Home Health & Medicine Conditions & Diseases Mental Disorders Alternate titles: OCD, compulsive behaviour, compulsive-obsessive behaviour, obsession, obsessive-compulsive neurosis Show
obsessive-compulsive disorder (OCD), also called obsessive-compulsive neurosis, type of mental disorder in which an individual experiences
obsessions or compulsions or both. Either the obsessive thought or the compulsive act may occur singly, or both may appear in sequence. Obsessions are recurring or persistent thoughts, images, or impulses that, rather than being voluntarily produced, seem to invade a person’s
consciousness despite his attempts to ignore, suppress, or control them. Obsessional thoughts are frequently morbid, shameful, repugnant, or merely tedious; they are usually experienced as being meaningless and are accompanied by anxiety to a varying degree. Common obsessions include thoughts about
committing violent acts, worries about contamination (as by shaking hands with someone), and doubt (as in wondering whether one had turned off the stove before leaving the house). Britannica Quiz 44 Questions from Britannica’s Most Popular Health and Medicine Quizzes How much do you know about human anatomy? How about medical conditions? The brain? You’ll need to know a lot to answer 44 of the hardest questions from Britannica’s most popular quizzes about health and medicine. Obsessions are accompanied by compulsions in approximately 80 percent of cases. Compulsions are urges or impulses to commit repetitive acts that are apparently meaningless, stereotyped, or ritualistic. The compulsive person may be driven to perform the act not as an end in itself but as a means to produce or prevent some other situation, although he is usually aware that the two bear no logical causal relation to each other. Most compulsive acts are rather simple—such as persistent hand washing, counting, checking (e.g., the turned-off stove), touching, or the repetition of stereotyped words or phrases. Occasionally, however, elaborately formalized and time-consuming ceremonials are necessary. The compulsive person usually knows the act to be performed is meaningless, but his failure or refusal to execute it brings on a mounting anxiety that is relieved once the act is performed. Should the sufferer be forcibly or externally prevented from performing the compulsive act, he may experience an overwhelming anxiety. Obsessive-compulsive disorders affect from two to three percent of the general population, occur equally in males and females, and can first appear at any age. The tricyclic antidepressant (TCA) drug clomipramine (Anafranil) and the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) have been found to markedly reduce the symptoms in about 60 percent of cases and have thus become the treatment of choice. Both drugs affect the brain’s metabolism of the neurotransmitter serotonin, and this had led researchers to suspect that obsessive-compulsive disorders arise primarily from defects in the brain’s neurochemical functioning rather than from purely psychological causes. A drug traditionally used for tuberculosis, d-cycloserine, has also been shown, when used in combination with behavioral therapy, to increase the rate of fear extinction in patients with OCD. The highest rates of the condition occur in high-stress groups, such as those who are young, divorced, or unemployed. This article was most recently revised and updated by Jeannette L. Nolen. BackgroundA personality disorder, as defined in the Diagnostic and Statistical Manual of the American Psychiatric Association, Fifth Edition (DSM-5) is an enduring pattern of inner experience and behavior that differs markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. (See Prognosis and Presentation.) Although the most common etiologies for personality disorders are multifactorial, these conditions may also be secondary to biologic, developmental, or genetic abnormalities. Stressful situations may often result in decompensation, revealing a previously unrecognized personality disorder. Indeed, personality disorders are aggravated by stressors, external or self-induced. Individuals may have more than 1 personality disorder. (See Pathophysiology and Etiology.) ClusterTen personality disorders, grouped into 3 clusters (ie, A, B, C), are defined in the DSM-5. [1] Cluster A disorders include the following (see Prognosis and Treatment):
Cluster B disorders include the following:
Cluster C disorders include the following:
PersonalityA concept has emerged that personality may be expressed in terms of the following 5 basic dimensions: [2]
This model is termed the 5-factor model, and it has developed a significant amount of acceptance among personality psychologists. The model has been used to describe the different accepted types of personality disorders. Most current research suggests that personality disorders may be differentiated by their interactions among the 5 dimensions rather than differences on any single dimension. PathophysiologyIn patients with personality disorder, abnormalities may be seen in the frontal, temporal, and parietal lobes. These abnormalities may be caused by perinatal injury, encephalitis, trauma, or genetics. Personality disorders are also seen with diminished monoamine oxidase (MAO) and serotonin levels. However, the relationships of anatomy, receptors, and neurotransmitters to personality disorders are purely speculative at this point. Frequently, a history of psychiatric disorders is present. In some cases, the patient has developmental abnormalities secondary to abuse or incest. EtiologyThe origin of personality disorders is a matter of considerable controversy. Traditional thinking holds that these maladaptive patterns are the result of dysfunctional early environments that prevent the evolution of adaptive patterns of perception, response, and defense. A body of data points toward genetic and psychobiologic contributions to the symptomology of these disorders; however, the inconsistency of the data prevents authorities from drawing definite conclusions. [5] Paranoid personality disorderA genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia exist. Psychosocial theories implicate projection of negative internal feelings and parental modeling. Schizoid personality disorderSupport for the heritability of this disorder exists. Schizotypal personality disorderThis disorder is genetically linked with schizophrenia. Evidence for dysregulation of dopaminergic pathways in these patients exists. Antisocial personality disorderA genetic contribution to antisocial behaviors is strongly supported. Low levels of behavioral inhibition may be mediated by serotonergic dysregulation in the septohippocampal system. There may also be developmental or acquired abnormalities in the prefrontal brain systems and reduced autonomic activity in antisocial personality disorder. This may underlie the low arousal, poor fear conditioning, and decision-making deficits described in antisocial personality disorder. [6] Borderline personality disorderPsychosocial formulations point to the high prevalence of early abuse (sexual, physical, and emotional) in these patients, and the borderline syndrome is often formulated as a variant