Obsessive-Compulsive Disorder: Symptoms, Causes and Treatment

Obsessive-compulsive disorder, or OCD, involves anxious thoughts or rituals you feel you can't control. If you have OCD, you may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals.

You may be obsessed with germs or dirt, so you wash your hands over and over. You may be filled with doubt and feel the need to check things repeatedly. You may have frequent thoughts of violence, and fear that you will harm people close to you. You may spend long periods touching things or counting; you may be pre-occupied by order or symmetry; you may have persistent thoughts of performing sexual acts that are repugnant to you; or you may be troubled by thoughts that are against your religious beliefs.

The disturbing thoughts or images are called obsessions, and the rituals that are performed to try to prevent or get rid of them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the anxiety that grows when you don't perform them.

A lot of healthy people can identify with some of the symptoms of OCD, such as checking the stove several times before leaving the house. But for people with OCD, such activities consume at least an hour a day, are very distressing, and interfere with daily life.

Most adults with this condition recognize that what they're doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their behavior is out of the ordinary.

OCD afflicts about 2.2 million American adults. It strikes men and women in approximately equal numbers and usually first appears in childhood, adolescence, or early adulthood.One-third of adults with OCD report having experienced their first symptoms as children. The course of the disease is variable--symptoms may come and go, they may ease over time, or they can grow progressively worse. Research evidence suggests that OCD might run in families.

Depression or other anxiety disorders may accompany OCD,and some people with OCD also have eating disorders. In addition, people with OCD may avoid situations in which they might have to confront their obsessions, or they may try unsuccessfully to use alcohol or drugs to calm themselves. If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home.

OCD generally responds well to treatment with medications or carefully targeted psychotherapy.

Causes of Obsessive-Compulsive Disorder

No one has found a single, proven cause for OCD. Some research shows that it may have to do with chemicals in the brain that carry messages from one nerve cell to another. One of these chemicals, called serotonin (say "seer-oh-tone-in"), helps to keep people from repeating the same behaviors over and over again. A person with OCD may not have enough serotonin. Many people with OCD can function better when they take medicines that increase the amount of serotonin in their brain. Obsessive-Compulsive Disorder Treatment

Introduction
Psychotherapy
Medications

Introduction

Obsessive-Compulsive Disorder is one of the most difficult to understand of all psychiatric illnesses. Persons who have this condition find themselves repeating certain behaviors or thoughts again and again and again and again. They know the repetition is unnecessary, but are unable to stop themselves. Common forms of this are checking locks, stoves, and lights, or recurrent intrusive thoughts of hurting oneself or one's children.

Afflicted individuals usually experience severe anxiety if unable to complete their rituals, though many therapies work by helping the individual learn that no catastrophe occurs when the behaviors do cease.

Research has shown that one of the most difficult problems in OCD is in getting family members to understand that the patient is unable to simply stop the behavior. Many times relatives become angry and upset when they are forced to deal with the time-consuming and unrealistic repetitive behaviors. With this background, it is no wonder that many patients do not volunteer their symptoms, and instead complain only of anxiety or depression.

Psychotherapy

For many years, OCD was seen as a purely psychological disorder, related to a desire to control one's environment or to undo some perceived wrong action. Insight oriented psychotherapy has been singularly unsuccessful in treating this group of disorders, however. Behavior therapies have had much more success, especially those with specific small steps geared to the exact obsessions.compulsions involved in the individual case.

Behavior therapy has a lot to offer individuals with this disorder. Two common and popular techniques are systematic desensitization and flooding. Systematic desensitization techniques involve gradually exposing the client to ever-increasing anxiety-provoking stimuli. It is important to note here, though, that such a technique should not be attempted until the client has successfully learned relaxation skills and can demonstrate their use to the therapist. Exposing a patient to either of these techniques without increased coping skills can result in relapse and possible harm to the client. Relaxation techniques may include imagery, breathing skills, and muscle relaxation. It is important for the client to find a relaxation technique which works best for them, before attempting something like systematic desensitization or flooding. Flooding allows the patient to face the most anxiety-provoking situation, while using the relaxation skills learned. Systematic desensitization is the preferred technique of the two; flooding is not recommended except in rare uses. Flooding's potential harm usually outweighs its potential benefits (e.g., traumatizing the individual further).

