OCD

Obsessive-Compulsive Disorder

If you or someone you care about has been diagnosed with Obsessive-Compulsive Disorder (OCD), you may feel you are the only person facing the difficulties of this illness. But you are not alone. In the United States, 1 in 50 adults have OCD, and twice that many have had it at some point in their lives. Worries, doubts, superstitious beliefs are common in everyday life. However, when they become so excessive such as hours of hand washing or driving around and around the block to check that an accident didn't occur then a diagnosis of OCD is made. In OCD, the brain gets stuck on a particular thought or urge and just can't let go. People with OCD often say the symptoms feel like a case of mental hiccups that won't go away. OCD is a medical brain disorder that causes problems in information processing. It is not your fault or the result of a "weak" or unstable personality.

Before the arrival of modern medications and cognitive behavior therapy, OCD was generally thought to be untreatable. Most people with OCD continued to suffer, despite years of ineffective psychotherapy. Today, luckily, treatment can help most people with OCD. Although OCD is usually completely curable only in some individuals, most people achieve meaningful and long-term symptom relief with comprehensive treatment.

OCD starts at any time from preschool age to adulthood (usually by age 40). One third to one half of adults with OCD report that it started during childhood. Unfortunately, OCD often goes unrecognized. On average, people with OCD see three to four doctors and spend several years seeking treatment before they receive a correct diagnosis. Studies find that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment. OCD tends to be under diagnosed and undertreated for a number of reasons. People with OCD are secretive about their symptoms or lack insight about their illness. Many healthcare providers are not familiar with the symptoms or are not trained in providing the appropriate treatments. Some people don't have access to treatment resources. This is unfortunate because earlier diagnosis and proper treatment, including finding the right medications, can help people avoid the suffering associated with OCD. This lessens the risk of developing other problems, such as depression, marital and work problems.

Symptoms

OCD involves having both obsessions and compulsions. A person with OCD may sometimes have one or the other.
Common obsessions are: contamination fears of germs, dirt, etc. imagining having harmed self or others, imagining losing control or aggressive urges, intrusive sexual thoughts or urges, excessive religious or moral doubt, forbidden thoughts A need to have things "just so" A need to tell, ask, confess common compulsions: washing repeating checking touching counting
OCD symptoms can occur in people of all ages. Not all Obsessive-Compulsive behaviors represent an illness. Some rituals (e.g., bedtime songs, religious practices) are a welcome part of daily life. Normal worries, such as contamination fears, may increase during times of stress, such as when someone in the family is sick or dying. Only when symptoms persist, make no sense, cause much distress, or interfere with functioning do they need clinical attention.

Obsessions. Obsessions are thoughts, images, or impulses that occur over and over again and feel out of your control. The person does not want to have these ideas. He finds them disturbing and intrusive, and usually recognizes that they don't really make sense. People with OCD worry excessively about dirt and germs and become obsessed with the idea that they are contaminated or contaminate others. They may have obsessive fears of having inadvertently harmed someone else even though they usually know this is not realistic. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust, doubt, or a sensation that things have to be done in a way that is "just so".
Compulsions. People with OCD try to make their obsessions go away by performing compulsions. Compulsions are acts the person performs over and over again, often according to certain "rules." People with an obsession about contamination may wash constantly to the point that their hands become raw and inflamed. A person may repeatedly check that she has turned off the stove or iron because of an obsessive fear of burning the house down. She may have to count certain objects over and over because of an obsession about losing them. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure. Rather, the rituals are performed to obtain relief from the discomfort caused by the obsessions.
Other features of Obsessive-Compulsive Disorder. OCD symptoms cause distress, take up time (more than an hour a day), or significantly interfere with the person's work, social life, or relationships. Most individuals with OCD recognize that their obsessions are coming from their own minds and are not just excessive worries about real problems. They realize that the compulsions they perform are excessive or unreasonable. When someone with OCD does not recognize that their beliefs and actions are unreasonable, this is called OCD with poor insight. OCD symptoms tend to wax and wane over time. Some may be little more than background noise; others may produce extremely severe distress.

Causes

There is no proven cause of OCD. Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are involved in OCD. Drugs that increase the brain concentration of serotonin often help improve OCD symptoms. Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in those who improve after taking a serotonin medication or receiving cognitive-behavioral psychotherapy. Although it seems clear that reduced levels of serotonin play a role in OCD, there are no laboratory tests for OCD. The diagnosis is made based on an assessment of the person's symptoms. When OCD starts suddenly in childhood in association with strep throat, an autoimmune mechanism may be involved, and treatment with an antibiotic may prove helpful.

OCD in Children

OCD can make daily life very difficult and stressful for children. OCD symptoms often take up a great deal of a child's time and energy. This makes it difficult to complete tasks such as homework or household chores. Children worry that they are "crazy" because they are aware their thinking is different than their friends and family. A child's self-esteem can be negatively affected because the OCD has led to embarrassment or has made the child feel "bizarre" or "out of control".

In the morning, they feel they must do their rituals right, or the rest of the day will not go well. Meanwhile, they are rushed to be on time for school. This combination of factors leads to feeling pressured, stressed, and irritable. In the evenings, they feel compelled to finish all of their compulsive rituals before they go to bed. They know they must get their homework done and take care of any household chores and responsibilities. Some children stay up late because of their OCD, and are often exhausted the following day.

Children with OCD frequently don't feel well physically. This may be due to the stress of having the disorder, or it may be poor nutrition or the loss of sleep. Obsessions and compulsions related to food are common, and these can lead to irregular or "quirky" eating habits. Many children with OCD are prone to stress-related ailments such as headache, or an upset stomach.

Children with OCD have episodes in which they are extremely angry with their parents. This is because the parents have become unwilling (or are unable!) to comply with the child's OCD-related demands. For example, children with obsessions about germs may insist that they be allowed to shower for hours, or demand that their clothes be washed numerous times or a particular way. Even when parents set reasonable limits, children with OCD can become anxious and angry. However, this anger does not justify physical or verbal abuse between parent and child. If violence or abuse occurs within the home, it should not be tolerated. Professional help should be sought.

Friendships and peer relationships are stressful for those with OCD because they try hard to conceal their rituals from peers. When the disorder is severe, this becomes impossible, and the child may get teased or ridiculed. Even when the OCD is not severe, it affects friendships because of the time spent preoccupied with obsessions and compulsions, or because friends react negatively to unusual OCD-related behaviors.