What is OCD and how is it treated?
OCD is characterized by obsessive thoughts, impulses, or images and compulsions (overt or mental rituals or behaviors) that are difficult to suppress and take a considerable amount of time, cause distress, and interfere with social activities, work, or school. OCD is a very heterogeneous disorder, with some patients having specific fears about bad things happening and others having feelings of discomfort that are more sensory in nature. Some common symptoms of OCD including fear of disease or illness and washing compulsions, fear of hurting someone or oneself and checking compulsions, fear or doing something morally "unacceptable", "not-just-right" experiences and sensations of discomfort associated with the need to organize and arrange items, and sensations of discomfort associated with the need to repeat behaviors a certain amount of times or in a certain order. OCD frequently co-occurs with depression and other anxiety disorders. OCD can also co-occur with Tourette's Disorder or other repetitive behaviors including hair-pulling (trichotillomania) and skin picking (excoriation disorder), especially among patients with prominent sensory symptoms.
OCD is not uncommon and affects about 2-3 % of the population and is equally common in males and females. Most patients have an age of onset in late adolescence/early adulthood, although a subset of patients start to experience their symptoms at a young age (< 15 years). There are several evidence-based treatments for the disorder including Exposure and Response Prevention (ERP), which is a cognitive-behavioral therapy technique involving therapist-guided graded exposure to the feared situation with gradual densensitization to symptom triggers over the course of multiple weeks. In addition, medications such as serotonin re-uptake inhibitors (SSRIs or SNRIs) can significantly improve symptoms in approximately half of patients, with treatment-resistent OCD sometimes requiring additional medications such as neuroleptics (dopamine blockers). There are several experimental treatments that are currently being tested to see if they can be helpful for patients whose symptoms are not sufficiently helped with the above methods. For very severe patients, deep brain stimulation treatment can also be used at specialty clinics. See some of the links below for more detailed information on symptoms and treatments for OCD.
International Obsessive-Compulsive Disorder Foundation (IOCDF)
Anxiety Disorders Association of America
What is Tourette Disorder (TD)/Tourette Syndrome and how is it treated?
TD is characterized by rapid and repetitive involuntary movements and vocalizations called “tics”. Although tics are experienced as uncontrollable, sometimes they are described as "semi-involuntary" because patients can typically exert some control over them to delay their expression for a brief period of time. Tics are usually preceded by a build-up of tension and sensations in the body, often in the body part that is performing the tic, called a "premonitory urge". This premonitory urge is involuntary and drives the expression of the tic. Premonitory urges may take many different forms, including itching, burning, tingling, or muscle tension that is only relieved when the tic is performed. Often TD patients can tell when a tic is going to happen because they feel the premonitory urge first. In fact, some therapies for TD are focused on helping patients identify this urge before the tic occurs and then performing a different behavior to compete with or "neutralize" the need to tic. Premonitory urges are thought to be very similar to symptoms in OCD involving sensory discomfort. OCD and TD often co-occur in the same person, particularly among OCD patients with prominent sensory symptoms. TD also co-occurs with attention-deficit hyperactivity disorder (ADHD) and other body-focused repetitive behaviors like hair-pulling and skin-picking.
TD occurs in about 0.5-1 % of the population, frequently has a very early age of onset before 10 years of age, and is more common in males. About one-half to two-thirds of children with TD find that their symptoms lessen considerably as they age, even without treatment. Evidence-based behavioral treatment for both children and adults includes habit reversal therapy (HRT), which teaches the patient to notice when a tic is about to happen before it happens (by detecting the premonitory urge), and then performing a different behavior that directly competes with the tic. In addition, certain medications called neuroleptics (dopamine blockers) or alpha-agonists can be useful in the treatment of severe tics. Experimental treatments are also being investigated and some patients respond to stimulation of the cortical motor areas using a therapy called Transcranial Magnetic Stimulation (TMS), which is a non-invasive way of changing activity in the brain via magnetic signals transmitted from an instrument placed outside of the head. See the links below for more detailed information on symptoms and treatments for TD and chronic tics.
Tourette Association of America
Tourette Syndrome Fact Sheet at the National Institute of Neurological Disorders and Stroke