obsessive complusive disorder
What is obsessive compulsive disorder?
Obsessive-compulsive disorder (OCD), one of the anxiety disorders, is
a potentially disabling condition that can persist throughout a person's
life. The individual who suffers from OCD becomes trapped in a pattern of
repetitive thoughts and behaviors that are senseless and distressing but
extremely difficult to overcome. obsessive compulsive disorder occurs in a spectrum from mild to
severe, but if severe and left untreated, can destroy a person's capacity
to function at work, at school, or even in the home.
The case histories in this brochure are typical for those who suffer
from obsessive-compulsive disorder--a disorder that can be effectively
treated. However, the characters are not real.
How common Is obsessive compulsive disorder?
For many years, mental health professionals thought of obsessive compulsive disorder as a rare
disease because only a small minority of their patients had the condition.
The disorder often went unrecognized because many of those afflicted with
obsessive compulsive disorder, in efforts to keep their repetitive thoughts and behaviors secret,
failed to seek treatment. This led to underestimates of the number of
people with the illness. However, a survey conducted in the early 1980s by
the National Institute of Mental Health (NIMH)--the Federal agency that
supports research nationwide on the brain, mental illnesses, and mental
health--provided new knowledge about the prevalence of obsessive compulsive disorder. The NIMH
survey showed that obsessive compulsive disorder affects more than 2 percent of the population,
meaning that obsessive compulsive disorder is more common than such severe mental illnesses as
schizophrenia, bipolar disorder, or panic disorder. Obsessive compulsive disorder strikes people of
all ethnic groups. Males and females are equally affected. The social and
economic costs of obsessive compulsive disorder were estimated to be $8.4 billion in 1990 (DuPont et
al, 1994).
Although obsessive compulsive disorder symptoms typically begin during the teenage years or
early adulthood, recent research shows that some children develop the
illness at earlier ages, even during the preschool years. Studies indicate
that at least one-third of cases of obsessive compulsive disorder in adults began in childhood.
Suffering from obsessive compulsive disorder during early stages of a child's development can cause
severe problems for the child. It is important that the child receive
evaluation and treatment by a knowledgeable clinician to prevent the child
from missing important opportunities because of this disorder.
Obsessions
These are unwanted ideas or impulses that repeatedly well up in the
mind of the person with obsessive compulsive disorder. Persistent fears that harm may come to self
or a loved one, an unreasonable concern with becoming contaminated, or an
excessive need to do things correctly or perfectly, are common. Again and
again, the individual experiences a disturbing thought, such as, "My hands
may be contaminated--I must wash them"; "I may have left the gas on"; or
"I am going to injure my child." These thoughts are intrusive, unpleasant,
and produce a high degree of anxiety. Sometimes the obsessions are of a
violent or a sexual nature, or concern illness.
Compulsions
In response to their obsessions, most people with obsessive compulsive disorder resort to
repetitive behaviors called compulsions. The most common of these are
washing and checking. Other compulsive behaviors include counting (often
while performing another compulsive action such as hand washing),
repeating, hoarding, and endlessly rearranging objects in an effort to
keep them in precise alignment with each other. Mental problems, such as
mentally repeating phrases, listmaking, or checking are also common. These
behaviors generally are intended to ward off harm to the person with obsessive compulsive disorder
or others. Some people with obsessive compulsive disorder have regimented rituals while others have
rituals that are complex and changing. Performing rituals may give the
person with obsessive compulsive disorder some relief from anxiety, but it is only temporary.
Insight
People with obsessive compulsive disorder show a range of insight into the senselessness of
their obsessions. Often, especially when they are not actually having an
obsession, they can recognize that their obsessions and compulsions are
unrealistic. At other times they may be unsure about their fears or even
believe strongly in their validity.
Resistance
Most people with obsessive compulsive disorder struggle to banish their unwanted, obsessive
thoughts and to prevent themselves from engaging in compulsive behaviors.
Many are able to keep their obsessive-compulsive symptoms under control
during the hours when they are at work or attending school. But over the
months or years, resistance may weaken, and when this happens, obsessive compulsive disorder may
become so severe that time-consuming rituals take over the sufferers'
lives, making it impossible for them to continue activities outside the
home.
