Obsessive Compulsive Disorder

What is Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorder (OCD) is an illness that has psychological symptoms but is thought to have a biological cause. It is characterized by recurring, unwanted thoughts, mental images, or impulses (called obsessions) and/or repetitive, ritualized behaviors that the person affected feels driven to perform (called compulsions).

What are Obsessions?

Obsessions are ideas, thoughts, or images, or impulses that are usually experienced as senseless, unpleasant, distasteful, or even repugnant. They usually involve doubt, worry, fear of contamination or fear of one's own aggression. They continue even though a person may try to ignore or suppress them. They are experienced as unpleasant and may provoke anxiety, guilt, shame, or other uncomfortable emotions. The most common obsessions are concerns that objects or other people might be "contaminated" by contact with germs, disease, dirt, chemicals, etc. The feeling of contamination is accompanied by an urge to wash or to clean. Other obsessions focus on fears that doors or windows have been left unlocked, appliances have been left on, important papers have been thrown away, mistakes have been made, etc.

Frightening thoughts about burglary, fire, and other losses often accompany these fears, forming part of the obsessive ideas. Some obsessive thoughts concern accidents or unfortunate events that might occur unless one superstitiously repeats particular actions or thoughts to prevent the disaster. Other obsessions take the form of unwanted urges or impulses to do something harmful, such as to be violent toward a loved one, or to fear unrealistically that you have hurt someone. One may worry incessantly that something has been lost or misplaced. Others experience the intrusion of nonsensical sounds, words, numbers, images, or blasphemous thoughts (if a religious person). Some people experience horrific or upsetting images.

Obsessions can take many forms. Ordinary people are concerned by many of the ideas, thoughts, images, or impulses underlying obsessive fears. Most of us are concerned about AIDS and other, diseases, and about harmful chemicals in the environment. We are careful not to leave hot appliances near materials, which might catch fire. We periodically experience odd impulses-Or form upsetting images. However, for those with OCD, the fear and guilt or other unpleasant emotions are out of proportion to the actual risk of danger or harm, driving them to carry out compulsions to rid themselves of the worry.

What are Compulsions?

Compulsions, also called rituals, are usually actions that are repeated in response to obsessions. Sometimes they are thought patterns that are performed to rid oneself of a disturbing obsession. Rituals are usually carried out according to certain rules or in a rigid fashion 'and are clearly excessive. These actions usually take the form of excessive or unrealistic attempts to prevent some dreaded event, such as getting a disease car being robbed. They are either distressing or so time consuming that they interfere with the daily routine. The person may recognize that the rituals are not reasonable but feels unable to control them. Children especially may not recognize that the rituals are not reasonable. Most compulsions are logically related to the type of obsessive ideas they attempt to reduce or prevent, although this is not always true. Because they temporarily reduce discomfort, rituals become habitual, and the person with OCD often has difficulty controlling them.

Examples of compulsions include:

• Hand washing, showering, or cleaning to remove "contamination."
• Checking to prevent feared dangers such as theft, fire, or loss of important things.
• Repeating actions or thoughts to prevent a catastrophic event from happening.
• Having to arrange objects in a particular way before beginning an activity.
• Needing repeated reassurance from others that a feared event has not or cannot happen.
• Endlessly checking to be sure that doors are locked or appliances turned off.
• Repeatedly retracing an automobile route to be sure that your car has not struck a pedestrian.
• Having to go through a door several times before you leave.
• Counting the number of times you do something.
• Touching

Some compulsions are performed mentally without any behavioral manifestation. Examples include praying to relieve guilt about an unwanted idea and repeating phrases or images in one's mind to prevent a catastrophe.

What Causes OCD?

The exact causes of OCD are unknown. However, many researchers now believe that OCD is biochemical in nature, caused by improper brain functioning. There is evidence that an abnormality in brain connections involving a neurotransmitter called serotonin may be involved. Additionally, psychological factors, stress, and simply engaging in the compulsive acts may heighten symptoms. OCD is not caused by family problems or attitudes learned in childhood, but this problem with brain functioning is commonly passed down genetically.

How Common is OCD?

• About 2.3% of the U.S. population ages 18 to 54 (approximately 3.3 million Americans) has active OCD in any given year
• OCD afflicts both men and women in equal numbers
• OCD typically begins during adolescence or early childhood; at least one-third of the cases of OCD diagnosed in adults began in childhood.
• Surveys estimate that in the U.S., as many as 1 in 40 adults and 1 in 100-200 children and teens may have OCD. It is hard to know for sure because...
• Most people who suffer from OCD hide their difficulties for many years before seeking help. In fact, many patients hide their OCD symptoms even after seeking help.

What Treatments are Available for OCD?

The only effective form of psychological treatment for OCD is behavior therapy. A type of behavior therapy known as "exposure and response prevention" is very useful for treating OCD. In this approach, a person deliberately and voluntarily exposes themselves to whatever triggers the obsessive thoughts, and then used techniques they have learned to avoid performing the compulsive rituals and to deal with the resulting anxiety. This type of treatment is very effective, but requires a strong commitment from the patient in order to employ it regularly.

Treatments which combine medications and behavioral therapy are often effective. Several medications that have strong serotonin effects have been proven effective in helping people with OCD:

• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Fluvoxamone (Luvox)
• Clomipramine (Anafranil)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• L-Citalopram (Lexapro)

Treatment with these medication sometimes requires a higher dose than is usually effective for treating people with depressive, and it usually takes much longer for the medication to begin working (6 to 13 weeks). If the first drug at the highest tolerable levels and a long enough trial period does not work, another should be tried. A number of new medications that may be effective for OCD are currently being studied to determine if they actually are effective or have any advantages over the current treatments.

Does OCD go Away?

Most patients with Obsessive-Compulsive Disorder experience a waxing and waning of symptoms. There are some people who have one episode of OCD and then remain symptom free for the rest of their lives. However, the majority of patients experience a flare-up of symptoms during stressful periods and times of change. At present, there are no cures for OCD, but there are effective forms of treatment.

OCD is sometimes accompanied by depression, eating disorders, substance abuse, attention deficit hyperactivity disorder, or other anxiety disorders. When a person also has other disorders, OCD is often more difficult to diagnose and treat. Symptoms of OCD can also coexist and may even be part of a spectrum of other brain disorders, such as Tourette's syndrome. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD.

Family Guidelines

Families typically respond to members with OCD in unhelpful ways by:

1. Assisting in the rituals to keep the peace
2. Not participating in the rituals, but allowing them
3. Refusing to acknowledge that the rituals exist
4. Punishing the person with OCD for the rituals
5. Arguing against seeking help

Families can help the person with OCD by recognizing the symptoms, seeking professional help, and learning about OCD from various resources.

Resources

There are many books, videos, and organizations that can provide a wealth of knowledge about OCD. Here is one:

OC Foundation Inc.
P.O. Box 70
Milford, Connecticut 06460
Tel: (203) 878-5669 Fax: (203) 874-2826 Infoline: (203) 874-3843
Website: www.ocfoundation.org