Is dopamine high or low in OCD

Obsessive-compulsive disorder (OCD, Obsessive-compulsive disorder)

Obsessive-compulsive disorder (formerly obsessive-compulsive disorder) makes people feel compelled to repeat actions and / or thoughts frequently. Compulsive actions - e.g. constant hand washing - and / or obsessive thoughts - e.g. repeating series of numbers - then reach an extent that leads to a considerable restriction in everyday life.

Obsessive-compulsive disorder is counted among the anxiety disorders, but has a special position in this group. There is a large overlap with the depressive illnesses. Well over half of people with obsessive-compulsive disorder have had at least one major depressive episode in their life. There is also a strong overlap with hypochondria.

Obsessive-compulsive disorder

Don't think about whether you've locked the front door now. You see - now you also know what an obsessive thought is - one that you can't get out of your head. How many people are affected by obsessive thoughts or compulsive actions and when the tic becomes an illness, this time Primar Privatdozent Doktor Martin Aigner will talk to the PodDoktor.

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Until the late 1970s, obsessive-compulsive disorder was considered a rather rare disorder. This has changed a lot in the last 20 years. It is now one of the more common mental disorders. The likelihood of developing obsessive-compulsive disorder in the course of a lifetime is around 2%, with men and women being affected roughly equally. The disease usually begins in early adulthood. Around 50% of those affected already showed obsessive-compulsive symptoms in childhood and adolescence.

What types of Obsessive Compulsive Disorder are there?


  • Washing and cleaning compulsory
  • Compulsive checking and checking, e.g. whether the door is locked or whether the stove has been turned off
  • compulsive turning on and off of the light switch
  • Collect
  • permanent ordering

Obsessive thoughts

Obsessive thoughts with different content (e.g. rows of numbers or individual sentences) have to be thought through over and over again. Religious and sexual content is also typical of obsessive-compulsive thoughts.

How does obsessive-compulsive disorder develop?

There is no clear, universally valid model for the development of OCD. In modern psychiatry it is assumed that several factors play a role in its development. Serious events in the life story (death of a loved one, divorce, sexual abuse), problems in dealing with feelings and their processing, problems in dealing with other people or changes in certain brain regions (so-called neurobiological variables) are considered significant.

In depth psychology, obsessive-compulsive disorder is understood as an expression of a disorder in the anal phase. In this phase, among other things, the elimination functions are in the foreground and the child is confronted with the issue of cleanliness for the first time. Obsessive-compulsive disorder can develop depending on how the child experiences this phase and how those around them treat it.

In this context, a messenger substance in the brain, the so-called serotonin, which is responsible, among other things, for impulse control, plays a crucial role. It has been shown that obsessive-compulsive patients who were given a drug that increases serotonin levels in the brain improved. The neurotransmitter dopamine also appears to play a role in the development of obsessive-compulsive disorder.

In general, psychiatry, psychotherapy, and clinical psychology assume that biological as well as social and psychological components can have an impact. There is also quite clear evidence that obsessive-compulsive disorder can also be genetic, that is, "inherited".

How does the obsessive-compulsive disorder work?

At the onset of obsessive-compulsive disorder, there are often recurring episodes with subsequent regression of symptoms. In about 30% of the cases there are rapid ups and downs in the symptoms. For some sufferers, there are always times when the disorder disappears completely. Such a course is called phasic.

In about half of the patients, the symptoms do not change over time. Here one speaks of a progressively chronic course of the disorder. However, such a course is only observed in 5-10% of patients.

How do sufferers experience obsessive-compulsive disorder?

About 90% of those affected have both compulsive acts and obsessive thoughts. In most cases, the thoughts and actions are recognized as meaningless by those affected.

They are well aware of their problem and often suffer very badly from it themselves. Only in a subgroup of patients is there no insight into the futility of compulsive actions and obsessive thoughts.