Shame and Secrecy
Obsessive compulsive disorder sufferers often attempt to hide their disorder rather than seek
help. Often they are successful in concealing their obsessive-compulsive
symptoms from friends and coworkers. An unfortunate consequence of this
secrecy is that people with obsessive compulsive disorder usually do not receive professional help
until years after the onset of their disease. By that time, they may have
learned to work their lives--and family members' lives--around the
rituals.
Long-lasting obsessive compulsive disorder symptomsObsessive compulsive disorder tends to last for years, even decades.
The symptoms may become less severe from time to time, and there may be
long intervals when the symptoms are mild, but for most individuals with
obsessive compulsive disorder, the symptoms are chronic.
What Causes obsessive compulsive disorder?
The old belief that obsessive compulsive disorder was the result of life experiences has been
weakened before the growing evidence that biological factors are a primary
contributor to the disorder. The fact that obsessive compulsive disorder patients respond well to
specific medications that affect the neurotransmitter serotonin suggests
the disorder has a neurobiological basis. For that reason, obsessive compulsive disorder is no
longer attributed only to attitudes a patient learned in childhood--for
example, an inordinate emphasis on cleanliness, or a belief that certain
thoughts are dangerous or unacceptable. Instead, the search for causes now
focuses on the interaction of neurobiological factors and environmental
influences, as well as cognitive processes.
OCD is sometimes accompanied by depression, eating disorders,
substance abuse disorder, a personality disorder, attention deficit
disorder, or another of the anxiety disorders. Co-existing disorders can
make obsessive compulsive disorder more difficult both to diagnose and to treat.
In an effort to identify specific biological factors
that may be important in the onset or persistence of obsessive compulsive disorder, NIMH-supported
investigators have used a device called the positron emission tomography
(PET) scanner to study the brains of patients with obsessive compulsive disorder. Several groups of
investigators have obtained findings from PET scans suggesting that obsessive compulsive disorder
patients have patterns of brain activity that differ from those of people
without mental illness or with some other mental illness. Brain-imaging studies of
obsessive compulsive disorder showing abnormal neurochemical activity in regions known to play a
role in certain neurological disorders suggest that these areas may be
crucial in the origins of obsessive compulsive disorder. There is also evidence that treatment with
medications or behavior therapy induce changes in the brain coincident
with clinical improvement.
Recent preliminary studies of the brain using magnetic resonance
imaging showed that the subjects with obsessive-compulsive disorder had
significantly less white matter than did normal control subjects,
suggesting a widely distributed brain abnormality in obsessive compulsive disorder. Understanding
the significance of this finding will be further explored by functional
neuroimaging and neuropsychological studies (Jenike et al, 1996).
Symptoms of obsessive compulsive disorder are seen in association with some other neurological
disorders. There is an increased rate of obsessive compulsive disorder in people with Tourette's
syndrome, an illness characterized by involuntary movements and
vocalizations. Investigators are currently studying the hypothesis that a
genetic relationship exists between obsessive compulsive disorder and the tic disorders.
Other illnesses that may be linked to obsessive compulsive disorder are trichotillomania (the
repeated urge to pull out scalp hair, eyelashes, eyebrows or other body
hair), body dysmorphic disorder (excessive preoccupation with imaginary or
exaggerated defects in appearance), and hypochondriasis (the fear of
having--despite medical evaluation and reassurance--a serious disease).
Genetic studies of obsessive compulsive disorder and other related conditions may enable scientists
to pinpoint the molecular basis of these disorders.
Other theories about the causes of obsessive compulsive disorder focus on the interaction
between behavior and the environment and on beliefs and attitudes, as well
as how information is processed. These behavioral and cognitive theories
are not incompatible with biological explanations.
Do I Have obsessive compulsive disorder?
A person with OCD has obsessive and compulsive behaviors that are
extreme enough to interfere with everyday life. People with obsessive compulsive disorder should not
be confused with a much larger group of individuals who are sometimes
called "compulsive" because they hold themselves to a high standard of
performance and are perfectionistic and very organized in their work and
even in recreational activities. This type of "compulsiveness" often
serves a valuable purpose, contributing to a person's self-esteem and
success on the job. In that respect, it differs from the life-wrecking
obsessions and rituals of the person with obsessive compulsive disorder.
