02. tbl. 101. árg. 2015

Obsessive-compulsive disorder. A hidden disorder

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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


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