Obsessive-compulsive disorder is a common and often chronic psychiatric illness that significantly interferes with the patient´s functioning and quality of life. The disorder is characterized by excessive intrusive and inappropriate anxiety evoking thoughts as well as time consuming compulsions that cause significant impairment and distress. The symptoms are often accompanied by shame and guilt and the knowledge of the general public and professional community about the disorder is limited. Hence it is frequently misdiagnosed or diagnosed late. There are indications that the disorder is hereditary and that neurobiological processes are involved in its pathophysiology. Several psychological theories about the causes of obsessive-compulsive disorder are supported by empirical evidence. Evidence based treatment is either with serotoninergic medications or cognitive behavioral therapy, particularly a form of behavioral therapy called exposure response prevention. Better treatment options are needed because almost a third of people with obsessive-compulsive disorder respond inadequatly to treatment. In this review article two cases of obsessive-compulsive disorder are presented. The former case is a young man with typical symptoms that respond well to treatment and the latter is a middle aged lady with severe treatment resistant symptoms. She underwent stereotactic implantation of electrodes and received deep brain stimulation, which is an experimental treatment for severe obsessive-compulsive disorder that does not respond to any conventional treatment.

Table I

Content and rate of obsessions and compulsions8

Obsessions	(%)	Compulsions	(%)
Contamination	38	Checking	28
Fear of harming self or others	24	Cleaning/washing	27
Symmetry concerns	10	Repeating	11
Somatic concerns	7	Mental rituals	11
Religious	6	Ordering	6
Sexual	6	Hoarding	4
Thoughts about hoarding	5	Counting	2
Unacceptable urges	4	Miscellaneous	11

 

Table II

Screening quetions for obsessive-compulsive disorder¹⁴

·         Do you wash or clean a lot?

·         Do you check things a lot?

·         Is there any thought that keeps bothering you that you would like to get rid of but can´t?

·         Do your daily activities take a long time to finish?

·         Are you concerned about orderliness or symmetry?

·         Do these problems trouble you?

Table III

Most common comorbid conditions with obsessive-compulsive disorder²²

Comorbid condition	%
Depression	37
Generalized anxiety disorder	31
Alcohol dependences	20
Panic disorder	22
Social phobia	17
Specific phobia	15
Drug depence	13

 

Figure 1

Repeated and time consuming handwashing is a common compulsion in obsessive-compulsive disorder

Figure 2

Ordering and arranging compulsions are often associated with symmetry obsessions

Figure 3

A three-dimensional stereotactic frame being used for placing electrodes in the brain