Obsessive-compulsive disorder (OCD) is a psychiatric anxiety disorder most commonly characterized by a subject's obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The 2007 version of the ICD is available online at http//wwwwho The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Psychiatry is a medical specialty which exists to study, prevent, and treat Mental disorders in Humans Psychiatric Anxiety disorder is a blanket term covering several different forms of abnormal pathological anxieties Fears and Phobias In clinical usage "fear" Intrusive thoughts are unwelcome involuntary thoughts images or unpleasant ideas that may become obsessions, are upsetting or distressing and can be difficult to be free of A ritual is a set of actions often thought to have Symbolic value the performance of which is usually prescribed by a Religion or by the Traditions OCD is distinguished from other types of anxiety, including the routine tension and stress that appear throughout life. Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components Although these signs are often present in OCD, a person who shows signs of infatuation or fixation with a subject/object, or displays traits such as perfectionism, does not necessarily have OCD, a specific and well-defined condition. Infatuation is the state of being completely carried away by unreasoned passion or Love; addictive love Perfectionism, in Psychology, is a belief that perfection can and should be attained

To be diagnosed with OCD, a person must have either obsessions or compulsions alone, or obsessions and compulsions, according to the DSM-IV-TR diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000) describes these obsessions and compulsions:^[1]

Obsessions

1. Recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. An impulse is a wish or urge particularly a sudden one It can be considered as a normal and fundamental part of Human Thought processes but also one that can become
2. The thoughts, impulses, or images are not simply excessive worries about real-life problems.
3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.
4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.

Compulsions

1. Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

In addition to these criteria, at some point during the course of the disorder, the individual must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning. ^[1] OCD often causes feelings similar to those of depression. In the fields of Psychology and Psychiatry, the terms depression or depressed refer to both expected and pathologically chronic or severe The phrase "obsessive-compulsive" has become part of the English lexicon, and is often used in an informal manner to describe someone who is meticulous or absorbed in a cause (see "anal retentive")^[2]. English is a West Germanic language originating in England and is the First language for most people in the United Kingdom, the United States SpecialShortpages.-- The term anal-retentive (or anally retentive, anal retentive) commonly abbreviated to "anal" is used Conversationally The simplification of a medical condition into a caricature is known as clinomorphism. Clinomorphism (from the Greek words klinikos meaning "bed" and morphos meaning "form" is the deliberate or unintentional simplification

History

Psychological theories

Scientists studying obsessive-compulsive disorder are split into two factions disagreeing over the illness's cause. One side believes that obsessive-compulsive behavior is a psychological disorder; the other side thinks it has a neurological origin. The Stanford University School of Medicine OCD webpage states, "Although the causes of the disorder still elude us, the recent identification of children with OCD caused by an autoimmune response to Group A streptococcal infection promises to bring increased understanding of the disorder's pathogenesis. Stanford University School of Medicine is a world renowned medical school affiliated with Stanford University and is located at Stanford The group A streptococcus bacterium ( Streptococcus pyogenes, or GAS) is a form of Streptococcus bacteria responsible for most cases "^[3]

From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual, or other obsessive thoughts were possessed by the Devil. Spirit possession is a concept of Paranormal, Supernatural and/or Superstitious belief in which spirits, gods, daemons Satan, ( Standard Hebrew Satan'el, English accuser) is a term that originates from the Abrahamic faiths, being traditionally Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through exorcism. Exorcism (from Late Latin exorcismus, from Greek exorkizein - to adjure is the practice of evicting Demons or other evil ^[4] In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts which manifested as symptoms. Sigmund Freud (ˈziːkmʊnt ˈfʁɔʏt born Sigismund Shlomo Freud (May 6 1856 &ndash September 23 1939 was an Austrian Psychiatrist who founded ^[4] Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious". ^[5]

The cognitive-behavioral model suggests that the behaviour is carried out to remove anxiety-provoking intrusive thoughts. Unfortunately this only brings about temporary relief as the thought re-emerges. Each time the behaviour occurs it is negatively reinforced (see Reinforcement) by the relief from anxiety, thereby explaining why the dysfunctional activity increases and generalises (extends to other, related stimuli) over a period of time. In Operant conditioning, reinforcement is an immediate increase in the strength of a response following a change in environment For example, after touching a door-knob a person might have the thought that they may develop a disease as a result of contamination. They then experience anxiety, which is relieved when they wash their hands. This might be followed by the thought "but did I wash them properly?" causing an increase in anxiety once more, the hand-washing once again rewarded by the removal of anxiety (albeit briefly) and the cycle being repeated when thoughts of contamination re-occur. The distressing thoughts might then spread to fear of contamination from e. g. a chair (someone might have touched the chair after touching the door handle).