of posttraumatic stress disorder. Mood disorders in first-degree relatives are strongly linked. Biologic factors, such as abnormal monoaminergic functioning (especially in serotonergic function) and prefrontal neuropsychological dysfunction, have been implicated but have not been well established by research. [7, 8] Histrionic personality disorderLittle research has been conducted to determine the biologic sources of this disorder. Psychoanalytic theories incriminate seductive and authoritarian attitudes by fathers of these patients. Narcissistic personality disorderNo data on biologic features of this disorder are available. In the classic model, narcissism functions as a defense against awareness of low self-esteem. More modern psychodynamic models postulate that this disorder can arise from an imbalance between positive mirroring of the developing child and the presence of an adult figure who can be idealized. Avoidant personality disorderThis personality disorder appears to be an expression of extreme traits of introversion and neuroticism. No data on biologic causes are available, although a diagnostic overlap with social phobia probably exists. Dependent personality disorderNo studies of genetics or of biologic traits of these patients have been conducted. Central to their psychodynamic constellation is an insecure form of attachment to others, which may be the result of clinging parental behavior. Obsessive-compulsive personality disorderModest evidence points toward the heritability of this disorder. Psychodynamically, these patients are viewed as needing control as a defense against shame or powerlessness. EpidemiologyOccurrence in the United StatesPersonality disorders affect 10-15% of the adult US population. The following are prevalences for specific personality disorders in the general population, across five studies from 2001 to 2010: [9]
Variance in prevalence rates across studies mostly reflects different thresholds of severity adopted by investigators. International occurrenceBecause the DSM-5 criteria are heavily bound to North American cultural definitions, epidemiologic data about personality disorders in other countries are notoriously unreliable. Sex-related demographicsAs previously mentioned, personality disorders, grouped into 3 clusters (ie, A, B, C), as defined in the DSM-5. [1] Sex-related demographics for disorders within these clusters include the following:
Age-related differences in incidencePersonality disorders generally should not be diagnosed in children and adolescents because personality development is not complete and symptomatic traits may not persist into adulthood. Therefore, the rule of thumb is that personality diagnosis cannot be made until the person is at least 18 years of age. Because the criteria for diagnosis of personality disorders are closely related to behaviors of young and middle adulthood, DSM-5 diagnoses of personality disorders are notoriously unreliable in the elderly population. PrognosisPersonality disorders are lifelong conditions, although attributes of cluster A and B disorders tend to become less severe and intense in middle age and late life. Individuals with a personality disorder are at risk for the following:
Patients with a cluster B personality disorder are particularly susceptible to problems of substance abuse, impulse control, and suicidal behavior, which may shorten their lives. Cluster C characteristics tend to become exaggerated in later life Morbidity and mortalityIn patients with a personality disorder, risk of death is usually related to conditions or behaviors resulting from the disorder. Consequently, death may result from suicide, substance abuse, trauma from motor vehicle accidents, or injuries from fighting. Patients with personality disorders are at higher risk than the general population for many (axis I) psychiatric disorders. Mood disorders are a particular risk across all personality diagnoses. Some comorbidities are more specific to particular personality disorders and clusters. Cluster A Cluster A disorders and their morbidities include the following:
Cluster B Cluster B disorders and their morbidities include the following:
Cluster C Cluster C disorders and their morbidities include the following:
Patient EducationPatients should be advised that their patterns of perception and response result from some combination of inheritance and personal history and that recovery is therefore likely to be a prolonged process, requiring effort and attention. The relevance of ongoing psychotherapy to long-standing vulnerabilities requires frequent reemphasis by the physician. Alcoholism and drug abuse are not merely complications of personality disorders, they are also aggravating factors. Patients need constant reminding that yielding to the temptation to drink or use drugs is likely to make their emotional distress worse and is certain to increase the risk of complications, including suicide. With the patient's permission, education can be provided to the family to alert them to the possibilities of disruptive and destructive behavior and can provide guidelines for limit setting and safety. Family support groups exist in some communities, and family support resources, such as Borderline Personality Disorder Family Groups and Stigma, are available online. The National Institute of Mental Health provides a fact sheet on borderline personality disorder that may be of use to families of persons with that condition. A resource for patients and families dealing specifically with borderline personality disorder is the National Educational Alliance for Borderline Personality Disorder.
Author Chief Editor Acknowledgements Jerry Balentine, DO Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine Disclosure: Nothing to disclose. Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy ofSciences,and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Robert Harwood, MD, MPH, FACEP, FAAEM Program Director, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Reference Salary Employment What are the 3 types of personality disorders?What types of personality disorder are there?. Paranoid personality disorder.. Schizoid personality disorder.. Schizotypal personality disorder.. Is obsessional neurosis the same as OCD?obsessive-compulsive disorder (OCD), also called obsessive-compulsive neurosis, type of mental disorder in which an individual experiences obsessions or compulsions or both. Either the obsessive thought or the compulsive act may occur singly, or both may appear in sequence.
When was OCD first recognized as a disorder?Obsessions and compulsions were first described in the psychiatric literature by Esquirol in 1838, and, by the end of the 19th century, they were generally regarded as manifestations of melancholy or depression.
What did OCD used to be called?Of course the name OCD did not come into being until the 20th century, but prior to that earlier references to symptoms we would now call Obsessive-Compulsive Disorder were surprisingly called scrupulosity .
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Which personality disorder was traditionally seen as a condition between neurosis and psychosis?
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