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Obsessive-Compulsive Disorder

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What is Obsessive-Compulsive Disorder (OCD)?
 
       Obsessive-Compulsive Disorder (OCD) is characterized by persistent, upsetting thoughts (obsessive thoughts or obsessions) and/or rituals (compulsive behaviors or compulsions) intended to control the anxiety that these thoughts produce. Most of the time, however, the rituals end up controlling the person.
 
        Healthy people have rituals, such as checking several times to see if the stove is turned off before leaving the house. The difference is that people with OCD perform their rituals even though doing so takes so long, sometimes up to several hours a day, that it interferes with daily life and is distressing to them. Although most adults with OCD realize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.
 
       OCD affects about 2.2 million American adults, and the problem can be accompanied by eating disorders, other Anxiety Disorders, or Depression. It affects men and women in roughly equal numbers and usually appears it childhood, adolescence, or early adulthood. Most people are first diagnosed at about age 19. One-third of adults with OCD developed symptoms as children, and research indicates that OCD might run in families.
 
       The course of the disorder is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves ("self-medicate").
 
One Person's Story:
 
       "I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times rather than once because three was a good-luck number and one wasn't. It took me forever to read anything because I'd have to count the lines in every paragraph. When I set my alarm clock at night I had to set it to a number that didn't add up to a bad-luck number.
 
       " Getting dressed in the morning was tough because I had a ritual, and if I didn't follow the ritual I'd get anxious and panicky and have to start all over again. I always worried that if I didn't do something right, my parents would die. I'd have these terrible thoughts of harming my parents. I knew that that was completely irrational, but the thoughts triggered more anxiety and more senseless rituals. Because of the amount of time I spent on rituals, I couldn't do a lot of things that were important to me.
 
       "I knew that the rituals didn't make sense, and I was deeply ashamed that I couldn't control my behavior. At first I was too embarrassed to get help, but a friend convinced me to call my doctor. I'm so glad that I did. I've been taking the medication that my doctor prescribed and seeing a therapist. The therapist taught me about OCD and helped me learn to cope with my fears and to stop wasting so much time on rituals."
 
What are the symptoms of Obsessive-Compulsive Disorder (OCD)?

       Common obsessions include:
  • repeated fears of contamination (becoming infected by shaking hands);
  • repeated doubts ( wondering whether or not you hurt someone in a traffic accident or left a door unlocked);
  • a need to have things in a particular order (intense distress when objects are disordered or messy;
  • aggressive or horrific impulses (to hurt your child or to shout an obscenity in church);
  • and sexual imagery (recurrent pornographic images).
       Common compulsions include both physical actions and mental actions. Physical actions include:
  • hand washing (a symptom of fear of contamination);
  • ordering (“A place for everything and everything in its place.”);
  • checking (making sure that the stove is turned off, the doors are locked, the iron is turned off, etc.);
  • repeatedly asking for reassurance (“You still love me, don’t you?”);
  • and performing sequences of certain actions (flipping the light switch on and off a certain number of times when entering and/or leaving a room).
       Mental actions include:
  • praying (praying constantly or saying different prayers for different times of day or situations);
  • counting (making sure that certain “bad” numbers are avoided, or doing things by threes, fours, etc.);
  • and repeating words silently to yourself (checking to make sure that you didn’t say the wrong thing or say something incorrectly).
       If a person becomes obsessed about germs or dirt, he may feel compelled to wash his hands over and over again, even to the point that they become cracked and bleeding. If he becomes obsessed about someone breaking into his house, he may feel compelled to lock and unlock all of the doors over and over again before being able to go to bed. If he becomes obsessed about being embarrassed in public, he may feel compelled to comb his hair over and over again in front of a mirror, even to the point that his hair begins to fall out and that he becomes "caught" in front of the mirror and can't move away from it. Performing such rituals isn't pleasurable for such people. At best, they obtain temporary relief from the anxiety caused by the obsessive thoughts.
 
What disorders often accompany Obsessive-Compulsive Disorder (OCD)?

