantly, then that is a
compulsion. Excessive washing ones hands,
and germ phobias are another
example. Counting mundane objects is
another example of a compulsion.
Some people with OCD have obsessions,
some have compulsions. Some have both.
OCD is highly neurophysiologic.
OCD has been shown to occur from irritation
of specific points of the subcortical brain
structures such as the caudate nucleus. The
subcortical part of the brain is the "primitive"
non thinking part of your brain deep in the
center. OCD is highly genetic. This means it
runs in families.
It is often genetically paired with anxiety,
tourette's (muscle twitches), and ADHD.
How does talk therapy work? OCD patients
need talk therapy in order to change their
thought patterns and OCD spirals. Think of
your brain like a muscle. The more you give
in to the OCD urges, the more you are
training your brain to think and behave OCD-
ish. The therapists is like a trainer in a gym.
The therapist guides you to think differently.
This trains your brain to relax.
The neurophysiology of OCD is strong.
Exercising your brain with talk therapy is
usually not enough for moderate to severe
symptoms. The longer a person has OCD,
the harder it is to break it. OCD gets more
permanent the longer you have it. So, you
should use all your weapons to defeat it.
Medications are a powerful weapon in your
arsenal. It should not be ignored.
The medications for OCD are the following
groups. 1. SSRIS (selective serotonin reuptake
inhibitors) 2. Tricyclic antidepresants 3.
1. SSRIS include Prozac, Zoloft, Paxil,
Lexapro, Luvox, Celexa, lexapro. These
meds including their side effects are covered
in more detail under my description of
"Depesion medications" page. Basically, the
idea is that working through the serotonin
system, these meds decrease the OCD
symptoms. SSRIS are first line treatment
because they work well with light side
effects. The ones that are most irritating that
occur more than once in a blue moon are
tiredness, 5 lb weight gain, sexual side
effects. These side effects are usually mild
and well tolerated especially when compared
to the benefits. Scarier but very very rare side
effects are bone loss and gastric bleeding,
All medications are serious, all meds have a
risk of death, although extremely unlikely.
Look at tylenol's side effect profile someday
2. The tricyclic antidepressant medications
described in more detail under
"antidepressant medications" page are
stronger than the SSRIS but also have more
risks of side effects, some serious like a
heart attack others uncomfortable like
sedation and blurry vision. This is usually a
second line medication for OCD. But don't let
its second line status fool you. It works really
well and is usually tolerated just fine. It is a
nice add on med to an SSRI.
3. Antipsychotics are a third line option.
These meds are now often called mood
stabilizers because they are also used to treat
bipolar disorder, Tourettes, depression,
anxiety, eating disorders. They have the
most serious side effects discussed under
the pages of "bipolar disorder treatment".
In conclusion, OCD is a treatable condition.
It is something that for most people,
professional help is needed. One should get
treatment as early as possible and not let the
disease fester. Like most medical conditions,
the longer it persists, the worse it gets, and
the harder it is to fix it, sometimes it can
become so entrenched, treatment can
become only partly effective. However, the
good news is early treatment seems to be
very successful. And, treatment no matter
how late seems to be able to reduce
Mitchell L. Glaser, MD. Chicago IL