Poorer insight has been linked to worse long-term outcome. This is most common in males with onset of OCD in childhood. These individuals tend to differ from those without a history of tic disorders in the themes of their OCD symptoms, comorbidity, course, and pattern of familial transmission.
Obsessions are repetitive and persistent thoughts e. Importantly, obsessions are not pleasurable or experienced as voluntary: they are intrusive and unwanted and cause marked distress or anxiety in most individuals. The individual attempts to ignore or suppress these obsessions e. Compulsions or rituals are repetitive behaviors e. Most individuals with OCD have both obsessions and compulsions. Compulsions are typically performed in response to an obsession e. The aim is to reduce the distress triggered by obsessions or to prevent a feared event e.
However, these compulsions either are not connected in a realistic way to the feared event e. Compulsions are not done for pleasure, although some individuals experience relief from anxiety or distress.
Criterion B emphasizes that obsessions and compulsions must be time-consuming e. This criterion helps to distinguish the disorder from the occasional intrusive thoughts or repetitive behaviors that are common in the general population e. The frequency and severity of obsessions and compulsions vary across individuals with OCD e. Associated Features Supporting Diagnosis The specific content of obsessions and compulsions varies between individuals. However, certain themes, or dimensions, are common, including those of cleaning contamination obsessions and cleaning compulsions ; symmetry symmetry obsessions and repeating, ordering, and counting compulsions ; forbidden or taboo thoughts e.
Some individuals also have difficulties discarding and accumulate hoard objects as a consequence of typical obsessions and compulsions, such as fears of harming others.
These themes occur across different cultures, are relatively consistent over time in adults with the disorder, and may be associated with different neural substrates. Importantly, individuals often have symptoms in more than one dimension. Individuals with OCD experience a range of affective responses when confronted with situations that trigger obsessions and compulsions.
For example, many individuals experience marked anxiety that can include recurrent panic attacks. Others report strong feelings of disgust. It is common for individuals with the disorder to avoid people, places, and things that trigger obsessions and compulsions. For example, individuals with contamination concerns might avoid public situations e. Females are affected at a slightly higher rate than males in adulthood, although males are more commonly affected in childhood.
Onset after age 35 years is unusual but does occur. The onset of symptoms is typically gradual; however, acute onset has also been reported. If OCD is untreated, the course is usually chronic, often with waxing and waning symptoms. Some individuals have an episodic course, and a minority have a deteriorating course.
Without treatment, remission rates in adults are low e. Onset in childhood or adolescence can lead to a lifetime of OCD. Compulsions are more easily diagnosed in children than obsessions are because compulsions are observable. However, most children have both obsessions and compulsions as do most adults. The pattern of symptoms in adults can be stable over time, but it is more variable in children. Some differences in the content of obsessions and compulsions have been reported when children and adolescent samples have been compared with adult samples.
These differences likely reflect content appropriate to different develop mental stages e. Risk and Prognostic Factors Temperamental. Greater internalizing symptoms, higher negative emotionality, and behavioral inhibition in childhood are possible temperamental risk factors. Physical and sexual abuse in childhood and other stressful or traumatic events have been associated with an increased risk for developing OCD.
Some children may develop the sudden onset of obsessive-compulsive symptoms, which has been associated with different environmental factors, including various infectious agents and a post-infectious autoimmune syndrome.
Genetic and physiological. The rate of OCO among first-degree relatives of adults with OCD is approximately two times that among first-degree relatives of those without the disorder; however, among first-degree relatives of individuals with onset of OCD in chilldhood or adolescence, the rate is increased I0-fold. Familial transmission is due in part to genetic factors e. Dysfunction in the orbitofrontal cortex, anterior cingulate cortex, and striatum have been most strongly implicated.
There is substantial similarity across cultures in the gender distribution, age at onset, and comorbidity of OCD. Moreover, around the globe, there is a similar symptom structure involving cleaning, symmetry, hoarding, taboo thoughts, or fear of harm.
However, regional variation in symptom expression exists, and cultural factors may shape the content of obsessions and compulsions. Gender-Related Diagnostic Issues Males have an earlier age at onset of OCD than females and are more likely to have eomorbid tic disorders. Gender differences in the pattern of symptom dimensions have been reported, with, for example, females more likely to have symptoms in the cleaning dimension and males more likely to have symptoms in the forbidden thoughts and symmetry dimensions.
Onset or exacerbation of OCD, as well as symptoms that can interfere with the mother-infant relationship e. Suicide attempts are also reported in up to one-quarter of individuals with OCD; the presence of comorbid major depressive disorder increases the risk.
Functional Consequences of Obsessive-Compulsive Disorder OCD is associated with reduced quality of life as well as high levels of social and occupational impairment. Impairment occurs across many different domains of life and is associated with symptom severity. Impairment can be caused by the time spent obsessing and doing compulsions. Other enhancements have been introduced to promote ease of use across all settings, including: Representation of developmental issues related to diagnosis; Integration of scientific findings from the latest research in genetics and neuroimaging; Consolidation of autistic disorder, Asperger's disorder, and pervasive developmental disorder into autism spectrum disorder; Streamlined classification of bipolar and depressive disorders; Restructuring of substance use disorders for consistency and clarity; Enhanced specificity for major and mild neurocognitive disorders; Transition in conceptualizing personality disorders; New disorders and features; Online enhancements.
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