obsessive-compulsive disorder

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Obsessive-Compulsive Disorder

 

Definition

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. Anxiety disorder is the experience of prolonged, excessive worry about circumstances in one's life. OCD is characterized by distressing repetitive thoughts, impulses or images that are intense, frightening, absurd, or unusual. These thoughts are followed by ritualized actions that are usually bizarre and irrational. These ritual actions, known as compulsions, help reduce anxiety caused by the individual's obsessive thoughts. Often described as the "disease of doubt," the sufferer usually knows the obsessive thoughts and compulsions are irrational but, on another level, fears they may be true.

Description

Almost one out of every 40 people will suffer from obsessive-compulsive disorder at some time in their lives. The condition is two to three times more common than either schizophrenia or manic depression, and strikes men and women of every ethnic group, age and social level. Because the symptoms are so distressing, sufferers often hide their fears and rituals but cannot avoid acting on them. OCD sufferers are often unable to decide if their fears are realistic and need to be acted upon.
Most people with obsessive-compulsive disorder have both obsessions and compulsions, but occasionally a person will have just one or the other. The degree to which this condition can interfere with daily living also varies. Some people are barely bothered, while others find the obsessions and compulsions to be profoundly traumatic and spend much time each day in compulsive actions.
Obsessions are intrusive, irrational thoughts that keep popping up in a person's mind, such as "my hands are dirty, I must wash them again." Typical obsessions include fears of dirt, germs, contamination, and violent or aggressive impulses. Other obsessions include feeling responsible for others' safety, or an irrational fear of hitting a pedestrian with a car. Additional obsessions can involve excessive religious feelings or intrusive sexual thoughts. The patient may need to confess frequently to a religious counselor or may fear acting out the strong sexual thoughts in a hostile way. People with obsessive-compulsive disorder may have an intense preoccupation with order and symmetry, or be unable to throw anything out.
Compulsions usually involve repetitive rituals such as excessive washing (especially handwashing or bathing), cleaning, checking and touching, counting, arranging or hoarding. As the person performs these acts, he may feel temporarily better, but there is no long-lasting sense of satisfaction or completion after the act is performed. Often, a person with obsessive-compulsive disorder believes that if the ritual is not performed, something dreadful will happen. While these compulsions may temporarily ease stress, short-term comfort is purchased at a heavy price—time spent repeating compulsive actions and a long-term interference with life.
The difference between OCD and other compulsive behavior is that while people who have problems with gambling, overeating or with substance abuse may appear to be compulsive, these activities also provide pleasure to some degree. The compulsions of OCD, on the other hand, are never pleasurable.
OCD may be related to some other conditions, such as the continual urge to pull out body hair (trichotillomania) fear of having a serious disease (hypochondriasis) or preoccupation with imagined defects in personal appearance disorder (body dysmorphia). Some people with OCD also have Tourette syndrome, a condition featuring tics and unwanted vocalizations (such as swearing). OCD is often linked with depression and other anxiety disorders.

Causes and symptoms

While no one knows for sure, research suggests that the tendency to develop obsessive-compulsive disorder is inherited. There are several theories behind the cause of OCD. Some experts believe that OCD is related to a chemical imbalance within the brain that causes a communication problem between the front part of the brain (frontal lobe) and deeper parts of the brain responsible for the repetitive behavior. Research has shown that the orbital cortex located on the underside of the brain's frontal lobe is overactive in OCD patients. This may be one reason for the feeling of alarm that pushes the patient into compulsive, repetitive actions. It is possible that people with OCD experience overactivity deep within the brain that causes the cells to get "stuck," much like a jammed transmission in a car damages the gears. This could lead to the development of rigid thinking and repetitive movements common to the disorder. The fact that drugs which boost the levels of serotonin, a brain messenger substance linked to emotion and many different anxiety disorders, in the brain can reduce OCD symptoms may indicate that to some degree OCD is related to levels of serotonin in the brain.
Recently, scientists have identified an intriguing link between childhood episodes of strep throat and the development of OCD. It appears that in some vulnerable children, strep antibodies attack a certain part of the brain. Antibodies are cells that the body produces to fight specific diseases. That attack results in the development of excessive washing or germ phobias. A phobia is a strong but irrational fear. In this instance the phobia is fear of disease germs present on commonly handled objects. These symptoms would normally disappear over time, but some children who have repeated infections may develop full-blown OCD. Treatment with antibiotics has resulted in lessening of the OCD symptoms in some of these children.
If one person in a family has obsessive-compulsive disorder, there is a 25% chance that another immediate family member has the condition. It also appears that stress and psychological factors may worsen symptoms, which usually begin during adolescence or early adulthood.