Treatment of obsessive compulsive disorder; Progress Through Research
Clinical and animal research sponsored by NIMH and other scientific
organizations has provided information leading to both pharmacologic and
behavioral treatments that can benefit the person with obsessive compulsive disorder. One patient
may benefit significantly from behavior therapy, while another will
benefit from pharmacotherapy. Some others may use both medication and
behavior therapy. Others may begin with medication to gain control over
their symptoms and then continue with behavior therapy. Which therapy to
use should be decided by the individual patient in consultation with his
or her therapist.
Pharmacotherapy
Clinical trials in recent years have shown that drugs that affect the
neurotransmitter serotonin can significantly decrease the symptoms of obsessive compulsive disorder.
The first of these serotonin reuptake inhibitors (SRIs) specifically
approved for the use in the treatment of obsessive compulsive disorder was the tricyclic
antidepressant clomipramine (AnafranilR). It was followed by
other SRIs that are called "selective serotonin reuptake inhibitors"
(SSRIs). Those that have been approved by the Food and Drug Administration
for the treatment of obsessive compulsive disorder are flouxetine (ProzacR), fluvoxamine
(LuvoxR), and paroxetine (PaxilR). Another that has
been studied in controlled clinical trials is sertraline
(ZoloftR). Large studies have shown that more than
three-quarters of patients are helped by these medications at least a
little. And in more than half of patients, medications relieve symptoms of
obsessive compulsive disorder by diminishing the frequency and intensity of the obsessions and
compulsions. Improvement usually takes at least three weeks or longer. If
a patient does not respond well to one of these medications, or has
unacceptable side effects, another SRI may give a better response. For
patients who are only partially responsive to these medications, research
is being conducted on the use of an SRI as the primary medication and one
of a variety of medications as an additional drug (an augmenter).
Medications are of help in controlling the symptoms of obsessive compulsive disorder, but often, if
the medication is discontinued, relapse will follow. Indeed, even after
symptoms have subsided, most people will need to continue with medication
indefinitely, perhaps with a lowered dosage.
Behavior Therapy
Traditional psychotherapy, aimed at helping the patient develop
insight into his or her problem, is generally not helpful for obsessive compulsive disorder.
However, a specific behavior therapy approach called "exposure and
response prevention" is effective for many people with obsessive compulsive disorder. In this
approach, the patient deliberately and voluntarily confronts the feared
object or idea, either directly or by imagination. At the same time the
patient is strongly encouraged to refrain from ritualizing, with support
and structure provided by the therapist, and possibly by others whom the
patient recruits for assistance. For example, a compulsive hand washer may
be encouraged to touch an object believed to be contaminated, and then
urged to avoid washing for several hours until the anxiety provoked has
greatly decreased. Treatment then proceeds on a step-by-step basis, guided
by the patient's ability to tolerate the anxiety and control the rituals.
As treatment progresses, most patients gradually experience less anxiety
from the obsessive thoughts and are able to resist the compulsive urges.
Studies of behavior therapy for obsessive compulsive disorder have found it to be a successful
treatment for the majority of patients who complete it. For the treatment
to be successful, it is important that the therapist be fully trained to
provide this specific form of therapy. It is also helpful for the patient
to be highly motivated and have a positive, determined attitude.
The positive effects of behavior therapy endure once treatment has
ended. A recent compilation of outcome studies indicated that, of more
than 300 obsessive compulsive disorder patients who were treated by exposure and response
prevention, an average of 76 percent still showed clinically significant
relief from 3 months to 6 years after treatment (Foa & Kozak, 1996).
Another study has found that incorporating relapse-prevention components
in the treatment program, including follow-up sessions after the intensive
therapy, contributes to the maintenance of improvement (Hiss, Foa, and
Kozak, 1994).
One study provides new evidence that cognitive-behavioral therapy may
also prove effective for obsessive compulsive disorder. This variant of behavior therapy emphasizes
changing the obsessive compulsive disorder sufferer's beliefs and thinking patterns. Additional
studies are required before the promise of cognitive-behavioral therapy
can be adequately evaluated. The ongoing search for causes, together with
research on treatment, promises to yield even more hope for people with
obsessive compulsive disorder and their families.