Biological explanations

There are many different theories about the cause of obsessive-compulsive disorder. The majority of researchers believe that there is some type of abnormality in the neurotransmitter serotonin, among other possible psychological or biological abnormalities; however, it is possible that this activity is the brain's response to OCD, and not its cause. See Chemical synapse for an introduction to concepts and terminology used in this article Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons Serotonin is thought to have a role in regulating anxiety, though it is also thought to be involved in such processes as sleep and memory function. Sleep is a Natural state of bodily rest observed throughout the animal kingdom In Psychology, memory is an organism's ability to store retain and subsequently retrieve information This neurotransmitter travels from one nerve cell to the next via synapses. Neurons (ˈnjuːɹɒn also known as neurones and nerve cells) are responsive cells in the Nervous system that process and transmit information Chemical synapses are specialized junctions through which Neurons signal to each other and to non-neuronal cells such as those in Muscles or Glands In order to send chemical messages, serotonin must bind to the receptor sites located on the neighboring nerve cell. In Biochemistry, a receptor is a Protein molecule embedded in either the Plasma membrane or Cytoplasm of a cell to which a mobile signaling It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential. This suggestion is supported by the fact that many OCD patients benefit from the use of selective serotonin reuptake inhibitors (SSRIs) — a class of antidepressant medications that allow for more serotonin to be readily available to other nerve cells. Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression ^[6] For more about this class of drugs, see the section about potential treatments for OCD. Obsessive-compulsive disorder (OCD is a Chronic Anxiety disorder most commonly characterized by obsessive Distressing Intrusive thoughts

Recent research has revealed a possible genetic mutation that could be the cause of OCD. In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD. "NIH" redirects here For other meanings of NIH see NIH (disambiguation. In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism The Serotonin transporter (SERT is a Monoamine transporter Protein. Moreover, in his study of identical twins, Rasmussen (1994) produced data that supported the idea that there is a "heritable factor for neurotic anxiety". ^[7] In addition, he noted that environmental factors also play a role in how these anxiety symptoms are expressed. However, various studies on this topic are still being conducted and the presence of a genetic link is not yet definitely established.

Another possible genetic cause of OCD was discovered in August 2007 by scientists at Duke University Medical Center in North Carolina. The Duke University Health System, combines the Duke University School of Medicine, the Duke University School of Nursing, the Duke Clinic and the member hospitals They genetically engineered mice that lacked a gene called SAPAP3. History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance This protein is highly expressed in the striatum, an area of the brain linked to planning and the initiation of appropriate actions. Proteins are large Organic compounds made of Amino acids arranged in a linear chain and joined together by Peptide bonds between the Carboxyl The striatum is a subcortical (ie inside rather than on the outside part of the Telencephalon. The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain The mice spent three times as much time grooming themselves as ordinary mice, to the point that their fur fell off. ^[8]

Technological advancements have allowed for the possibility of brain imaging. Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/ Pharmacology of the Brain Using tools like positron emission tomography (PET scans), it has been shown that those with OCD tend to have brain activity that differs from those who do not have this disorder. Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the ^[9] This suggests that brain functioning in those with OCD may be impaired in some way. A popular explanation for OCD is that offered in the book Brain Lock by Jeffrey Schwartz, which suggests that OCD is caused by the part of the brain that is responsible for translating complex intentions (e. g. , "I will pick up this cup") into fundamental actions (e. g. , "move arm forward, rotate hand 15 degrees, etc. ") failing to correctly communicate the chemical message that an action has been completed. This is perceived as a feeling of doubt and incompleteness, which then leads the individual to attempt to consciously deconstruct their own prior behavior — a process which induces anxiety in most people, even those without OCD.

It has been theorized that a miscommunication between the orbitofrontal cortex, the caudate nucleus, and the thalamus may be a factor in the explanation of OCD. The orbitofrontal cortex (OFC is a region of association cortex of the Human brain involved in cognitive processes such as Decision-making. The caudate nucleus is a nucleus located within the Basal ganglia of the Brains of many animal species The thalamus (from Greek θάλαμος = room chamber, IPA= /ˈθæləməs/ is a pair and symmetric part of the brain The orbitofrontal cortex (OFC) is the first part of the brain to notice whether or not something is wrong. When the OFC notices that something is wrong, it sends an initial "worry signal" to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to interpret the worrying event. The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in compulsive behaviors in an attempt to relieve this apprehension. ^[6] This overactivity of the OFC is shown to be attenuated in patients who have successfully responded to SSRI medication. Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders The increased stimulation of the serotonin receptors 5-HT2A and 5-HT2C in the OFC is believed to cause this inhibition. Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons The mammalian 5-HT2A receptor is a subtype of the 5-HT2 receptor which belongs to the Serotonin receptor family and is a G protein coupled receptor In the field of Neurochemistry, 5-HT receptors are receptors for the Neurotransmitter and peripheral signal mediator Serotonin, also ^[10]

Some research has discovered an association between a type of size abnormality in different brain structures and the predisposition to develop OCD. Through the use of magnetic resonance imaging (MRI), researchers at Cambridge's Brain Mapping Unit were able to discover distinctive patterns in the brain structure of individuals with OCD and their close family members. ^[11] This is the first instance in which it has been demonstrated that those with a familial risk of developing OCD have anatomical differences when compared with ordinary individuals. The discovery of these structural differences in the area of the brain associated with stopping motor response may ultimately aid researchers who seek to determine which genes contribute to the development of OCD.