Diagnosis

People with obsessive-compulsive disorder feel ashamed of their problem and often try to hide their symptoms. They avoid seeking treatment. Because they can be very good at keeping their problem from friends and family, many sufferers do not get the help they need until the behaviors are deeply ingrained habits and hard to change. As a result, the condition is often misdiagnosed or underdiagnosed. All too often, it can take more than a decade between the onset of symptoms and proper diagnosis and treatment.
While scientists seem to agree that OCD is related to a disruption in serotonin levels, there is no blood test for the condition. Instead, doctors diagnose OCD after evaluating a person's symptoms and history.

Treatment

Obsessive-compulsive disorder can be effectively treated by a combination of cognitive-behavioral therapy and medication that regulates the brain's serotonin levels. Drugs that are approved to treat obsessive-compulsive disorder include fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft), all selective serotonin reuptake inhibitors (SSRIs) that affect the level of serotonin in the brain. Older drugs include the antidepressant clomipramine (Anafranil), a widely-studied drug in the treatment of OCD, but one that carries a greater risk of side effects. Drugs should be taken for at least 12 weeks before deciding whether or not they are effective.
Cognitive-behavioral therapy (CBT) teaches patients how to confront their fears and obsessive thoughts by making the effort to endure or wait out the activities that usually cause anxiety without compulsively performing the calming rituals. Eventually their anxiety decreases. People who are able to alter their thought patterns in this way can lessen their preoccupation with the compulsive rituals. At the same time, the patient is encouraged to refocus attention elsewhere, such as on a hobby.
In a few severe cases where patients have not responded to medication or behavioral therapy, brain surgery may be tried as a way of relieving the unwanted symptoms. Surgery can help up to a third of patients with the most severe form of OCD. The most common operation involves removing a section of the brain called the cingulate cortex. The serious side effects of this surgery for some patients include seizures, personality changes and less ability to plan.

Alternative treatment

Because OCD sometimes responds to SSRI antidepressants, a botanical medicine called St. John's wort (Hypericum perforatum) might have some beneficial effect as well, according to herbalists. Known popularly as "Nature's Prozac," St. John's wort is prescribed by herbalists for the treatment of anxiety and depression. They believe that this herb affects brain levels of serotonin in the same way that SSRI antidepressants do. Herbalists recommend a dose of 300 mg., three times per day. In about one out of 400 people, St. John's wort (like Prozac) may initially increase the level of anxiety. Homeopathic constitutional therapy can help rebalance the patient's mental, emotional, and physical well-being, allowing the behaviors of OCD to abate over time.

Prognosis

Obsessive-compulsive disorder is a chronic disease that, if untreated, can last for decades, fluctuating from mild to severe and worsening with age. When treated by a combination of drugs and behavioral therapy, some patients go into complete remission. Unfortunately, not all patients have such a good response. About 20% of people cannot find relief with either drugs or behavioral therapy. Hospitalization may be required in some cases.
Despite the crippling nature of the symptoms, many successful doctors, lawyers, business people, performers and entertainers function well in society despite their condition. Nevertheless, the emotional and financial cost of obsessive-compulsive disorder can be quite high.

Resources

Organizations

Anxiety Disorders Association of America. 11900 Park Lawn Drive, Ste. 100, Rockville, MD 20852. (800) 545-7367. http://www.adaa.org.
National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 22201-3042. (800) 950-6264. http://www.nami.org.
National Anxiety Foundation. 3135 Custer Dr., Lexington, KY 40517. (606) 272-7166. http://www.lexington-on-line.com/naf.html.
Obsessive-Compulsive Anonymous. P.O. Box 215, New Hyde Park, NY 11040. (516) 741-4901. 〈west24th@aol.com〉 http://members.aol.com/west24th/index.html.
Obsessive-Compulsive Foundation. P.O. Box 70, Milford, CT 06460. (203) 874-3843. 〈JPHS28A@Prodigy.com〉 〈http://pages.prodigy.com/alwillen/ocf.html〉.

