Obsessive Compulsive Disorder

OCD is a type of anxiety (say: ang- zye -uh-tee) that happens when there is a problem with the way the brain deals with normal worrying and doubts. Kids with OCD worry a lot . And they feel afraid about bad things that could possibly happen.

Obsessive thoughts and compulsive behaviors represent recurring efforts to control overwhelming anxiety, guilt, or unacceptable impulses that persistently enter the consciousness. The word obsession refers to a recurrent idea, thought, impulse, or image that's intrusive and inappropriate, causing marked anxiety or distress. A compulsion is a ritualistic, repetitive, and involuntary defensive behavior or action. Performing a compulsive behavior reduces the patient's anxiety and increases the probability that the behavior will recur. Compulsions are commonly associated with obsessions.

Patients with obsessive-compulsive disorder (OCD) are prone to abuse psychoactive substances, such as alcohol and nxiolytics, in an attempt to relieve their anxiety. In addition, other anxiety disorders, Tourette syndrome,attention deficient hyperactivity disorder (ADHD), and major depression commonly coexist with OCD. OCD is typically a chronic condition with remissions and flare-ups and is likely to begin during adolescence. Mild forms of the disorder are relatively common in the population at large. Although OCD tends to affect men and women equally, men typically have the disorder earlier in life than women, with most men being diagnosed between ages 6 and IS, whereas women are typically diagnosed in their 20s. Also, men are more likely to have chronic OCD whereas women are more likely to have acute, or episodic, OCD.

What causes OCD?

The cause of OCD is unknown. Research indicates that there are abnormalities in central nervous system serotonin transmission and in the paralimbic circuit. Some studies suggest the possibility of brain lesions, but the most useful research and clinical studies base an explanation on psychological theories. In addition, major depression, organic brain syndrome, and schizophrenia may contribute to the onset of OCD. Some authorities think OCD is closely related to certain eating disorders. Also, someone who has a blood relative with OCD is more likely to develop OCD than someone who doesn't. Even so, not everyone who has a relative with the disorder will necessarily develop it.

Signs and symptoms of OCD

The psychiatric history of a patient with this disorder may reveal the presence of obsessive thoughts, words, or mental images that persistently and involuntarily invade the consciousness. Some common obsessions include thoughts of violence (such as stabbing, shooting, maiming, or hitting), thoughts of contamination (images of dirt, germs, or feces), repetitive doubts and worries about a tragic event, and repeating or counting images, words, or objects in the environment. The patient recognizes that the obsessions are a product of her own mind and that they interfere with normal daily activities.

The patient's history may also reveal the presence of compulsions, which are irrational and recurring impulses to repeat a certain behavior. Common compulsions include repetitive touching, sometimes combined with counting; doing and undoing (for instance, opening and closing doors or rearranging things); washing (especially hands); and checking (to be sure no tragedy has occurred since the last time she checked). In many cases, the patient's anxiety is so strong that she'll avoid the situation or the object that evokes the impulse.

When the obsessive-compulsive phenomena are mental, observation may reveal no behavioral abnormalities. However, compulsive acts may be observed. feelings of shame, nervousness, or embarrassment may prompt the patient to try limiting these acts to her own private time.

Diagnosis information

For characteristic findings in patients with this condition, see Diagnosing OCD, page 374. Coexisting disorders, such as depression, ADHD, and eating, personality, or anxiety disorders, can make OCD more difficult to diagnose. Although there's no laboratory test that diagnoses OCD, the disorder usually causes severe distress and interferes with a person's normal routine,work, social activities, and relationships.

Treatment of OCD

OCD is tenacious, but improvement occurs in 60% to 70% of patients who obtain treatment. Current treatment usually involves a combination of medication and cognitive behavioral therapy. Other types of psychotherapy may also be helpful.

The most effective medications are selective serotonin reuptake inhibitors, such as fluoxetine (Prozac),paroxetine (Paxil), sertraline (Zoloft), and fluvoxamine (Luvox); and tricyclic antidepressants such as clomipramine (Anafranil). These drugs help decrease the frequency and intensity of the obsessions and compulsions. Improvement usually takes three or more weeks and the patient will have to continue the medication indefinitely.

Behavioral therapies - aversion therapy, thought stopping, thought switching, flooding, implosion therapy, and exposure and response prevention - have also been effective.

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Are other illnesses associated with OCD?

People with OCD often have other kinds of anxiety, like phobias (such as fear of spiders or fear of flying) or panic attacks.

People with OCD also may have depression, attention deficit hyperactivity disorder, an eating disorder or a learning disorder such as dyslexia.

Having one or more of these disorders can make diagnosis and treatment more difficult, so it's important to talk to your doctor about any symptoms you have, even if you're embarrassed.

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Special considerations and Prevention

• Approach the patient unhurriedly.
• Provide an accepting atmosphere; don't appear shocked, amused, or critical of the ritualistic behavior.
• Keep the patient's physical health in mind. For example, compulsive hand washing may cause skin breakdown; rituals or preoccupations may cause inadequate food and fluid intake and exhaustion. Provide for basic needs, such as rest, nutrition, and grooming, if the patient becomes involved in ritualistic thoughts and behaviors to the point of self-neglect.
• Let the patient know you're aware of her behavior. For example, you might say, "I noticed you've made your bed three times today; that must be very tiring for you." Help the patient explore feelings associated with the behavior. For example, ask her, "What do you think about while you're performing your chores?"
• Make reasonable demands and set reasonable limits, explaining their purpose clearly. Avoid creating situations that increase frustration and provoke anger, which may interfere with treatment or may trigger an obsessive or compulsive thought.
• Explore patterns leading to the behavior or recurring problems.
• Engage the patient in activities to create positive accomplishments and to raise sell-esteem and confidence.
• Encourage active diversionary activities, such as whistling or humming a tune, to divert attention from the unwanted thoughts and to promote a pleasurable experience.
• Help the patient develop new ways to solve problems. and cultivate more effective coping skills by setting limits on unacceptable behavior (for example, by limiting the number of times per day she may indulge in compulsive behavior). Gradually shorten the time allowed. Help her focus on other feelings or problems for the remainder of the time.
• Identify insight and improved behavior (reduced compulsive behavior and fewer obsessive thoughts). Evaluate behavioral changes by your own observations and the patient's reports.
• Identify disturbing topics of conversation that reflect underlying anxiety or terror.
• Help the patient identify progress and set realistic expectations of hersell and others.
• Work with the patient and other treatment team members to establish behavioral goals and to help the patient tolerate anxiety in pursuing these goals.