OBSESSIVE-COMPULSIVE DISORDER

DEFINITION

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. A person with an anxiety disorder worries excessively about the circumstances of his or her life over a long period of time. OCD is characterized by distressing thoughts that never seem to go away. These thoughts are often accompanied by images that are powerful, unusual, frightening, or absurd.

A person with OCD deals with these thoughts and feelings with ritualized actions. A ritualized action is a behavior that is performed again and again in exactly the same way. Patients believe that these actions will protect them from the terrible thoughts in their minds. Ritualized actions are often unusual and meaningless. They are also called compulsions or compulsive behaviors.

OCD is sometimes known as the "disease of doubt." The patient often knows that his or her obsessive thoughts and ritualized actions are not rational (make no logical sense). Yet he or she may still worry that the fears may be true.

DESCRIPTION

About one out of every forty people will experience obsessive-compulsive disorder at some time in their lives. It occurs with equal frequency among men and women, all ages, and all ethnic groups. Many people with the disorder try to hide their condition from other people. Yet they are unable to avoid acting out their compulsions.

Most people with OCD have both obsessions and compulsions. Some people may have only obsessions or only compulsions. The extent to which OCD affects a person's daily life varies. Some people are barely bothered. Others are terribly troubled by their obsessions. They may spend a large part of the day carrying out their compulsive behaviors.

An obsession is an irrational thought that occurs again and again. As an example, a person might think, "My hands are dirty, and I must wash them again." The person's hands may be (and probably are) totally clean. Yet the person cannot get the thought out of his or her mind that the hands are still dirty.

Some typical obsessions include:

• Fear of dirt, germs, or contamination
• A desire to perform violence on other people
• A feeling of responsibility for other people's safety
• Fear of hitting a pedestrian with a car
• Excessive religious feelings
• Intense sexual thoughts

A compulsion is a particular behavior that is performed repeatedly to protect against an obsession. Some common compulsions are excessive washing (especially hand washing or bathing); housecleaning; and touching, counting, arranging, or hoarding objects. The patient may feel better while performing these actions. But that sense of satisfaction does not last long. Soon, the person will feel the need to do the action again.

For a person with OCD, a compulsive behavior is a form of protection. He or she feels that something terrible will happen if the behavior

An obsessive fear of dirt and germs can lead to compulsive handwashing. (©

Eric Nelson

. Reproduced by permission of

Custom Medical Stock Photo

.)

is not repeated. The behavior may relieve stress for a short time, but it does not bring any kind of pleasure to the patient.

OCD is sometimes related to other emotional disorders. For example, some people feel a constant urge to pull hair out of their bodies. Others are constantly afraid of catching some terrible disease. Still others worry that there is something wrong with the way their bodies look. OCD is often linked with depression (see depressive disorders entry) and other anxiety disorders.

CAUSES

The cause of obsessive-compulsive disorder has not yet been found. Many researchers believe that it may be inherited. If one person in a family has OCD, there is a 25 percent chance that another family member will also have the condition. Stress and other psychological factors may also contribute to the development of OCD.

One popular theory is that OCD is caused by low levels of seratonin (pronounced sihr-uh-TOE-nun), a neurotransmitter. Neurotransmitters are chemicals that occur in the brain. They are responsible for delivering electrical signals from one nerve cell to another and help control many of the mental activities that occur in the brain.

Some researchers think that OCD develops when the brain produces too much or too little of some particular neurotransmitter. In such a case, nerve messages cannot travel smoothly from one part of the brain to another. They may begin to recycle—that is, to travel again and again across the same set of nerves. This constant repetition of nerve messages might be responsible for the repetitive behavior characteristic of compulsions.

Another theory is that OCD may be related to childhood episodes of strep throat (see strep throat entry), a bacterial infection. In some children, strep throat antibodies attack a certain part of the brain. Antibodies are chemicals produced by the immune system. Their job is to fight off infections. But antibodies can sometimes cause damage to the body itself. Researchers think that damage to the brain caused by strep throat antibodies may lead to obsessions and compulsions such as fear of germs and excessive hand washing. Some children with OCD have benefited from treatment with antibiotics.

SYMPTOMS

While some children may experience OCD, symptoms usually begin when a person reaches adolescence. While everyone has a tendency to double check to make sure that the doors are locked or the stove is turned off when leaving the house, the compulsions of OCD sufferers are so great that they may interfere with daily life. Individuals with the disorder have been known to wash their hands for hours at a time or to rearrange and clean their household several times throughout a day. They usually recognize that their behavior is irrational, but they have no control over their actions.

