Dr. K: OCD often a matter of degree

Dear Dr. K: The term OCD is used so casually these days. How can you identify someone who truly has obsessive-compulsive disorder?

Dear Reader: There’s a little bit of what is called “psychiatric illness” in most of us. For example, at one time or another we may all feel compelled to line up our pencils or double-check that we’ve locked the door.

In contrast, a person with OCD who has the obsession that his front door is unlocked may feel the compulsion to check the lock 10 or 20 times each night. He remembers that he’s already checked it many times, and it definitely was locked. But he still worries that somehow it got unlocked since the last time he checked. It’s not rational; it’s just a mental pressure that a person with OCD must respond to.

The two defining symptoms of OCD are obsessive thoughts and compulsive rituals.

Obsessions are persistent, repeated, anxiety-provoking or distressing thoughts. They intrude into a person’s consciousness.

Compulsive rituals are persistent, excessive, repetitive behaviors. The goal of the ritual is to reduce the anxiety caused by obsessive thoughts.

In OCD, the obsessions and compulsions are excessive and distressing. They are time-consuming. They may interfere with personal relationships, and performance at work or school.

The most effective treatment for OCD is a combination of psychotherapy and medication. Ongoing treatment may be necessary.

Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat OCD. They include sertraline (Zoloft) and citalopram (Celexa). Tricyclic antidepressants also may be effective, particularly clomipramine (Anafranil).

A number of psychotherapy techniques may be helpful. Cognitive behavioral therapy (CBT) can help a person with OCD recognize the unreasonableness of fearful, obsessive thinking. The therapist sometimes teaches specialized techniques that can help extinguish the compulsions.

So OCD is a matter of degree. If your obsessive thoughts or compulsive behaviors occur repeatedly throughout the day, and interfere with life at home or at work, you’ve got a problem — and several possible solutions.

Dr. Anthony L. Komaroff is a physician and professor at Harvard Medical School. Go to his website, www.AskDoctorK.com, to send questions and get additional information.