       Obsessive-Compulsive Disorder does not seem to be associated with any general or specific medical conditions in adults, although excessive hand-washing in those with a fear of contamination may cause skin problems. OCD in adults is sometimes associated with Major Depressive Disorder, other Anxiety Disorders, Eating Disorders, and some Personality Disorders. In children, it’s sometimes associated with Learning Disorders and Disruptive Behavior Disorders. From 35% to 50% of children and adults with Tourette’s Disorder also suffer from OCD, although only 5% to 7% of those with OCD also suffer from Tourette’s. Childhood onset of OCD is sometimes associated with Group A beta-hemolytic streptococcal infection (scarlet fever and “strep throat”).

What causes Obsessive-Compulsive Disorder (OCD)?

       There's no single cause for OCD. Rather, it most likely results from a combination of genetic, biochemical, environmental, and psychological factors. OCD is a disorder of the brain. Brain-imaging scans such as magnetic resonance imaging (MRI) have shown that the parts of the brain responsible for regulating mood, thought, sleep, appetite, and behavior function abnormally in people with OCD. In addition, important neurotransmitters (chemical messengers) are out of balance. This knowledge doesn't explain WHY people develop OCD, however.

       OCD appear to run in families, suggesting a genetic component. OCD also occurs in people without family histories of OCD, however. The probability that anyone will experience OCD results from the interaction between multiple genes and environmental or other factors. In addition, trauma, the loss of a loved one, a difficult relationship, or any other significantly stressful situation may trigger OCD. Subsequent episodes of OCD may not have an identifiable trigger, though.

How is Obsessive-Compulsive Disorder (OCD) diagnosed?

       Even the most severe OCD is highly treatable. As is true of most medical and psychological disorders, the earlier that treatment begins the more effective it is and the higher the likelihood that recurrences can be prevented.

       The first step toward getting help is to see your Primary Care Provider (PCP), the medical provider whom you see for other disorders. Certain medications and medical conditions can cause the same symptoms as OCD. Your PCP can rule out these conditions by conducting a physical examination, asking questions, and/or ordering lab tests. If medications and medical conditions can be ruled out, your PCP will then prescribe an appropriate medication and/or refer you to a mental health professional for further evaluation.

       A mental health professional will conduct a complete diagnostic evaluation, including a discussion of any family history of OCD and other psychological disorders and a complete history of symptoms. This history will include when your OCD started; how long you've had OCD; how severe your OCD is; whether or not you've had OCD before; if so whether or not you received treatment and how successful that treatment was; whether or not alcohol and/or substance abuse are involved; whether or not there are other psychological disorders present; and whether or not you feel suicidal and/or are planning to harm or kill yourself.  

How is Obsessive-Compulsive Disorder (OCD) treated?

       Effective therapies for Obsessive-Compulsive Disorder (OCD) are available, and research is uncovering new treatments that can help most people with OCD lead productive, fulfilling lives. The most common treatments are medication, psychotherapy, and a combination of the two. Medication can’t cure OCD, but it can keep it under control while you participate in psychotherapy. The most common medications used to treat OCD are antidepressants, anti-anxiety drugs, and beta-blockers. Antidepressant medications were developed to treat depression but are also effective for anxiety. Although these medications begin to alter brain chemistry after the very first dose, their full effects require a series of changes to occur in the brain, so it usually take about four to sixs weeks for symptoms to begin to fade. It’s therefore important to take an antidepressant long enough for it to work for you.

       Antidepressants normalize the functioning of neurotransmitters (chemical messengers) in the brain, primarily serotonin, norepinephrine, and dopamine. These particular chemical messengers are involved in regulating mood, although there's still no complete understanding of how this occurs. These medications include newer types, such selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), and older types, such as tricyclics/tetracyclics (TCAs) and monoamine oxidase inhibitors (MAOIs). Wellbutrin (bupropion) is a unique antidepressant, unrelated to any other, which, while it's more effective for depression than anxiety, is sometimes used to treat anxiety by itself or in conjunction with an SSRI.
 