DIAGNOSIS

Psychiatrists diagnose obsessive-compulsive disorder based on the described symptoms. No blood tests or other kinds of laboratory tests are available for diagnosing OCD. Many people with the condition are never diagnosed or are diagnosed only after many years. The delay in diagnosis is due to the shame that many patients feel about their condition. They become skillful at hiding their symptoms from other people.

TREATMENT

Two forms of treatment are used with obsessive-compulsive behavior: drugs and cognitive-behavioral therapy. The drugs used with OCD are designed to alter the amount of neurotransmitters in the brain. They include fluoxetine (pronounced floo-AHK-suh-teen, trade name Prozac), paroxetine (pronounced par-AHK-suh-teen, trade name Paxil), and sertraline (pronounced SIR-truh-leen, trade name Zoloft). An older drug that is sometimes used is clomipramine (pronounced KLO-mip-ruh-meen, trade name Anafranil). However, Clomipramine has more side effects than the newer drugs listed.

Cognitive-behavioral therapy is a form of counseling conducted by trained medical professionals. The goal is to help patients understand the basis of their disorder. They are encouraged to accept the fact that they have fears and obsessive thoughts. Then they are helped to find ways to tolerate the conditions that cause their anxiety and avoid performing the ritualistic activities of their compulsions. Patients sometimes find it helpful to think about other things by taking up a hobby or finding activities of interest.

Some patients do not benefit from drugs or cognitive-behavioral therapy. Brain surgery is the treatment of last resort with these patients. Surgery involves removing the small part of the brain that controls compulsive behavior. The surgery is successful in about a third of all cases. It may have very serious side effects, however, including seizures, personality changes, and loss of some mental functions.

Alternative Treatment

St. John's wort is sometimes recommended as a treatment for OCD. St. John's wort is an herb that has long been used to treat anxiety and depression. Some practitioners believe that the herb has the same effect on neurotransmitters as the conventional drugs described. Research suggests that a very small fraction of people with OCD may benefit from the use of St.-John's-wort.

Some people believe that homeopathic treatments can help people with OCD. They try to rebalance a patient's mental, emotional, and physical wellbeing, allowing compulsive behaviors to disappear over time.

Chloe Ruth, age fourteen, takes medication for her anxiety and obsessive-compulsive disorder. Obsessive-compulsive disorder occurs with equal frequency among men and women, all age groups, and all ethnic groups. (Reproduced by permission of

AP/Wide World Photos

)

PROGNOSIS

The prognosis for obsessive-compulsive disorder varies widely among patients. If left untreated, the condition can last for decades. People go through periods when symptoms alternate between mild and severe. The symptoms usually get worse with age.

Treatment with drugs and cognitive-behavioral therapy can be very helpful. Some people recover from the disorder completely. They may need to stay on some type of treatment program for many years, however, or even for life. About 20 percent of all OCD patients do not respond to any form of treatment. These individuals may require hospitalization.

Many people with OCD can eventually live happy and productive lives. They find success in nearly every career field, from doctors and lawyers to businesspeople and entertainers. Keeping the condition under control can be very difficult, however. It may require a considerable emotional effort and a serious financial investment.

PREVENTION

There are no known ways to prevent obsessive-compulsive disorder.

FOR MORE INFORMATION

Books

Dumont, Raeann. The Sky Is Falling: Understanding and Coping with Phobias, Panic, and Obsessive-Compulsive Disorder. New York: W. W. Norton & Company, 1996.

Foa, E., and R. Wilson. Stop Obsessing! How to Overcome Your Obsessions and Compulsion. New York: Bantam Books, 1991.

Schwartz, Jeffrey. Free Yourself from Obsessive-Compulsive Behavior: A Four-Step Self-Treatment Method to Change Your Brain Chemistry. New York: HarperCollins, 1996.

Swedo, S. E., and H. L. Leonard. It's Not All in Your Head. New York: HarperCollins, 1996.

Organizations

Anxiety Disorders Association of America. 11900 Parklawn Drive, Suite 100, Rockville, MD 20852. (301) 231-9350. http://www.adaa.org.

National Alliance for the Mentally Ill. 200 N. Glebe Road, #1015, Arlington, VA 22203-3728. (800) 950-NAMI. http://www.nami.org.

National Mental Health Association. 1021 Prince Street, Alexandria, VA 22314-2971. (800) 969-NMHA. http://www.nmha.org.

Obsessive-Compulsive Anonymous. PO Box 215, New Hyde Park, NY 11040. (516) 739-0662. http://members.aol.com/west24th.