Symptoms and prevalence

OCD is manifested in a variety of forms. Studies have placed the prevalence between one and three percent, although the prevalence of clinically recognized OCD is much lower, suggesting that many individuals with the disorder are unaccounted for clinically. ^[12] The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD. Social stigma is severe social disapproval of personal characteristics or Beliefs that are against cultural norms. Another reason for not seeking treatment is because many sufferers of OCD do not realize that what they are suffering from is OCD, mainly because the typical depiction of the disorder in the media and elsewhere only covers a few of the many symptoms of OCD.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession-related anxiety. Obsessive-compulsive disorder (OCD is a Chronic Anxiety disorder most commonly characterized by obsessive Distressing Intrusive thoughts To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, or repeatedly washing hands at regular intervals throughout the day. Physical symptoms may include those brought on from anxeties and unwanted thoughts, as well as tics or Parkinson's disease-like symptoms: rigidity, tremor, jerking arm movements, or involuntary movements of the limbs. A tic is a sudden repetitive nonrhythmic stereotyped motor movement or vocalization involving discrete muscle groups Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's

Symptoms related to performing tasks may include repeated hand washing or clearing of the throat; specific counting systems or counting of steps; doing repetitive actions -- more generally, this can involve an obsession with numbers or types of numbers (e. g. , odd numbers).

Symptoms related to fears and worries may include fear of acting out on violent or aggressive impulses (e. g. , stabbing friends or family); worries about sexual obsessions which are intrusive, unwanted sexual thoughts (e. Sexual obsessions are obsessions with sex and in the context of Obsessive-compulsive disorder (OCD these are extremely common (Foa et al 1995 g. , fear of being homosexual or fear of being a pedophile); chronic worries about having to have certain items to get to sleep, eat, or leave home; fear of going crazy. Homosexuality refers to sexual behavior with or attraction to people of the same sex or to a Homosexual orientation. The term pedophilia or paedophilia has a range of definitions as found in Psychology, law enforcement and the popular vernacular Sometimes, the individual having intrusive thoughts will try to "cancel out" bad thoughts with good thoughts. A major subtype of the fear category is the fear of contamination:(see mysophobia); some sufferers may fear the presence of human body secretions such as saliva, blood, sweat, tears, vomit, or mucus, or excretions such as urine or feces. Mysophobia is a term used to describe a Pathological fear of contact with dirt to avoid contamination and Germs. For the band see Saliva (band; for the village in Azerbaijan see Səliva. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products Tears are the liquid product of a process of lacrimation to clean and lubricate the Eyes The word lacrimation may also be used in a medical or literary sense Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the In vertebrates mucus is a slippery secretion produced by and covering Mucous membranes It is a viscous Colloid containing Antiseptic enzymes (such as Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus Some OCD sufferers even fear that the soap they are using is contaminated. ^[13]

There are many other possible symptoms, and it is not necessary to display those described in the list above to be considered as suffering from OCD. Formal diagnosis should be performed, of course, by a mental health professional (a psychologist, a psychiatrist, a psychoanalyst, etc). A mental health professional is a person who offers services for the purpose of improving an individual's Mental health or to treat Mental illness. Mental health professional A psychologist is a practitioner of Psychology, the systematic investigation of the mind including Behavior, Cognition, A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders Psychoanalysis is a body of ideas developed by Austrian physician Sigmund Freud and his followers which is devoted to the study of human psychological functioning and behavior Furthermore, possessing the symptoms above is not an absolute diagnosis of OCD. OCD sufferers are aware that such thoughts and behavior are not rational,^[14] but feel bound to comply with them to fend off feelings of panic or dread. Rationality as a term is related to the idea of Reason, a word which following Webster's may be derived as much from older terms referring to

In an attempt to relate further the immense distress that those afflicted with this condition must bear, Barlow and Durand (2006) use the following example. ^[15] They implore readers not to think of pink elephants. Their point lies in the assumption that most people will immediately create an image of a pink elephant in their minds, even though told not to do so. The more one attempts to stop thinking of these colorful animals, the more one will continue to generate these mental images. This phenomenon is termed the "Thought Avoidance Paradox", and it plagues those with OCD on a daily basis, for no matter how hard one tries to get these disturbing images and thoughts out of one's mind, feelings of distress and anxiety inevitably prevail. Although everyone may experience unpleasant thoughts at one time or another, these are usually warranted concerns that are short-lived and fade after an adequate time period has lapsed. However, this is not the case for OCD sufferers. ^[16]

OCD is often confused with the separate condition obsessive-compulsive personality disorder. The two are not the same condition, however. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic — marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD, by contrast, are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with anxiety; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions. Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components ^[17] This is a significant difference between these disorders.

Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.

Some OCD sufferers exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such patients, because they may be, at least initially, unwilling to cooperate. Exposure and response prevention (ERP is a treatment method available from behavioral psychologists and cognitive-behavioral therapists for a variety of anxiety disorders For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually delusional, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not. A delusion is commonly defined as a fixed False Belief and is used in everyday language to describe a belief that is either false fanciful or derived from Deception

OCD is different from behaviors such as gambling addiction and overeating. Overeating can refer either to eating too much at one time or to eating too much on average People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical depression over time. Mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life — particularly its substantial consumption of time — can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available.

Related disorders

People with OCD may be diagnosed with other conditions, such as anorexia nervosa, social anxiety disorder, bulimia nervosa, Tourette syndrome, compulsive skin picking, body dysmorphic disorder, trichotillomania, and (as already mentioned) obsessive-compulsive personality disorder. Anorexia Nervosa is a psychiatric Diagnosis that describes an Eating disorder characterized by low Body weight and Body image distortion Social phobia (DSM-IV 30023 also known as social anxiety disorder (DSM-IV 300 Bulimia nervosa is an Eating disorder characterized by recurrent Binge eating, followed by compensatory behaviors referred to as "purging" Tourette syndrome (also called Tourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome, GTS or more commonly simply Tourette's Dermatillomania (also known as compulsive skin picking or CSP) is an Impulse control disorder and form of Self-injury characterized by the repeated Body dysmorphic disorder ( BDD) (previously known as Dysmorphophobia and sometimes referred to as Body dysmorphia) is a psychiatric disorder Trichotillomania (TTM or "trich" as it is commonly known is an impulse control disorder or form of Self-injury characterized by the repeated urge There is some research demonstrating a link between drug addiction and OCD as well. Drug addiction is widely considered a pathological state. The disorder of addiction involves the progression of acute Drug use to the development of drug-seeking Many who suffer from OCD suffer also from panic attacks. Panic attacks are sudden discrete periods of intense anxiety mounting Physiological arousal fear stomach problems and discomfort that are associated with a variety of There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among OCD patients may serve as a type of compulsive behavior and not just as a coping mechanism. Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components Compulsive behavior is behavior which a person does "compulsively" i Depression is also extremely prevalent among sufferers of OCD. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an "out of control" type of feeling. Anxiety disorder is a blanket term covering several different forms of abnormal pathological anxieties Fears and Phobias In clinical usage "fear" ^[18]

Some cases are thought to be caused at least in part by childhood streptococcal infections and are termed PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). Streptococcus is a Genus of spherical Gram-positive bacteria belonging to the phylum Firmicutes and the PANDAS is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. The streptococcal antibodies become involved in an autoimmune process. Antibodies (also known as immunoglobulins, abbreviated Ig) are Gamma globulin Proteins that are found in Blood or other Bodily Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be "caught" via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that antibiotics may eventually be used to treat or prevent it. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa ^[19]

Demographics and other statistics

In a 1980 study of 20,000 adults from New Haven, Baltimore, St. Louis, Durham, and Los Angeles, the lifetime prevalence rate of OCD for both sexes was recorded at 2. Durham (ˈdʌrəm in RP, locally ˈdʏrəm is a small city and main settlement of the City of Durham district of County Durham, England Los Angeles (lɑˈsændʒələs los ˈaŋxeles in Spanish) is the largest City in the state of California and the American West 5 percent. Education also appears to be a factor. The lifetime prevalence of OCD is lower for those who have graduated high school than for those who have not (1. 9 percent versus 3. 4 percent). However, in the case of college education, lifetime prevalence is higher for those who graduate with a degree (3. 1 percent) than it is for those who have only some college background (2. 4 percent). As far as age is concerned, the onset of OCD usually ranges from the late teenage years until the mid-20s in both sexes, but the age of onset tends to be slightly younger in males than in females. ^[20]

Violence is very rare among OCD sufferers, but the disorder is often debilitating to their quality of life. Violence is the exertion of force so as to injure or abuse The word is used broadly to describe the destructive action of natural phenomena like Storms and Earthquakes Quality of life is the degree of well-being felt by an individual or group of people Also, the psychological self-awareness of the irrationality of the disorder can be painful. Irrationality is talking or acting without regard of Rationality. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. To avoid perceived obsession triggers, they also often avoid certain situations or places altogether.

