According to the DSM IV, One must meet the following criteria in order to be diagnosed with Obsessive Compuslive Disorder:

A. Either obsessions or compulsions:

Obsessions as defined by (1), (2), (3) and (4):

1. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
   
2. The thoughts, impulses, or images are not simply excessive worries about real-life problems.
   
3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.
   
4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion).

Compulsions as defined by both (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
   
2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.

C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the persons normal routine, occupational (or academic) functioning, or usual social activities or relationships.

D. If another disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g, preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).

E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Postpartum Obsessive Compulsive Disorder

Obsessive Compulsive Disorder affects about three to five percent of women after giving birth. (Bennett, S.S. et. al. 2003) Symptoms include:

• Intrusive, repetitive and persistent thoughts, usually about something bad happening to the baby. You may also have thoughts about killing yourself, the baby or someone else. (Obsessing)
  
• Tremendous sense of anxiety, horror and disgust about these thoughts. (You could never imagine carrying them out.)
  
• Repetitive behavior in an attempt to reduce the anxiety resulting from these thoughts. (Compulsions) i.e. not letting anyone hold the baby, avoiding holding the baby yourself, hiding the knives, trying not to be alone with the baby, etc.

According to the DSM IV, One must meet the following criteria in order to be diagnosed with Panic Disorder:

A. Both (1) and (2):

1. Recurrent unexpected Panic Attacks (see below)
   
2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
   • persistent concern about having additional attacks
     
   • worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
     
   • a significant change in behavior related to the attacks

B. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

C. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Post Traumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).

A panic attack is a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

• palpitations, pounding heart, or accelerated heart rate
  
• sweating
  
• trembling or shaking
  
• sensations of shortness of breath or smothering
  
• feeling of choking
  
• chest pain or discomfort
  
• nausea or abdominal distress
  
• feeling dizzy, unsteady, lightheaded, or faint
  
• derealization (feelings of unreality) or depersonalization (being detached from oneself)
  
• fear of losing control or going crazy
  
• numbness or tingling sensations in your hands and/or feet
  
• fear of dying
  
• paresthesias (numbing or tingling sensations)
  
• chills or hot flushes

Postpartum Panic Disorder

Panic Disorder occurs in about ten percent of women during and after childbirth. (Bennett, S.S. et. al. 2003) Symptoms can include fear of getting pregnant again. Also Read Fear of Childbirth

These conditions improve with treatment. According to the University of Maryland Medical Center, treatment options for anxiety disorders include:

Treatment Plan

If a physical cause is identified as the reason for your anxiety, your health care provider can make a treatment plan for you. There are also several ways to treat anxiety that has no physical cause. Short-term counseling can boost your self-esteem and help you learn coping strategies and problem-solving techniques. Your health care provider may also suggest trying a method of relaxation, such as deep breathing techniques. Occasionally, your health care provider may prescribe drugs to help until you have mastered these techniques.

Drug Therapies

Prescription

Antianxiety Medications

• Benzodiazepines -- a group of drugs that help reduce anxiety and have sedating effects. They may cause drowsiness, constipation, or nausea. Do not take these drugs if you have narrow-angle glaucoma, a psychosis, or are pregnant.
• Buspirone (BuSpar) -- an anti-anxiety drug that does not appear to cause drowsiness. However, you must take it for 2 weeks before feeling any effect. Side effects include insomnia, nervousness, light-headedness, upset stomach, nausea, diarrhea, and headaches.

Antidepressant Medications

• Tricyclic antidepressants -- a group of drugs that relieve depression (which can accompany anxiety). These medications tend to have numerous side effects.

Over the Counter

N/A

Complementary and Alternative Therapies

Mind-body techniques, nutrition, exercise, and herbs may treat anxiety. Progressive muscle relaxation, diaphragmatic breathing, biofeedback, meditation, and self-hypnosis can help you relax and reduce your anxiety. A regular program of exercise can help treat generalized anxiety disorder and panic attacks. Talk with your health care provider about these techniques.

