OCD

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder characterized by recurrent, persistent, unwanted, and unpleasant thoughts (obsessions) and repetitive, purposeful ritualistic behaviors that the person feels driven to perform (compulsions). A cardinal feature of this disorder is an awareness of the irrationality or excess of the obsessions and compulsions accompanied by an inability to control them.

Typical compulsions include an irresistible urge to wash your hands repeatedly, clean, check doors to confirm they’re locked, return repeatedly to appliances to make sure they’re off, touch, repeat, count, arrange, or save items. Typical obsessions include over concern about dirt and contamination, fear of acting on violent or aggressive impulses, feeling overly responsible for the safety of others, abhorrent religious (blasphemous) and sexual intrusions, and inordinate concern with arrangement or symmetry. Obsessions may accompany compulsions, or compulsions may occur alone.

The difference between obsessive-compulsive disorder and milder forms of obsession or compulsion seen in otherwise healthy people is that for the sufferer the obsessions or compulsions cause marked distress, are time-consuming, and significantly interfere with the person’s normal routine, occupational functioning, usual social activities, and relationships with others.

Onset in adolescence occurs in about a third of cases. In another third symptoms appear in early adulthood, and in the last third they start later in life. If not treated appropriately, the disorder is often chronic, with waxing and waning of symptoms.

An effective mode of psychotherapy is behavioral therapy, in which the patients are gradually exposed to their feared or triggering situation but are prevented from performing accompanying compulsions. This approach, which focuses on treating the symptoms rather than trying to understand their origin, seems to be more effective in treating the ritualistic behavior (compulsions) than the pervasive thoughts (obsessions). Obsessive-compulsive disorder often eases with medications that affect the brain’s serotonergic system, such as clorimipramine (Anafranil), fluvoxamine (Luvox), and fluoxetine (Prozac). TMS is being used to reduce the obsessions and anxiety that occurs with OCD. A recent area of focus is the supplementary motor area using a slow pulse stimulation.

Dr. Phil featured OCD during an episode airing October 2012. The link below shows videos of neuroradiologic studies showing target areas for TMS. The treatment “Bob” received is TMS.

TMS featured on Dr. Phil

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Selected References

• Modulation of motor cortex excitability in obsessive-compulsive disorder: an exploratory study on the relations of neurophysiology measures with clinical outcome.
  Mantovani A1, Rossi S, Bassi BD, Simpson HB, Fallon BA, Lisanby SH.
  Psychiatry Res. 2013 Dec 30;210(3):1026-32. abstract
• Randomized sham-controlled trial of repetitive transcranial magnetic stimulation in treatment-resistant obsessive-compulsive disorder.
  Mantovani A, Simpson HB, Fallon BA, Rossi S, Lisanby SH.
  Int J Neuropsychopharmacol. 2010 Mar;13(2):217-27.
• Safety and efficacy of repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder: a review.
  Jaafari N, Rachid F, Rotge JY, Polosan M, El-Hage W, Belin D, Vibert N, Pelissolo A.
  World J Biol Psychiatry. 2012 Mar;13(3):164-77
• A randomized controlled study of sequentially applied repetitive transcranial magnetic stimulation in obsessive-compulsive disorder.
  Kang JI, Kim CH, Namkoong K, Lee CI, Kim SJ.
  J Clin Psychiatry. 2009 Dec;70(12):1645-51.
• Effect of prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a preliminary study.
  Greenberg BD, George MS, Martin JD, Benjamin J, Schlaepfer TE, Altemus M, Wassermann EM, Post RM, Murphy DL.
  Am J Psychiatry. 1997 Jun;154(6):867-9.

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*At this time, TMS is not FDA-aproved for the treatment of OCD, which would be considered an off-label application.