        Anti-anxiety medications, primarily benzodiazepines, reduce daytime anxiety and excessive excitement and generally quiet or calm people. At low doses they have few side effects other than drowsiness and dizziness; at higher doses they produce significant drowsiness and facilitate sleep. (WARNING; It is especially important to limit or better yet avoid alcohol while taking any benzodiazepine.) Because they are potentially addictive, benzodiazepines are typically prescribed for only short periods of time, especially for people with histories of alcohol and/or drug abuse. An exception to this is people with Panic Disorder, who can generally take benzodiazepines for up to a year without risk of harm. Some people experience withdrawal or discontinuation symptoms if they stop taking benzodiazepines abruptly instead of tapering off of them gradually. Some also experience rebound anxiety, a resurgence of anxiety stronger than they felt before starting on the medication. Unfortunately, these problems inhibit some Primary Care Providers from prescribing benzodiazepines in adequate doses or, in some cases, prescribing them at all. Buspar (buspirone), which is not a benzodiazepine, is a unique anti-anxiety medication primarily used to treat Generalized Anxiety Disorder (GAD). Unlike benzodiazepines, Buspar must be taken consistently for at least two weeks before it begins to provide significant benefit. Beta blockers such as Inderal (propranolol) are used to treat heart conditions, but can also be used to prevent the physical symptoms of some of the Anxiety Disorders, particularly Social Phobia. If one medication doesn't work, be open to trying another. People who don't improve after taking one medication increase their chances of getting better by switching to a different medication or adding a second medication.
 
       Psychotherapy involves talking with a trained mental health professional, such as a Counselor, Psychiatrist, Psychologist, or Social Worker, to explore what is causing the OCD and how to manage or eliminate the symptoms. Some types of psychotherapy are short-term (10 to 20 weeks) and others are long-term (more than 20 weeks). Which might be suitable for you can be determined between you and the mental health professional whom you see. There are many types of psychotherapy, all of which can be effective in treating OCD, but two types, Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), have well-established histories of being effective. CBT helps people change negative and self-critical styles of thinking and behaving that contribute to or worsen anxiety, replacing them with more positive, functional, and adaptive ways. For example, CBT can help people experiencing OCD face situations that cause fear or anxiety and become less reactive (desensitized) to them. CBT often lasts about 12 weeks. Research indicates that the effects of CBT last longer than those of treatment with medication for people with Panic Disorder, and possibly for those with OCD, PTSD, and Social Phobia. If CBT is effective, a recurrence of the disorder can often be effectively treated quickly and easily with a brief refresher. IPT helps people understand and work through dysfunctional and/or maladaptive relationships that contribute to or worsen OCD. It emphasizes the relationships between a person and other people rather than that person’s internal psychological processes. It’s intended to change the person’s symptoms by helping him deal more realistically and effectively with his family, marital, parental, and work situations.
 
       For those who have mild or moderate OCD psychotherapy alone is often the best treatment option. However, for certain people, especially those who have severe OCD, a combination of psychotherapy and medication may be necessary.

How can I help someone who is suffering from
Obsessive-Compulsive Disorder (OCD)?

       If you know someone who has OCD, odds are that his or her anxiety affects you, too. The first and most important thing that you can do to help a friend, family member, or coworker who has OCD is to help him get diagnosed and treated. You might have to schedule an appointment on behalf of the person or even go with him to see a provider. Encourage him to stay in treatment or to seek different treatment if no improvement occurs after six to eight weeks of medication or eight to 12 weeks of psychotherapy. In addition:
  • don’t downplay or trivialize the anxiety;
  • don’t demand improvement if the person isn't in treatment;
  • offer emotional support, understanding, and patience;
  • engage the person in conversation and, most importantly, listen nonjudgmentally;
  • never criticize or belittle feelings the person expresses, but rather point out realities and offer hope;
  • never ignore comments about suicide. Encourage the person to share these thoughts with his provider and/or mental health professional, and report them yourself if you believe the person won't;
  • invite the person to participate in walks, outings, and other activities. Keep trying even if he declines, but don't push him to do too much too soon. Making the person feel as if you have too many expectations of him may inadvertently cause feelings of failure;
  • and remind the person that with time and treatment the OCD will inevitably improve.
© 2010
Dr. Thomas E. Hranilovich
Licensed Psychologist

Psychiatric Associates / 4084 Okemos Rd. / Suite A / Okemos, MI 48864
Phone: (517) 347-4848 / Fax: (517) 347-4844