Obsessions and compulsions can be extremely time consuming. In some cases, sufferers need hours each day to complete their actions. These rituals interfere with the normal daily routine, professional performance and social interaction with other people. The partner in particular is often severely affected.

Attempts are made again and again to suppress the compulsive actions and thoughts. Often, however, this only leads to a delay, i.e. the compulsory rituals are "processed" at a later point in time. Patients often try long to hide their disorder. As a result, it takes an average of 15 years for a person with OCD to seek therapeutic help.

How are obsessive-compulsive disorder diagnosed?

A doctor, psychologist or psychotherapist will get an idea of ​​the disease in a detailed discussion. Questionnaires can also be used.

In order to be able to make the diagnosis of obsessive-compulsive disorder, the following points must be met according to the ICD-10 catalog (international classification of diseases):

  • Obsessions and / or compulsions occur on most days for a minimum of two weeks.
  • Obsessive thoughts and / or compulsive actions are assessed as own thoughts or self-controlled actions. This is how one can distinguish obsessive-compulsive disorder from psychosis, in which the thoughts and actions appear to be imposed from the outside. Distinguishing between obsessive-compulsive disorder and schizophrenia is not always easy.
  • Obsessive thoughts and / or compulsive acts are repeatedly assessed by the person concerned as unpleasant and at least one obsessive thought or compulsive act is viewed as inappropriate.
  • If the person concerned tries to ignore the urge to think or act, it cannot be suppressed in the long term.
  • The everyday life of the person affected is impaired.
  • Obsessive-compulsive thoughts and / or compulsive acts must not appear as a symptom of another mental illness.
  • The compulsion to brood, i.e. the constant circling of thoughts, is also classified as an obsessive-compulsive disorder, provided that the person concerned does not suffer from depression.

Compulsive behavior in other mental disorders

Compulsive acts and obsessive thoughts also occur in the context of other mental illnesses (e.g. depression). These are also characterized by increased tension or restlessness, which must be reduced.

If the person concerned is willing to take risks, they perceive these compulsive impulses as pleasurable and they are acted out. By living out the pressing impulse, the pent-up tension eases. In these cases one speaks of so-called impulse control disorders, e.g .:

  • Kleptomania (compulsive stealing)
  • Shopping frenzy (compulsive shopping)
  • Gambling addiction
  • Bulimia nervosa (addiction to eating and vomiting)

If the person is more concerned with security, the pressing impulses are experienced with fear. Compulsive actions are performed on behalf of the compulsive impulses, but also lead to a short-term relief of tension. This is then not an obsessive-compulsive disorder. In these cases one speaks of so-called somatoform disorders, e.g .:

  • hypochondria
  • Dysmorphophobia (the subjective belief that one is disfigured by a deformity)
  • Anorexia nervosa (anorexia)

Tics and compulsions in OCD

There is a clear and close relationship between tics and obsessive-compulsive disorder. About 30–60% of patients with so-called Tourette's syndrome have obsessive thoughts and / or compulsive actions. Complex tics are often difficult to distinguish from compulsions.

++ More on the topic: Treatment for Obsessive Compulsive Disorder ++

Find out here why compulsions and other mental disorders are not taboo and why it is important to speak openly about them.

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Dr. Martin Aigner, Dr. med. Lisa Demel, Univ. Prof. Dr. Ilse Kryspin-Exner, clinical psychologist
Editorial editing:
Silvia Hecher, Mag. (FH), MSc

Status of medical information:

German Institute for Medical Documentation and Information (DIMDI), Graubner B (Ed.): ICD-10-GM 2009 - Systematic Directory: International Statistical Classification of Diseases and Related Health Problems - 10th Revision - German Modification. Deutscher Ärzte-Verlag 2008

Franklin ME et al .: Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. Journal of the American Medical Association, September 2011

World Federation of Societies of Biological Psychiatry (WFSBP): Guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision. In: The World Journal of Biological Psychiatry 2008

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