How to Get Help for obsessive compulsive disorder
If you think that you have obsessive compulsive disorder, you should seek the help of a mental
health professional. Family physicians, clinics, and health maintenance
organizations may be able to provide treatment or make referrals to mental
health centers and specialists. Also, the department of psychiatry at a
major medical center or the department of psychology at a university may
have specialists who are knowledgeable about the treatment of obsessive compulsive disorder and are
able to provide therapy or recommend another doctor in the area.
What the Family Can Do to Help
OCD affects not only the sufferer but the whole family. The family
often has a difficult time accepting the fact that the person with obsessive compulsive disorder
cannot stop the distressing behavior. Family members may show their anger
and resentment, resulting in an increase in the obsessive compulsive disorder behavior. Or, to keep
the peace, they may assist in the rituals or give constant reassurance.
Education about obsessive compulsive disorder is important for the family. Families can learn
specific ways to encourage the person with obsessive compulsive disorder to adhere fully to behavior
therapy and/or pharmacotherapy programs. Self-help books are often a good
source of information. Some families seek the help of a family therapist
who is trained in the field. Also, in the past few years, many families
have joined one of the educational support groups that have been organized
throughout the country.
OCD Research
Research into treatment for obsessive compulsive disorder is ongoing in several areas--ways of
increasing availability of effective behavior therapy; cognitive therapy;
relapse prevention; methods of reducing medication in patients who have a
history of being unable to tolerate medication, such as small, liquid
doses of flouxetine or the use of intravenous clomipramine; and
neurosurgery, a new approach to treatment-refractory obsessive compulsive disorder. In the very few
centers where neurosurgery has been performed as a clinical procedure,
candidates are generally restricted to those who have failed to respond to
conventional treatments, including behavior therapy and pharmacotherapy.
In addition to research into treatment modalities, NIMH researchers
are conducting studies into possible linkage of obsessive compulsive disorder to some autoimmune
diseases (diseases in which infection-fighting cells, or antibodies, turn
against the body, trying to destroy it). Other NIMH-supported studies
compare behavior therapy, pharmacotherapy, and a combination of both.
Anecdotal reports of the successful use of electroconvulsive therapy
(ECT) in obsessive compulsive disorder have been published over the past several decades. Most
often, the benefit from ECT has been short lived, and this treatment is
now generally restricted to instances of treatment-resistant obsessive compulsive disorder
accompanied by severe depression.
If You Have Special Needs
Individuals with obsessive compulsive disorder are protected under the Americans with
Disabilities Act (ADA). Among organizations that offer information related
to the ADA are the ADA Information Line at the U.S. Department of Justice,
(202) 514-0301, and the Job Accommodation Network (JAN), part of the
President's Committee on the Employment of People with Disabilities in the
U.S. Department of Labor. JAN is located at West Virginia University, 809
Allen Hall, P.O. Box 6122, Morgantown, WV 26506, telephone (800) 526-7234
(voice or TDD), (800) 526-4698 (in West Virginia).
The Pharmaceutical Research and Manufacturers Association publishes a
directory of indigent programs for those who cannot afford medications.
Physicians can request a copy of the guide by calling 800-762-4636
(800-PMA-INFO).
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
For Further Information about OCD
For further information on obsessive compulsive disorder, its treatment, and how to get help,
you may wish to contact the following organizations:
Anxiety Disorders Association of America
8730 Georgia Ave, Suite
600
Silver Spring, MD 20910
Phone: (240) 485-1001
Fax: (240)
485-1035
Internet: http://www.adaa.org
Makes referrals to professional members and to support groups. Has a
catalog of available brochures, books, and audiovisuals.
Association for Advancement of Behavior Therapy
305 Seventh
Ave.
New York, NY 10001
Telephone
212-647-1890
http://server.psyc.vt.edu/aabt/
Membership listing of mental health professionals focusing on behavior
therapy.
