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 "OCD is a medical
brain disorder that causes problems in information processing. It's not your fault or the result of a "weak" or unstable
personality."
"I couldn't do anything without rituals. They invaded every
aspect of my life. Counting really bogged me down. I would wash my hair 3 times as opposed to once because 3 was a good luck
number & 1 wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night,
I had to set it to a number that wouldn't add up to a "bad" number."
The disturbing thoughts or images are called obsessions
& the rituals performed to try to prevent or get rid of them are called compulsions. There
is no pleasure in carrying out the rituals you're drawn to, only temporary relief from the anxiety that grows when you don't perform them.
A large body of scientific evidence suggests
that OCD results from a chemical imbalance in the brain.
For years, mental health professionals incorrectly
assumed OCD resulted from bad parenting or personality
defects.
Clinical researchers have
implicated certain brain regions in OCD. They have discovered a strong link between OCD & a brain chemical called serotonin. Serotonin is a neurotransmitter that helps nerve cells communicate.
Scientists
have also observed that people with OCD have increased metabolism in the basal ganglia &
the frontal lobes of the brain. This, scientists believe, causes repetitive movements, rigid thinking & lack of spontaneity.
Successful treatment with medication or behavior therapy produces a decrease in the over activity of this brain circuitry. People with OCD often
have high levels of the hormone vasopressin.
In layperson's terms, something
in the brain is stuck, like a broken record. Judith Rapoport, M.D., describes it in her book, The Boy
Who Couldn't Stop Washing, as "grooming behaviors gone wild."
Characteristics & Course
OCD is characterized
by obsessions & compulsions. However, it isn't the only disorder with these symptoms. Obsessions are recurring thoughts, urges or images; in OCD these are experienced as alien, intrusive & distressing.
Compulsions are
repetitive behaviors (rituals) that patients feel compelled to perform.
Obsessions & compulsions
can take many forms. In recent years, public awareness of OCD has been raised by movies
& television shows featuring characters with OCD contamination obsessions
& typical cleaning & hand-washing compulsions.
Another familiar set of
symptoms is an obsessive fear accompanied by a compulsion to check (e.g., fearing burglars & repeatedly checking that doors & windows are locked shut).
However, not all
obsessions & compulsions come in neat, sensible pairings.
Typical obsessions
are listed in Table 1; these include preoccupation with contamination, unacceptable violent or sexual thoughts, doubting, concern about asymmetry or imperfections & thoughts that something will go wrong.
Typical rituals
are listed in Table 2; these include washing, cleaning, checking, counting, repeating & arranging. Although some patients
may have obsessions without any compulsions, often the compulsive behaviors are simply not recognized as they can be mental acts or very subtle behaviors.
An OCD
patient might need to have specific thoughts or mental images in order to counter an obsession (e.g., the image of a loved one being harmed might be countered by picturing something good happening to the
person).
Patients who have fearful thoughts may hold their breath until the thought passes, shake their head, or blink. Patients generally perform rituals to reduce anxiety
created by thoughts of fearful consequences.
However, some
patients perform rituals simply because of a general sense of foreboding or because it feels wrong if they do not.
OCD
patients usually have good insight. They recognize that their fears are unrealistic,4 yet, their distress compels them to perform rituals.
In their worst
moments, insight may waver & fears may seem not only realistic but inevitable unless the ritual is performed.
Although in
severe cases of OCD insight may be lost, it must have
been present at some time to meet diagnostic criteria.5 It's normal to have occasional unwanted thoughts or perform repetitive or superstitious behaviors accompanied by transient anxiety, but an OCD diagnosis requires that symptoms cause marked distress, be time consuming (≥1 hour/day), or significantly interfere with functioning.5
OCD
onset is often in late adolescence or young adulthood, though it can begin at any age. Childhood onset isn't rare.
Onset is earlier in males than in females. The course is chronic & waxes & wanes in severity, often in response to
stress.
OCD strikes people of
all ethnic groups w/males & females equally affected.
The social & economic
costs of OCD were estimated to be $8.4 billion in 1990 (DuPont et al, 1994).
People can
be so ashamed of their compulsions & obsessions that they refuse
to seek treatment or allow anyone to know they're dealing w/ OCD.
OCD symptoms usually
begin during the teen years or in early adulthood & recent research shows that some children develop the illness at earlier ages, even during the preschool years.
Studies
also indicate that at least 1/3 of the cases of OCD in adults began in childhood.
