OCD Obsessive Compulsive Disorder: Obsessions are intrusive, irrational thoughts or unwanted ideas or impulses that repeatedly manifest in a person’s mind. Again and again, the person experiences disturbing thoughts, such as “Did I lock all the doors”; “My hands must be contaminated; I must wash them”; “I may have left the gas stove on”; “I am going to injure my child.” On one level, the sufferer knows these obsessive thoughts are irrational. But on another level, he or she fears these thoughts might be true but cannot let go of them. Trying to avoid such thoughts creates great anxiety, in fact OCD is a form of anxiety. Recently the DSMV is considering reclassifying OCD as a separate disorder apart from anxiety.
Compulsions are repetitive, slavish rituals such as hand washing, counting, checking, hoarding, or arranging. An individual repeats these actions, perhaps feeling momentary relief, but without feeling satisfaction or a sense of completion. People with OCD feel they must perform these compulsive rituals or something bad will happen. Or they are simply feel a bondage to these thoughts much in the same way as an addiction.
Most people at one time or another experience obsessive thoughts or compulsive behaviors. Obsessive compulsive disorder occurs when an individual experiences obsessions and compulsions for more than an hour each day, in a way that interferes with his or her life. When the thoughts and behaviors get to a point of disabling a normal functioning life; it is time to seek help.
Possible Causes of OCD – Obsessive Compulsive Disorder
A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain, like other mental disorders, is this environmental or genetic? OCD symptoms are not relieved by psycho-analysis or other forms of “talk therapy,” but there is evidence that behavior therapy can be effective when augmented with medication.
People whose brains are injured sometimes develop OCD, which suggests it is a physical condition. If a placebo is given to people who are depressed or who experience panic attacks, 40% will say they feel better. If a placebo is given to people who experience obsessive-compulsive disorder, only about 2% say they feel better. This also suggests a physical condition. Additionally when DBS deep brain stimulation is used to treat OCD, it has a fairly good success rate which might suggest that this is a chemical or neurological disorder.
Clinical researchers have identified certain brain regions in OCD; they have discovered a strong link between OCD and a brain chemical called serotonin. Serotonin is a neurotransmitter that helps nerve cells communicate and plays a role in mood. OCD also seems to have a genetic component to it or at least a familial aspect whereby the obsessive behavior of a parent is likely to show up in some of the children. There is new genetic data that claims that prenatal stress can actually change the genes of the fetus and therefore provide the genetic basis for many mental illnesses. Scientists have also observed that people with OCD have increased metabolism in the basal ganglia and the frontal lobes of the brain. This, scientists believe, causes repetitive movements, rigid thinking, and lack of spontaneity. Successful treatment with medication or behavior therapy produces a decrease in the over-activity of this brain region. People with OCD often have high levels of the hormone Vasopressin. This means something in the brain is stuck, like a broken record. As a caveat, these behaviors can also be learned behaviors and passed on from parent to child, especially when the child is exposed to these behaviors at an impressionable age. Regardless of the cause, the end result is still a chemical imbalance in the brain.
People with OCD Have The Tendency To Mask This Disorder
People with OCD generally attempt to hide their problem rather than seek help. Due to the stigma attached to mental illness, nearly 50% of people suffering from a mental illness often postpone treatment for up to 10 years. This is an awful statistic and is decreasing with education and awareness. People with OCD generally do not receive professional help until years after the onset of their disease. By that time, the obsessive compulsive rituals may be deeply ingrained and very difficult to change. They have to get to the point of being sick and tired of the ritual. People can also hold their families “hostage” to their compulsive behavior; especially if the family is not educated about the illness and doesn’t mandate treatment. As with many mental illnesses the family suffers along with the patient.
How Long Does OCD Last
OCD will not go away by itself so it is important to seek treatment. Although symptoms may become less severe from time to time, OCD is a chronic disease. Fortunately, effective treatments are available that make life with OCD much easier to manage. Some have reported remission due to their ability to discern obsessive thoughts from true fears and then ignore the thoughts and reduce the incidences of the behavior.
Age as a Factor in OCD
OCD usually starts at an early age, often before adolescence. It may be mistaken at first for autism, pervasive developmental disorder, or Tourette’s syndrome, a disorder that may include obsessive doubting and compulsive touching as symptoms. Sometimes it shows up as habits and twitches that are written off as benign behaviors or “bad habits” that will be out grown such as facial twitches, blinking, fastidious demands of order and cleanliness; hoarding or sloppiness; all of these can be signs of OCD. Like depression, OCD tends to worsen as the person grows older if left untreated. We hope that when the OCD is treated while the person is still young, the symptoms will not get worse with time.
Other Examples of Behaviors Typical of People who Suffer From OCD
Repeatedly check things, perhaps dozens of times before feeling secure enough to go to sleep or leave the house. Is the stove off? Is the door locked? Is the alarm set?