Madison Institute of Medicine
Obsessive Compulsive Information
Center
7617 Mineral Point Road, Suite 300
Madison, WI
53717-1914
Telephone: 608-827-2470
Fax:
608-827-2479
http://healthtechsys.com/mimocic.html
Computer data base of over 13,000 references updated daily. Computer
searches done for nominal fee. No charge for quick reference questions.
Maintains physician referral and support group lists.
Freedom From Fear
308 Seaview Ave.
Staten Island, NY
10305
Telephone: 718-351-1717
http://www.freedomfromfear.com
Offers a free newsletter on anxiety disorders and a referral list of
treatment specialists.
Obsessive-Compulsive Foundation, Inc.
337 Notch Hill Road
North
Branford, CT 06471
Phone: (203) 315-2190
Fax: (203)
315-2196
E-mail: info@ocfoundation.org
Internet:
http://www.ocfoundation.org/
Offers free or at minimal cost brochures for individuals with the
disorder and their families. In addition, videotapes and books are
available. A bimonthly newsletter goes to members who pay an annual
membership fee of $45.00. Has over 250 support groups nationwide. Can
refer to mental health professionals and treatment facilities in your area
with experience in treating obsessive compulsive disorder by mail.
Tourette Syndrome Association, Inc.
42-40 Bell Boulevard
New
York, NY 11361-2874
Telephone:
800-237-0717
http://ba.mgh.harvard.edu
Publications, videotapes, and films available at minimal cost.
Newsletter goes to members who pay an annual fee of $45.00.
Trichotillomania Learning Center
1215 Mission Street, Suite
2
Santa Cruz, CA 95060-3558
Telephone: 831-457-1004
E-mail:
trichster@aol.com
http://www.trich.org
Membership fee of $35.00 includes information packet and bimonthly
newsletter.
For information on other mental disorders, contact:
Information Resources and Inquiries Branch
National Institute of
Mental Health
6001 Executive Boulevard, Rm. 8184, MSC 9663
Bethesda,
MD 20892-9663
Telephone: 301-443-4513
e-mail: nimhinfo@nih.gov
Books Suggested for Further ReadingBaer L. Getting Control.
Overcoming Your Obsessions and Compulsions. Boston: Little, Brown
& Co., 1991.
DeSilva P and Rachman S. Obsessive-compulsive Disorder: that
Facts. Oxford: Oxford University Press, 1992.
Foa EB and Wilson R. Stop Obsessing! How to Overcome Your Obsessions
and Compulsions. New York: Bantam Books, 1991.
Foster CH. Polly's Magic Games: A Child's View of
Obsessive-Compulsive Disorder. Ellsworth, ME: Dilligaf Publishing,
1994.
Greist JH. Obsessive Compulsive Disorder: A Guide. Madison, WI:
Obsessive Compulsive Disorder Information Center. rev. ed., 1992.
(Thorough discussion of pharmacotherapy and behavior therapy)
Jenike MA. Drug Treatment of obsessive compulsive disorder in Adults. Milford, CT: OC
Foundation, 1996. (Answers frequently asked questions about obsessive compulsive disorder and drug
treatments)
Johnston HF. Obsessive Compulsive Disorder in Children and
Adolescents: A Guide. Madison, WI: Child Psychopharmacology
Information Center, 1993.
Matisik EN. The Americans with Disabilities Act and the
Rehabilitation Act of 1973: Reasonable Accommodation for Employees with
obsessive compulsive disorder. Milford, CT: OC Foundation, 1996.
Neziroglu F. and Yaryura-Tobias JA. Over and Over Again:
Understanding Obsessive-compulsive Disorder. Lexington, MA: DC Health,
1991.
Rapoport JL. The Boy Who Couldn't Stop Washing: The Experience and
Treatment of Obsessive-Compulsive Disorder. New York: E.P. Dutton,
1989.
Steketee GS and White K. When Once Is Not Enough: Help for Obsessive
Compulsives. Oakland, CA: New Harbinger, 1990.
VanNoppen BL, Pato MT, and Rasmussen S. Learning to Live with
obsessive compulsive disorder. Milford, CT: OC Foundation, 1993.
VideotapeThe Touching Tree. Jim Callner, writer/director,
Awareness films. Distributed by the O.C. Foundation, Inc., Milford, CT.
(about a child with obsessive compulsive disorder)
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