Experiencing OCD
during early stages of a child's development can cause severe problems for the child. It's important that the child receive evaluation & treatment by an experienced mental health professional to prevent
the child from missing important opportunities because of this disorder.
OCD is a medical brain disorder
that causes problems in information processing. It's not your fault or the result of a "weak" or
unstable personality.
"Symptoms"
of Obsessive Compulsive Disorder
OCD is a very real,
chronic, often severe condition that's associated w/recurrent intrusive thoughts that cause
extreme discomfort or anxiety (obsessions) &/or senseless repetitive actions (compulsions)
that are performed in an effort to try to reduce discomfort & anxiety.
OCD's symptoms can range from:
- Counting things over & over
In today's society
the symptoms are often confused w/highly driven individuals who're in total control of their environment.
Personal hygiene,
domestic cleanliness & perfectionism are usually regarded as virtues:
- Perfect grooming turns heads
- A spotless house wins praise
- Corporate culture rewards organizational skills
- Counting objects is a common obsession
What are some common obsessions?
The following are some common obsessions:
- Fear of dirt or germs
- Disgust with bodily waste or fluids
- Concern with order, symmetry (balance) & exactness
- Worry that a task has been done poorly, even when the person
knows this is not true
- Fear of thinking evil or sinful thoughts
- Thinking about certain sounds, images, words or numbers all the time
- Need for constant reassurance
- Fear of harming a family member or friend
Copyright © 1994-2005 American Academy of Family Physicians
Permission is granted to print and photocopy this material for nonprofit educational uses. Written permission is required
for all other uses, including electronic uses
While those experiencing
OCD continue on their way, obsessing & performing their compulsions, many people who
are unaware of the OCD, praise them for their efficiency & organizational
skills.
There's such a
thing as too much of a good thing though!
Individuals with OCD
feel more like someone mysteriously enslaved by incomprehensible forces beyond his or her control. The urges to continually fulfill their tasks can often cause further problems, such as:
more symptoms
- Persistent, unpleasant, & unwelcome mental images, often
with a violent theme
- Uncontrollable urges to count, touch or reorganize everything
in sight
- Repeatedly checking that the door is locked or the stove is
turned off because you're convinced that disaster will strike unless you do so
Most Common
Obsessive Intrusive Thoughts
Fear
of Contamination
Fearing dirt, germs, cancer, AIDS, bodily waste, asbestos, chemicals, radiation, sticky substances - causing common compulsions, i.e. - ritualistic hand washing
Fear of Causing Harm to Others:
Putting
poison in food, spreading illness, smothering a child, pushing a stranger in front of a car, running over a pedestrian -
common compulsion that occurs -
repeating or checking behavior
Imagining
losing control of aggressive urges - common compulsion that occurs - checking
Fear of Making a Mistake:
Setting fire to the house, flooding the house,
losing something valuable, bankrupting the company - common compulsion that occurs - praying
Fear of Behaving in a Socially Unacceptable Manner:
Swearing, making sexual advances,
saying the wrong thing - common compulsion that occurs
- touching
Excessive religious or moral doubt
- common
compulsion that occurs - counting
A need to have things "just so" - common
compulsion that occurs - Hoarding
or saving
OCD has been described as, "hiccups of the mind."
Obsessions: recurrent or persistent mental images, thoughts or ideas, which may result in compulsive behaviors, repetitive, rigid & self-prescribed
routines that are intended to prevent the manifestation of the obsession.
OCD often co-exists with depression & anxiety. Individuals recognize that the obsessive thoughts & ritualized behavior patterns
are senseless & excessive although they can't stop them, in spite of strenuous efforts to ignore or suppress the thoughts or actions.
Obsessions & compulsions don't always coexist; over 1/2 of OCD sufferers have obsessive thoughts without ritualistic behavior. There's some evidence that the symptoms improve over time & that nearly 1/2 will
eventually recover completely or have only minor symptoms.
OCD is time-consuming,
distressing & can disrupt normal functioning. Much research suggests that a critical feature in this disorder is an overinflated sense of responsibility, in which the patient's thoughts center around possible dangers & an urgent need to do something about it.
The obsessive thoughts or images can range from mundane worries about whether one has locked a door to bizarre &
frightening fantasies of behaving violently toward a loved one.
The compulsive
acts triggered by such obsessions might include repetitive checking for locked doors or unlit stove burners or calls to loved
ones at frequent intervals to be sure they're safe.
Some people are
compelled to wash their hands every few minutes or spend inordinate amounts of time cleaning their surroundings in order to
subdue the fear of contagion.
