Obsessive-Compulsive Disorders

Obsessive-compulsive disorder is characterized by anxious thoughts or
rituals you feel you can't control. If you have OCD, as it's called, 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 might be preoccupied by thoughts of violence and fear that you will
harm people close to you.

You may spend long periods of time touching things or counting;

you may be preoccupied by order or symmetry;

You may have persistent thoughts of performing sexual acts that are
repugnant to you;

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 dispel them are called compulsions.
There is no pleasure in carrying out the rituals you are drawn to, only
temporary relief from the discomfort caused by the obsession.

A lot of healthy people can identify with having some of the symptoms of
OCD, such as checking the stove several times before leaving the house.
But the disorder is diagnosed only when 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 strikes men and women in
approximately equal numbers and afflicts roughly 1 in 50 people. It can
appear in childhood, adolescence, or adulthood, but on the average it first
shows up in the teens or early adulthood. A third of adults with OCD
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. Evidence
suggests that OCD might run in families. Depression or other anxiety
disorders may accompany OCD. And some people with OCD have eating
disorders. In addition, they 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, but more often it doesn't develop to those
extremes.

Treatments for OCD

A combination of the two treatments is often helpful for most patients. Some
individuals respond best to one therapy, some to another. Two medications
that have been found effective in treating OCD are clomipramine and
fluoxetine. A number of others are showing promise, however, and may
soon be available.

Behavioral therapy, specifically a type called exposure and response
prevention, has also proven useful for treating OCD. It involves exposing
the person to whatever triggers the problem and then helping him or her
forego the usual ritual for instance, having the patient touch something dirty
and then not wash his hands. This therapy is often successful in patients
who complete a behavioral therapy program, though results have been less
favorable in some people who have both OCD and depression

Brain imaging studies using a technique called positron emission
tomography (PET) have compared people with and without OCD. Those
with OCD have patterns of brain activity that differ from people with other
mental illnesses or people with no mental illness at all. In addition, PET
scans show that in individuals with OCD, both behavioral therapy and
medication produce changes in the striatum. This is graphic evidence that
both psychotherapy and medication affect the brain.

















(Source: NIMH, National Institute for Mental Health).