Treatment

According to the Expert Consensus Guidelines for the Treatment of obsessive-compulsive disorder, behavioral therapy (BT), cognitive therapy (CT), medications, or any combination of the three, are first-line treatments for OCD. Behaviour therapy is a form of Psychotherapy used to treat depression, Anxiety disorders, Phobias, and other forms of Psychopathology Cognitive Therapy (CT is a type of Psychotherapy developed by American Psychiatrist Aaron T Psychiatric medication is a licenced Psychoactive drug taken to exert an effect on the Mental state and used to treat Mental disorders Usually utilized Psychodynamic psychotherapy may help in managing some aspects of the disorder, but there are no controlled studies that demonstrate effectiveness of psychoanalysis or dynamic psychotherapy in OCD. Psychodynamic psychotherapy is a form of Depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate Psychoanalysis is a body of ideas developed by Austrian physician Sigmund Freud and his followers which is devoted to the study of human psychological functioning and behavior ^[21]

Behavioral therapy

The specific technique used in BT/CBT is called exposure and ritual prevention (also known as "exposure and response prevention") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. Exposure and response prevention (ERP is a treatment method available from behavioral psychologists and cognitive-behavioral therapists for a variety of anxiety disorders Exposure and response prevention (ERP is a treatment method available from behavioral psychologists and cognitive-behavioral therapists for a variety of anxiety disorders At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school. ) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all — again, without performing the ritual behavior of washing or checking. See also Habit (psychology In Psychology, habituation is the psychological process in humans and animals in which there is a decrease in behavioral

This has been demonstrated to be the most effective treatment for OCD. In the UK, psycho-surgery cannot be performed unless a course of treatment from a suitably qualified cognitive-behavioural therapist has been carried out.

Medication

Medications as treatment include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Seroxat, Paxil, Xetanor, ParoMerck, Rexetin), sertraline (Zoloft, Stimuloton), fluoxetine (Prozac, Bioxetin), escitalopram (Lexapro), and fluvoxamine (Luvox) as well as the tricyclic antidepressants, in particular clomipramine (Anafranil). Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders Paroxetine (trade names Seroxat, Paxil, Parotin, Aropax, Xetanor, ParoMerck, Rexetin) is a Selective serotonin Escitalopram (trade names Lexapro, Cipralex) is the pure (S Enantiomer of Citalopram and is a Selective serotonin reuptake inhibitor Fluvoxamine ( Luvox) is an Antidepressant which functions as a Selective serotonin reuptake inhibitor. Tricyclic antidepressants (abbreviation TCAs) are a class of Antidepressant drugs first used in the 1950s Clomipramine (brand-name Anafranil) is a Tricyclic antidepressant. SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons Neurons (ˈnjuːɹɒn also known as neurones and nerve cells) are responsive cells in the Nervous system that process and transmit information Instead, serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety and obsessive thoughts. In Biochemistry, a receptor is a Protein molecule embedded in either the Plasma membrane or Cytoplasm of a cell to which a mobile signaling Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious. Clomipramine (brand-name Anafranil) is a Tricyclic antidepressant.

Serotonergic antidepressants typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. Serotonergic means "related to the Neurotransmitter Serotonin " An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression In addition to this, the treatment usually requires high doses. Fluoxetine, for example, is usually prescribed in doses of 20 mg per day for clinical depression, whereas with OCD the dose will often range from 20 mg to 80 mg or higher, if necessary. In most cases antidepressant therapy alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Other medications such as riluzole, memantine, gabapentin (Neurontin), lamotrigine (Lamictal), and low doses of the newer atypical antipsychotics olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) have also been found to be useful as adjuncts in the treatment of OCD. Riluzole is a drug used to treat Amyotrophic Memantine is the first in a novel class of Alzheimer's disease medications acting on the Glutamatergic system by blocking NMDA glutamate receptors Gabapentin (brand name Neurontin) is a medication originally developed for the treatment of Epilepsy. Lamotrigine (marketed as Lamictal (ləˈmɪktəl by GlaxoSmithKline, called Lamictin in South Africa, he למוג'ין ( Lamogine The atypical antipsychotics (also known as second generation antipsychotics) are a group of Antipsychotic drugs used to treat psychiatric conditions Olanzapine ( Zyprexa, Zyprexa Zydis, Zalasta, Zolafren, Olzapin, or in combination with Fluoxetine Symbyax) is Quetiapine ( kwe-TYE-a-peen marketed by AstraZeneca as Seroquel and by Orion Pharma as Ketipinor, is an Atypical antipsychotic Risperidone (pronounced Ris-PER-ǐ-dōn and sold under the trade name Risperdal in the Netherlands, United States, Canada, the

The use of antipsychotics in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their dopamine receptor antagonism), at high doses these same antipsychotics have proven to cause dramatic obsessive-compulsive symptoms even in those patients who do not normally have OCD. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. Dopamine receptors are a class of metabotropic G protein-coupled receptors that are prominent in the Vertebrate Central nervous system (CNS This is most likely due to the antagonism of 5-HT2A receptors becoming very prominent at these doses and outweighing the benefits of dopamine antagonism. Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief enzyme that is responsible for metabolising antipsychotics — CYP2D6 — so the dose will be effectively higher than expected when these are combined with SSRIs. Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. Cytochrome P450 2D6 (CYP2D6 a member of the Cytochrome P450 mixed-function oxidase system is one of the most important enzymes involved in the metabolism of Xenobiotics Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results. Thus, according to the Obsessive Compulsive Foundation, the antipsychotic treatment that is not added into SSRI treatment can cause on-set OCD symptoms.

