Obsessive-Compulsive Disorder Issues Pertinent to Women

Abstract

Obsessive-compulsive disorder (OCD) is a psychiatric condition first described 100 years ago [1]. The pathognomic features of the disorder are persistent, intrusive, senseless thoughts and impulses (obsessions) and repetitive, intentional behaviors (compulsions). Patients with the disorder recognize that their thoughts and behaviors are excessive and unreasonable and they struggle to resist them. The lifetime prevalence of OCD is estimated to be 1–3%, based on population-based surveys conducted in many communities both nationally and internationally [2,3]. Although the disorder affects individuals of all ages, the period of greatest risk is from childhood to early adulthood [4,5]. Patients experience a chronic or episodic course with exacerbations that can substantially impair social, occupational and academic functioning; according to the WHO, OCD is among the ten most disabling medical conditions worldwide [6]. Moreover, the burden placed on, and stresses experienced by, family members are considerable [7]. Medications and behavior therapy can control symptoms, but the course is chronic or relapsing in most cases, and cure is rare. The causes for OCD are unknown. The strongest known risk factor is genetics, as demonstrated by both family and twin studies [8–12]. Heritability has been estimated from these studies to be in the order of 80%. A neuroimmunologic hypothesis is under study, which posits that an acute syndrome may emerge in children as a poststreptococcal infection event (pediatric autoimmune veuropsychiatric disorders associated with streptococcal infection, PANDAS) [13]. There is strong evidence that the pathophysiology involves the cortico-striato pallido-thalamic circuitry [14,15], based on a considerable body of neuroimaging and cognitive neuroscience research in this area [16]. Although the phenomenological form of obsessions and compulsions are particularly stereotypic, there is considerable diversity in their content, ranging from contamination, sexual, religious and aggressive concerns through compulsive hoarding, checking, ordering and counting. There have been inconsistent reports that women are more affected by some more than other symptoms. While all symptoms are extremely bothersome, some are more unique to women. Examples from my practice, among many more, include: fears that everyday physical contact with one’s child may (irrationally) be construed as sexually abusive, concerns that inadvertently one may have poisoned one’s child; and that one will overlook serious maladies among the common complaints of one’s child.