Additional behavior and cognitive-behavioral techniques which may have some effectiveness for people who suffer from this disorder include saturation and thought-stopping. Through saturation, the client is directed to do nothing but think of one obsessional thought which they have complained about. After a period of time of concentration on this one thought (e.g., 10-15 minutes at a time) over a number of days (3-5 days), the obsession can lose some of its strength. Through thought-stopping, the individual learns how to halt obsessive thoughts through proper identification of the obsessional thoughts, and then averting it by doing an opposite, incompatible response. A common incompatible response to an obsessive thought is simply by yelling the word "Stop!" loudly. The client can be encouraged to practice this in therapy (with the clinician's help and modeling, if necessary), and then encouraged to transplant this behavior to the privacy of their home. They can also often use other incompatible stimuli, such as tweaking a rubber-band which is around their wrist whenever they have a thought. The latter technique would be more effective in public, for example.

Medications

In the last 25 years, medications have been found to be fairly successful in the treatment of OCD. First was the tricyclic antidepressant clomipramine (Anafranil). This has been followed by several of the newer SSRI class anti-depressants that act selectively on the re-uptake of serotonin, a neurotransmitter. In the last few years, neuro-imaging studies have begun to disclose the underlying pathophysiology of OCD. The area of the brain that functions abnormally is directly next to those areas that relate to tick disorders such as Tourette's Syndrome and to Attention Deficit Disorder. It now seems that variable amounts of dysfunction produce clinical symptoms that may be virtually all in one of these areas, or may be overlapping. Many people with ADD also have tics, as do many people with OCD. Most unexpected is the finding that children who have Rheumatic Fever and develop Sydinham's Chorea have a significantly increased risk of OCD. Therefore treatment with antibiotics early in an infectious illness may reduce the chances of future obsessive thinking. Obsessive-compulsive personality disorder

Obsessive-compulsive personality disorder is a condition characterized by a chronic preoccupation with rules, orderliness, and control.

This disorder tends to occur in families and thus may have a genetic component. Obsessive-compulsive personality disorder most often occurs in men. It should not be confused with obsessive-compulsive disorder (OCD), which is another psychiatric condition that shares some symptoms with obsessive-compulsive personality disorder.

People with obsessive-compulsive personality disorder believe that their preoccupations are appropriate. They tend to be high achievers and have a sense of urgency about their actions. They may become extremely upset if others disturb their rigidly ordered routines.

Symptoms of Obsessive-compulsive personality disorder

A person with this personality disorder has symptoms of perfectionism that usually begin in early adulthood. This perfectionism may interfere with the person's ability to complete a given task because the rigid standards cannot be upheld. People with this disorder may emotionally withdraw when they are not able to control a situation.

Signs and tests

Some of the common signs of obsessive-compulsive personality disorder include:

Perfectionism
Inflexibility
Preoccupation with details, rules, and lists
Reluctance to allow others to do things
Excessive devotion to work
Restricted expression of affection
Lack of generosity
Inability to throw things away, even if there is no value in the object

Treatment of Obsessive-compulsive personality disorder

Medications such as selective serotonin reuptake inhibitors (for example, Prozac) may help reduce obsessions and compulsions. Cognitive-behavioral therapy may also help, and medications in combination with talk therapy may be more effective than either treatment alone.

Expectations (Prognosis)

The outlook for people with obsessive-compulsive personality disorder tends to be better than that of other personality disorders. The self-imposed rigidness and control of people with obsessive-compulsive personality disorder may prevent many of the complications -- such as drug abuse -- that are common to the other personality disorders. However, the social isolation common with this illness may eventually lead to feelings of depression later in life.

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