The naturally occurring sugar inositol may be an effective treatment for OCD. Inositol, (of which the most prominent naturally occurring form is myo -inositol cis -1235- trans -46-cyclohexanehexol) is a carbocyclic Inositol appears to modulate the actions of serotonin and has been found to reverse desensitisation of the neurotransmitter's receptors. See Chemical synapse for an introduction to concepts and terminology used in this article ^[22] St John's Wort has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities, and studies have emerged that have shown positive results. St John's wort (pronounced) used alone refers to the species Hypericum perforatum, also known as Tipton's Weed or Klamath weed, but with qualifiers is However, a double-blind study, using a flexible-dose schedule (600-1800 mg/day), found no difference between St John's Wort and the placebo. ^[23] Studies have also been done that show nutrition deficiencies may also contribute to OCD and other mental disorders. Mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as Certain vitamin and mineral supplements may aid in such disorders and provide the nutrients necessary for proper mental functioning. A vitamin is an Organic compound required as a Nutrient in tiny amounts by an Organism. Dietary minerals are the Chemical elements required by living Organisms other than the four elements Carbon, Hydrogen, Nitrogen, and A nutrient is food or chemicals that an organism needs to live and grow or a substance used in an organism's metabolism which must be taken in from its environment ^[24]

Recent research has found increasing evidence that opioids may significantly reduce OCD symptoms, though the addictive property of these drugs likely stands as an obstacle to their sanctioned approval for OCD treatment. An opioid is a chemical Substance that has a Morphine -like action in the body Anecdotal reports suggest that some OCD sufferers have successfully self-medicated with opioids such as Ultram and Vicodin, though the off-label use of such painkillers is not widely accepted, again because of their addictive qualities. Tramadol ( INN) (ˈtræmədɒl is an atypical Opioid which is a centrally acting Analgesic, used for treating moderate to severe Pain. Hydrocodone or dihydrocodeinone is a semi-synthetic Opioid derived from two of the naturally occurring Opiates Codeine and Thebaine Tramadol is an atypical opioid that may be a viable option as it has a low potential for abuse and addiction, mild side effects, and shows signs of rapid efficacy in OCD. Tramadol ( INN) (ˈtræmədɒl is an atypical Opioid which is a centrally acting Analgesic, used for treating moderate to severe Pain. Substance abuse is the overindulgence in and dependence of a Drug or other chemical leading to effects that are detrimental to the individual's physical and mental health The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as Tramadol not only provides the anti-OCD effects of an opiate, but also inhibits the re-uptake of serotonin (in addition to norepinephrine). For other uses see Opiate (disambiguation, or for the class of drugs see Opioid. Reuptake, or re-uptake, is the reabsorption of a Neurotransmitter by the Neurotransmitter transporter of a pre-synaptic Neuron after Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a This may provide additional benefits, but should not be taken in combination with antidepressant medication unless under careful medical supervision due to potential serotonin syndrome. An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use inadvertent interactions between drugs or the recreational ^[25]

Research has generally shown that psychotherapy, in combination with psychotropic medication, is more effective than either option alone. Psychotherapy is an Interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living Recent studies at the University of Arizona using the tryptamine alkaloid psilocybin have shown promising results. The University of Arizona (also referred to as UA, U of A, or Arizona) is a Land-grant and space-grant public institution Tryptamine is a Monoamine Alkaloid found in Plants and Animals. This article is about the chemical compounds alkaloids For the Pharmaceutical company in the Republic of Macedonia see Alkaloid (company. Psilocybin (IPA /saɪləˈsaɪbɪn/ (also known as psilocybine) is a psychedelic Indole of the Tryptamine family found in Psilocybin ^[26] There are reports that other hallucinogens such as LSD and peyote have produced similar benefits. The general group of pharmacological agents commonly known as hallucinogens can be divided into three broad categories Psychedelics, Dissociatives Lophophora williamsii (loʊˈfɒfərə wɪlˈjæmsiaɪ lō-fof′ŏ-ră will-yăm′sē-ī better known by its common name Peyote, (from the It has been hypothesised that this effect may be due to stimulation of 5-HT2A receptors and, less importantly, 5-HT2C receptors. The mammalian 5-HT2A receptor is a subtype of the 5-HT2 receptor which belongs to the Serotonin receptor family and is a G protein coupled receptor In the field of Neurochemistry, 5-HT receptors are receptors for the Neurotransmitter and peripheral signal mediator Serotonin, also This causes, among many other effects, an inhibitory effect on the orbitofrontal cortex, an area of the brain in which hyperactivity has been strongly associated with OCD. The orbitofrontal cortex (OFC is a region of association cortex of the Human brain involved in cognitive processes such as Decision-making. Hyperactivity can be described as a physical state in which a person is abnormally and easily excitable or exuberant ^[27]