Nutrition

• Avoid caffeine, alcohol, nicotine, sugar, and refined foods,. Cut down on foods that are known to cause allergies. Common food allergens are dairy, soy, citrus, peanuts, tree nuts, wheat, fish, wheat, fish, eggs, corn, food colorings, and additives. Eat more fresh vegetables, whole grains, and protein to nourish your nervous system,.
• Calcium (1,000 mg per day), magnesium (400 to 600 mg per day), and B complex (50 to 100 mg per day) help support the nervous system and minimize the effects of stress.

Herbs

Herbs can be a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not use tinctures. Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures singly or in combination as noted.

A tea (3 to 4 cups per day) or tincture (10 to 20 drops 4 to 6 times per day) from the following herbs will help reduce anxiety and strengthen the nervous system.

• Kava kava (Piper methysticum) for mild to moderate anxiety. The FDA has issued a warning concerning kava's effect on the liver. In rare cases, severe liver damage has been reported. If you take kava, do not use it for more than a few days, and tell your doctor before taking it.
• Valerian ( Valeriana officinalis ) and lemon balm ( Melissa officinalis ), or valerian combined with St. John's wort (Hypericum perforatum) for mild to moderate anxiety. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines; barbiturates, narcotics; antidepressants; and antihistamines. Do not take valerian if you are pregnant or nursing. Valerian can also affect the liver, so do not take it if you have liver problems. St. John's wort can affect other drugs you may be taking, including antidepressants, birth control, or other medications. You should avoid St. John's wort while pregnant or nursing. Talk to your doctor before using St. John's wort with any other medications.
• Other herbs sometimes suggested for anxiety include passionflower (Passiflora incarnata), ginger (zingiber officinalis), chamomile (Matricaria chamomilla), lemon balm, and licorice (glycyrrhiza glabra). Avoid licorice if you have heart failure, heart disease, kidney or liver disease, or high blood pressure. Do not take licorice if you take a diuretic, blood thinner, or anti-depressant such as Prozac.

You may take kava kava (100 to 200 mg 2 to 4 times a day) and valerian (150 mg 2 to 3 times per day) as a dried extract to maximize its effect on moderate anxiety.

Essential oils of lemon balm, bergamot, and jasmine are calming, and you can use them as aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of anxiety based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconitum -- for anxiety accompanied by irregular or forceful heartbeat, shortness of breath, or fear of death.
• Arsenicum album -- for excessive anxiety that has no clear cause and is accompanied by restlessness, especially after midnight. It also may be used for perfectionists, including children, who worry about everything.
• Phosphorus -- for an impending sense of doom and anxiety when alone. It also may be used for impressionable adults and children who are easily influenced by the anxiety of others.
• Lycopodium -- for performance and other types of anxiety in those who are insecure, yet hide their low self-esteem with arrogance and bravado. It also may treat children with anxiety accompanied by bedwetting.
• Gelsemium -- for performance anxiety resulting in diarrhea, headache, dizziness, weakness, shakiness and trembling, or trouble speaking.
• Argentum nitricum -- for performance anxiety (such as before tests in school-age children) with rapid heart rate, feeling of faintness, diarrhea, or flatulence.

Acupuncture

Some evidence shows that acupuncture can help reduce the symptoms of anxiety, particularly when combined with behavioral desensitization (including psychotherapy). One study showed that benefits continued as long as one year after treatment. Acupuncturists treat people with anxiety based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. With anxiety, a qi deficiency is often detected in the kidney or spleen meridians. In addition to performing needling techniques, acupuncturists may also employ lifestyle and breathing techniques as well as herbal and dietary therapy.

Massage

Therapeutic massage can help reduce anxiety and alleviate stress.

Following Up

Follow your health care provider's instructions, and practice relaxation techniques as needed.

Special Considerations

Be sure to tell your health care provider if you are pregnant. Call your provider if you experience any significant side effects from prescribed medications.

While the herbal tea suggested above is safe during pregnancy, you should avoid the dried extracts of kava kava, valerian and St. John's wort if you are pregnant or nursing.

• Bennett, S.S., Indman, P.: Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression. San Hose, CA, Moodswing Press, 2003.
  
• DSM IV
• Alternative Treatment Options for Anxiety from The University of Maryland Medical Center (UMMC)