- Fear they will harm others. Example: A man’s car hits a pothole on a city street and he fears it was actually a body
- Feel dirty and contaminated. Example: A woman is fearful of touching her baby because she might contaminate the child
- Constantly arrange and order things. Example: A child can’t go to sleep unless he lines up all his shoes correctly
- Excessively concerned with body imperfections – insist on numerous plastic surgeries, or spend many, many hours a day body-building
- Ruled by numbers, believing that certain numbers represent good and others represent evil, excessive counting
Heredity as a Factor in OCD
Heredity appears to be a strong factor. If you have OCD, there’s a 25% chance that one of your immediate family members will have it. It definitely seems to run in families. This however is tenuous and will depend on your views of genetics versus environmental factors. Often overlooked is the, environment, parents, and others in the development of a young person conceptual framework and brain developing and synapses through adolescence. We have all heard the expression “A child’s brain is like a sponge”; this is true and environmental factors play a significant role in OCD.
OCD Can be Effectively Treated
Medication and behavior therapy are key in the treatment of OCD. Both affect brain chemistry, which in turn affects behavior. Medication can regulate serotonin, reducing obsessive thoughts and compulsive behaviors. through behavior modification, in mild cases of OCD people can be taught to ignore the thought when it is presented to the mind; or to tell yourself “don’t worry if you left the coffee pot on, your insurance will cover the damages…”
Anafranil (clomipramine): A tricyclic antidepressant, Anafranil has been shown to be effective in treating obsessions and compulsions. The most commonly reported side effects of this medication are dry mouth, constipation, nausea, increased appetite, weight gain, sleepiness, fatigue, tremor, dizziness, nervousness, sweating, visual changes, and sexual dysfunction. There is also a risk of seizures, thought to be dose-related. People with a history of seizures should not take this medication. Anafranil should also not be taken at the same time as a monoamine oxidase inhibitor (MAOI).
Many of the antidepressant medications known as selective serotonin re-uptake inhibitors (SSRIs) have also proven effective in treating the symptoms associated with OCD. The SSRIs most commonly prescribed for OCD are Luvox (fluvoxamine), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline).
Luvox (fluvoxamine): Common side effects of this medication include dry mouth, constipation, nausea, sleepiness, insomnia, nervousness, dizziness, headache, agitation, weakness, and delayed ejaculation.
Paxil (paroxetine): Side effects most associated with this medication include dry mouth, constipation, nausea, decreased appetite, sleepiness, insomnia, tremor, dizziness, nervousness, weakness, sweating, and sexual dysfunction.
Prozac (fluoxetine): Dry mouth, nausea, diarrhea, sleepiness, insomnia, tremor, nervousness, headache, weakness, sweating, rash, and sexual dysfunction are among the more common side effects associated with this drug.
Zoloft (sertraline): Among the side effects most commonly reported while taking Zoloft are dry mouth, nausea, diarrhea, constipation, sleepiness, insomnia, tremor, dizziness, agitation, sweating, and sexual dysfunction.
Celexa (Citalopram) Side effects may include dry mouth, nausea, or drowsiness.
SSRIs should never be taken at the same time as MAOIs.
Some physicians make the mistake of prescribing a medication for only3 or 4 weeks. That really isn’t long enough. Medication should be tried consistently for 10 to 12 weeks before its effectiveness can be judged. Therapeutic levels for the psychotropic drugs don’t work on a gradual increase as the time and dosing increases. It often takes a minimum dosage and time before any benefit is experienced from these medications.
Behavior Modification Therapy – OCD
Behavior therapy is not traditional psychotherapy. It is “exposure and response prevention,” and it is effective for many people with OCD. Patients are deliberately exposed to a feared object or idea, either directly or by imagination, and are then discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand-washer may be urged to touch an object he or she believes is contaminated and denied the opportunity to wash for several hours. When the treatment works well, the patient gradually experiences less anxiety from the obsessive thoughts and becomes able to refrain from the compulsive actions for extended periods of time. As previously mentioned; often the patient has to train him or her to identify and ignore the obsessive thoughts and over time the anxiety will often dissipate with the thoughts.
Several studies suggest that medication and behavior therapy are equally effective in alleviating symptoms of OCD. About half of the patients with this disorder improve substantially with behavior therapy; the rest improve moderately. Response to treatment varies from person to person. Most people treated with effective medications find their symptoms reduced by about 40 percent to 50 percent. That can often be enough to change their lives, to transform them into functioning individuals. Extreme cases of OCD can be the toughest illnesses to treat when the patient is unresponsive to both medication and cognitive therapy and has treatment resistant OCD.
A few patients find that neither treatment produces significant change, and a small number of people are fortunate to go into total remission when treated with effective medication and behavior therapy. Read more about what is OCD.