Emerging evidence suggests that regular nicotine treatment may be helpful in improving symptoms of OCD, although the pharmacodynamical mechanism by which this improvement is achieved is not yet known, and more detailed studies are needed to fully confirm this hypothesis. Nicotine is an Alkaloid found in the Nightshade family of plants ( Solanaceae) which constitutes approximately 0 Pharmacodynamics is the study of the Biochemical and Physiological effects of drugs on the body or on microorganisms or parasites within or on the body and the mechanisms A hypothesis (from Greek) consists either of a suggested explanation for a phenomenon (an event that is observable or of a reasoned proposal suggesting a possible Anecdotal reports suggest OCD can worsen when cigarettes are smoked as a way of obtaining nicotine. ^[28]

Psychosurgery

For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. For the Tourniquet album refer to Psycho Surgery. Psychosurgery is a subset of Neurosurgery ( Surgery In this procedure, a surgical lesion is made in an area of the brain (the cingulate bundle). A lesion is any abnormal tissue found on or in an organism usually damaged by disease or trauma In one study, 30% of participants benefited significantly from this procedure. ^[15] Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue, although their efficacy has not been conclusively demonstrated. Vagus nerve stimulation (VNS is an adjunctive treatment for certain types of intractable Epilepsy and major depression. The human brain controls the Central nervous system (CNS by way of the Cranial nerves and Spinal cord, the Peripheral nervous system (PNS

Transcranial magnetic stimulation

Though in its early stages of research, Transcranial magnetic stimulation (TMS) has shown promising results. Transcranial magnetic stimulation ( TMS) is a noninvasive method to excite neurons in the Brain: weak Electric currents are induced in the tissue by rapidly The magnetic pulses are focused on the brain's supplementary motor area (SMA), which plays a role in filtering out extraneous internal stimuli, such as ruminations, obsessions, and tics. The supplementary motor area (SMA is a part of the sensorimotor Cerebral cortex (perirolandic i The TMS treatment is an attempt to normalize the SMA's activity, so that it properly filters out thoughts and behaviors associated with OCD. ^[29][30]

Neuropsychiatry

OCD primarily involves the brain regions of the striatum, the orbitofrontal cortex and the cingulate cortex. Anatomical regions of the brain are listed vertically following hierarchies that are standard in Neuroanatomy. The striatum is a subcortical (ie inside rather than on the outside part of the Telencephalon. The orbitofrontal cortex (OFC is a region of association cortex of the Human brain involved in cognitive processes such as Decision-making. The cingulate cortex is a part of the Brain situated in the medial aspect of the cortex. OCD involves several different receptors, mostly H₂, M₄, NK₁, NMDA, and non-NMDA glutamate receptors. In Biochemistry, a receptor is a Protein molecule embedded in either the Plasma membrane or Cytoplasm of a cell to which a mobile signaling H2 receptors positively coupled to Adenylate cyclase via Gs. It is a potent stimulant of cAMP production Muscarinic receptors, or mAChRs, are Acetylcholine receptors that form Metabotropic Ion channels in the Plasma membranes of certain In Neuroscience, Substance P is a Neuropeptide: a short-chain Polypeptide that functions as a Neurotransmitter and as a Neuromodulator The NMDA receptor ( NMDAR) is an Ionotropic receptor for Glutamate ( NMDA ( N -methyl D -aspartate is a name of its selective Glutamate receptors are Transmembrane receptors located on Neuron membranes The receptors 5-HT_1D, 5-HT_2C, and the μ opioid receptor exert a secondary effect. 5-hydroxytryptamine (serotonin receptor 1D, also known as HTR1D, is a 5-HT receptor, but also denotes the human Gene encoding it 5-hydroxytryptamine (serotonin receptor 2C, also known as HTR2C, is a 5-HT2 receptor, but also denotes the human Gene encoding it Opioid receptors are a group of G-protein coupled receptors with Opioids as Ligands The Endogenous Opioids are Dynorphins The H₂, M₄, NK₁, and non-NMDA glutamate receptors are active in the striatum, whereas the NMDA receptors are active in the cingulate cortex. The NMDA receptor ( NMDAR) is an Ionotropic receptor for Glutamate ( NMDA ( N -methyl D -aspartate is a name of its selective

