Obsessive-compulsive disorder (OCD) is a complex brain disorder that affects the lives of 1 to 3 percent of children and adults worldwide without respect to cultural differences or geography. The onset of this illness can be as young as ages 2 to 4 years with approximately one-half of adults having experienced symptom onset during childhood or adolescence (Karno and Golding, 1990). The World Health Organization's 1996 summary of the global burden of disease found OCD to be the eighth leading cause of disease burden for adults ages 15 to 44 years in developed countries, and the fourth leading cause for women in this group. Almost one-third (28 percent) of the disease burden for all adults in this age group was attributed to mental illness, with 5 of the 10 leading causes including unipolar major depression (1), schizophrenia (4), self-inflicted injuries (5), bipolar disorder (6), and OCD (8) (Murray and Lopez, 1996).
Textbook of Biological Psychiatry. Edited by Jaak Panksepp Copyright © 2004 by Wiley-Liss, Inc. ISBN: 0-471-43478-7
The symptoms of OCD are not new to our society and have been present and documented in many forms throughout written history. In medieval times, individuals who displayed sexual or blasphemous thoughts were considered to be possessed and would have been "treated" with an attempt to remove the offending spirit through various forms of torture often leading to death. One of the most well-recognized literary descriptions of OCD is Shakespeare's Lady MacBeth with her obsessive guilt and ritualistic hand-washing. Scrupulosity is a religious form of OCD documented for almost 500 years throughout the writings of members of the Roman Catholic Church. The described symptoms of this condition mirror our current definition of OCD (O'Flaherty, 1966). The Roman Catholic Church conducted the first systematic survey of scrupulosity in 1927 on 400 girls in a Catholic high school and found 17 of the girls to have behaviors and/or thoughts regarding religious preoccupations and cleaning and washing habits that were considered excessive (Mullen, 1927).
Obsessive-compulsive disorder was first described in the psychiatric literature in adults by Esquirol in 1839 and in children by Janet in 1903. Early reports in the literature contained descriptions of repetitive, unwanted thoughts or rituals often characterized by magical thinking. As the disorder came to be better defined, it was classified as one of the neuroses rather than a symptom of melancholy. By the early 20th century the description of OCD shifted to include psychodynamic features. Freud's writings conceptualized obsessions as resulting from unconscious conflicts and emotional antecedents (Freud, 1909; 1913). He also speculated on the similarities between the symptoms of OCD and children's games and religious rituals. However, even Freud questioned whether psychodynamic theory was sufficient to explain the symptoms of OCD.
Observations of the association between certain neurological disorders and OCD have lead to the current view of OCD as a neurobiologic illness. Clinical research has demonstrated an increase in obsessive-compulsive symptomatology in patients with neurologic diseases known to involve basal ganglia structures, including Sydenham chorea (Swedo et al., 1993), Tourette syndrome (Leckman et al., 1997), and Huntington's chorea (Cummings and Cunningham, 1992). Current neurobiological research has focused on the possible localization of brain circuits mediating obsessive-compulsive behaviors and possible mechanisms for behavioral encoding. This research has directly led to advancements in the diagnosis and treatment of OCD improving the quality of life and clinical outcomes for many people suffering with this illness.
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