Key terms

Anxiety disorder — This is the experience of prolonged, excessive worry about circumstances in one's life. It disrupts daily life.
Cognitive-behavior therapy — A form of psychotherapy that seeks to modify behavior by manipulating the environment to change the patient's response.
Compulsion — A rigid behavior that is repeated over and over each day.
Obsession — A recurring, distressing idea, thought or impulse that feels "foreign" or alien to the individual.
Selective serotonin reuptake inhibitors (SSRIs) — A class of antidepressants that work by blocking the reabsorption of serotonin in brain cells, raising the level of the chemical in the brain. SSRIs include Prozac, Zoloft, Luvex, and Paxil.
Serotonin — One of three major neurotransmitters found in the brain that is related to emotion, and is linked to the development of depression and obsessive-compulsive disorder.

ob·ses·sive-com·pul·sive dis·or·der (OCD),

1. a type of anxiety disorder the essential features of which include recurrent obsessions, persistent intrusive ideas, thoughts, impulses or images, or compulsions (repetitive, purposeful, and intentional behaviors performed to decrease anxiety in response to an obsession) sufficiently severe to cause marked distress, be time-consuming, or significantly interfere with the person's normal routine, occupational functioning, or usual social activities or relationships with others.
See also: obsessive-compulsive personality disorder.
2. a DSM diagnosis that is established when the specified criteria are met.
See also: obsessive-compulsive personality disorder.

obsessive-compulsive disorder

(əb-sĕs′ĭv-kəm-pŭl′sĭv, ŏb-)
n.
Abbr. OCD A psychiatric disorder characterized by the presence of either obsessions (repeated, unwanted, often distressing thoughts), or compulsions (the feeling of being driven to repeatedly perform certain behaviors or mental activities), or both, with the symptoms being severe enough to impair normal functioning.

ob·ses′sive-com·pul′sive adj.

obsessive-compulsive disorder (OCD)

an anxiety disorder characterized by recurrent and persistent thoughts, ideas, and feelings or repetitive acts sufficiently severe to cause marked distress, consume considerable time, or significantly interfere with the patient's occupational, social, or interpersonal functioning. See also compulsive ritual.

obsessive-compulsive disorder

Obsessive-compulsive neurosis, OCD Psychiatry A disabling anxiety disorder characterized by repetitive patterns of intrusive and persistent thoughts–obsessions and behaviors–compulsions that are senseless–eg, rituals, distressing, and extremely difficult to overcome; OCD affects 1-2% of Americans, has a neurophysiopathologic component and may respond to TCAs Management Clomipramine for trichotillomania and other forms of OCD. Cf Obsessive-compulsive personality disorder.

ob·ses·sive-com·pul·sive dis·or·der

(OCD) (ŏb-ses'iv-kŏm-pŭl'siv dis-ōr'dĕr)
A type of anxiety disorder the essential feature of which is recurrent obsessions, persistent, intrusive ideas, thoughts, impulses or images, or compulsions (repetitive, purposeful, and intentional behaviors performed in response to an obsession) sufficiently severe to cause markeddistress, be time-consuming, or interfere significantly with the person's normal routine, occupational functioning, or usual social activities or relationships with others.

obsessive-compulsive disorder

A psychiatric disorder featuring frequent bouts of anxiety associated with intrusive thoughts or feelings with little relevance to events (obsessions), or recurrent strong promptings to perform an act, such as washing one's hands (compulsions), logically recognized as unnecessary or irrelevant. These thoughts or promptings are so frequent and intrusive as to cause distress or disability. There is often depression and sometimes suicide. Treatment is with tricyclic antidepressant drugs or behaviour therapy. It is claimed that the disorder can be cured by cognitive behaviour therapy.

ob·ses·sive-com·pul·sive dis·or·der

(OCD) (ŏb-ses'iv-kŏm-pŭl'siv dis-ōr'dĕr)
Type of anxiety disorder the essential features of which include recurrent obsessions, persistent intrusive ideas, thoughts, impulses or images, or compulsions.

obsessive-compulsive disorder (OCD),

n the abnormal behavior of a person who tends to perform repetitive acts or rituals, usually as a means of releasing tension or relieving anxiety.
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