The activity of certain receptors is positively correlated to the severity of OCD, whereas the activity of certain other receptors is negatively correlated to the severity of OCD. Correlations where activity is positively correlated to severity include the histamine receptor (H₂); the Muscarinic acetylcholine receptor(M₄); the Tachykinin receptor (NK₁); and non-NMDA glutamate receptors. The histamine receptors are a class of G-protein coupled receptors with Histamine as their Endogenous Ligand. Muscarinic receptors, or mAChRs, are Acetylcholine receptors that form Metabotropic Ion channels in the Plasma membranes of certain There are three known Mammalian Tachykinin receptors termed NK1 NK2 and NK3 Glutamate receptors are Transmembrane receptors located on Neuron membranes Correlations where activity is negatively correlated to severity include the NMDA receptor(NMDA); the Mu opioid receptor (μ opioid); and two types of 5-HT receptors (5-HT_1D and 5-HT_2C) The central dysfunction of OCD may involve the receptors nk1, non-NMDA glutamate receptors, and NMDA, whereas the other receptors could simply exert secondary modulatory effects. The NMDA receptor ( NMDAR) is an Ionotropic receptor for Glutamate ( NMDA ( N -methyl D -aspartate is a name of its selective The μ opioid receptors (MOR are a class of Opioid In the field of Neurochemistry, 5-HT receptors are receptors for the Neurotransmitter and peripheral signal mediator Serotonin, also In the field of Neurochemistry, 5-HT receptors are receptors for the Neurotransmitter and peripheral signal mediator Serotonin, also Glutamic acid (abbreviated as Glu or E) is one of the 20 Alpha Amino acids It is not among the human Essential amino acids Its

Pharmaceuticals that act directly on those core mechanisms are aprepitant (nk1 antagonist), riluzole (glutamate release inhibitor), and tautomycin (NMDA receptor sensitizer). Aprepitant is a chemical compound that belongs to a class of drugs called Substance P antagonists (SPA Riluzole is a drug used to treat Amyotrophic Tautomycin is a chemical that occurs naturally in Shellfish. It is a large chemical that is comprised mostly of several Phenol rings Also, the anti-Alzheimer's drug memantine is being studied by the OC Foundation in its efficacy in reducing OCD symptoms due to it being an NMDA antagonist. Memantine is the first in a novel class of Alzheimer's disease medications acting on the Glutamatergic system by blocking NMDA glutamate receptors NMDA receptor antagonists are a class of Anesthetics that work to antagonize, or inhibit the action of the N-methyl d-aspartate receptor ( NMDAR One case study published in The American Journal of Psychiatry suggests that "memantine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation. The American Journal of Psychiatry (AJP is the official journal of the American Psychiatric Association (APA and the most widely read and cited Psychiatric "^[31] The drugs that are popularly used to fight OCD lack full efficacy because they do not act upon what are believed to be the core mechanisms.

See also

• Anorexia nervosa
• Asperger syndrome
• Basal ganglia
• Body dysmorphic disorder
• Caudate nucleus
• Compulsive hoarding
• Dermatillomania
• Intrusive thoughts
• Monk (TV series) about a detective with obsessive-compulsive disorder
• Mysophobia
• Obsessive-compulsive personality disorder
• Orbitofrontal cortex
• PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections
• Scrupulosity
• Sexual obsessions
• Social phobia
• Thalamus
• Thought suppression
• Tourette syndrome
• Trichotillomania
• Yale-Brown Obsessive Compulsive Scale

References

Further reading

• My Worktime Routine, ISBN 1-59-113901-5, by David Vince.
• Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, ISBN 0-06-098711-1, by Jeffrey M. Schwartz.
• Treatment of the Obsessive Personality, ISBN 0-87668-881-4, by Leon Salzman
• Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty'' (2003), ISBN 1-58542-246-0, by Jonathan Grayson.
• Just Another Day, ISBN 1-59-113901-5, by Shadi Srour.
• The Treatment of Obsessions, ISBN 0-19-851537-5, by Stanley Rachman.
• The Mind and the Brain: Neuroplasticity and the Power of Mental Force, ISBN 0-06-098847-9, by Jeffrey M. Schwartz, Sharon Begley.
• The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts, ISBN 0-452-28307-8, by Lee Baer.
• Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well (2000), ISBN 0-19-514092-3, by Fred Penzel.
• What you can change. . . and what you can't, ISBN 0-449-90971-9, by Martin E. P. Seligmann, chap. "obsessions"
• Tormenting Thoughts and Secret Rituals: The Hidden Epidemic of Obsessive-Compulsive Disorder, ISBN 0-440-50847-9, by Ian Osborn.
• The Art of Meditation ISBN 81-7992-164-6 by David A. Cooper, Jaico Publishing House
• Overcoming Obsessive Compulsive Disorder: A self-help guide using Cognitive Behavioural Techniques (2005) ISBN 1-84119-936-2 by David Veale and Rob Willson