Certain other obsessive
disorders, including body dysmorphic disorder (BDD), trichotillomania & Tourette's syndrome, may be part of the OCD spectrum.
-
In BDD, people
are obsessed believing they're extremely ugly.
-
People with trichotillomania continually
pull their hair, leaving bald patches.
-
Symptoms of Tourette's syndrome include jerky
movements, tics & uncontrollably uttering obscene words.
OCD shouldn't be
confused w/obsessive-compulsive personality, which defines certain character traits (e.g., being a perfectionist, excessively consciousness, morally rigid & preoccupied w/rules &
order).
These traits don't
necessarily occur in people w/obsessive-compulsive disorder, which is a psychiatric condition.
Common
Compulsive Ritualistic Behaviors
Associated w/OCD
Cleaning/Washing
Hand washing, showering or cleaning oneself repeatedly
Checking/Questioning
Checking to see if light switches, appliances &
faucets are off; if doors are locked; numbers are correct
Collecting/Hoarding
Collecting old objects, mail
or trash to the point of filling up one's home
Counting/Repeating
Counting to a certain number or counting objects
over & over; repeatedly performing a movement or set of movements before being able to move on.
Arranging/Organizing
Arranging items in perfect symmetry or in a particular order (i.e., cans or books on shelves)
What are some common compulsions?
The following are some common compulsions:
- Cleaning & grooming, such as washing hands, showering or
brushing teeth over & over again
- Checking drawers, door locks & appliances to be sure they
are shut, locked or turned off
- Repeating, such as going in & out of a door, sitting down
& getting up from a chair, or touching certain objects several times
- Ordering & arranging items in certain ways
- Counting over & over to a certain number
- Saving newspapers, mail or containers when they're no longer
needed
- Seeking constant reassurance & approval
Copyright © 1994-2005 American Academy of Family Physicians
Permission is granted to print and photocopy this material for nonprofit educational uses. Written permission is required
for all other uses, including electronic uses.
Co-existing Disorders
OCD is sometimes accompanied by:
A person having
more than one disorder find that OCD is often more difficult to diagnose & treat.
Symptoms
of OCD can also coexist & may even be part of a spectrum of neurological disorders, such as Tourette's
syndrome.
Appropriate diagnosis & treatment of other disorders are important
to successful treatment of OCD.
How do people w/OCD typically
react to their disorder?
People w/OCD generally
attempt to hide their problem rather than seek help. Often they are remarkably successful in concealing their obsessive-compulsive
symptoms from friends & co-workers.
An unfortunate consequence
of this secrecy is that people w/OCD generally don't receive professional help until years after the onset of their disease.
By that time, the obsessive-compulsive
rituals may be deeply ingrained & very difficult to change.
Other mental illnesses possibly linked
to OCD are:
Genetic
studies of OCD & other related conditions may enable scientists to pinpoint the molecular basis of these disorders.
Other theories about the causes of OCD focus on the interaction between behavior
& the environment, on beliefs & attitudes, as well as how information is processed. These behavioral & cognitive theories aren't incompatible w/biological explanations.
Are other illnesses associated with OCD?
People with OCD often have
other kinds of anxiety, like phobias (i.e., fear of spiders or flying) or panic attacks.
They may also may have:
Having one or more of these disorders
can make diagnosis & treatment more difficult, so it's important to talk to your doctor about any symptoms you have, even
if you're embarrassed.
Copyright © 1994-2005 American Academy of Family Physicians
Permission is granted to print and photocopy this material for nonprofit educational uses. Written permission is required
for all other uses, including electronic uses.
Treatment of OCD
Researchers have found that clomipramine (Anafranil), an antidepressant medication, helps alleviate painful, intrusive thoughts & repetitive
behaviors. Clomipramine has a powerful effect on the neurotransmitter serotonin & helps increase
the amount of this important brain chemical to improve communication between the nerve cells.
2 other antidepressant medications, sertraline (Zoloft) <click the underlined link, left,
to read info included w/the purchase of Zoloft - difficult reading> & fluoxetine (Prozac), have also been shown to be effective in easing
symptoms.
Researchers are currently investigating 2 other medications, paroxetine & fluvoxamine, that may be equally effective in alleviating obsessions & compulsions.
Like clomipramine, these medications affect the level of neurotransmitters in the brain & have shown
great promise in treating obsessive-compulsive disorder.
As w/all medications, antidepressants have some side effects. The most common side effects are:
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