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Obsessive-Compulsive Disorder: A Treatable Disorder
The purpose of this information is to explain Obsessive-Compulsive
Disorder. We hope that it may help you to decide if you may have this disorder.
It suggests a reasonable approach to promote proper detection and treatment
This is intended for educational information only. Treatment for appendicitis
is not a 'do it yourself' project. Neither is treatment for OCD. If you
believe, after reading this, that you might have OCD, you should see your
physician who can either diagnose and treat you, or refer you to a specialist.
A Case History
Bob saw his psychiatrist for treatment of depression for six months
before he finally had the courage to bring up his other "secret" problem.
Since childhood he had a compulsion to count things. He had to count the
letters in words and in people's names. If the letters added up to any
number except 9 he felt a sense of release and could stop counting. He
knew it was silly but nevertheless he had a fear that if he did not do
this something bad could happen to his mom or dad. He seemed unable to
stop doing this. He did poorly in school because he was distracted by his
secret compulsion to count letters when he should have been paying attention
to the teacher's lessons. He was later bothered as a teenager by upsetting
sacrilegious mental images when he was in church. Having these sacrilegious
images made him feel that he lost his soul for eternity.
In addition to these two problems, he was having trouble driving. When
he felt a bump as his tire rolled over a little stone, he would think he
may had accidentally run over a pedestrian. He would instantly check his
rearview mirror for the injured person he feared was lying on the road.
Relieved to not see an injured person, he would start to drive forward.
Obsessing that the injured person might have been flung entirely off the
road by the impact, he would then stop, and back up his car to the scene,
and search the ditch and weeds. These obsessions and compulsions were taking
over his life but he was too embarrassed to tell anyone about them, even
his psychiatrist, up till now.
His psychiatrist explained that this was caused by OCD, a metabolic-physiological
abnormality, and was treatable with one of about six special medications
that work on a chemical in the brain called serotonin. After the medication
began to work, they would employ special psychological maneuvers to help
overcome this problem.
The psychiatrist told him that with the combined treatment an average person
can expect improvement in 3 months. This knowledge filled him with hope
for a better future.
What is It?
Anxiety about thoughts or rituals over which you feel you have little
control is typical of OCD. OCD can take so many different forms. Let's
try to make sense of it.
Obsessions are thoughts, often intrusive and upsetting.
Obsessions are to be distinguished from ruminations or worries about routine
life issues such as finances, children or job security. Some examples of
obsessions in OCD may be thoughts or mental images of an upsetting nature
like violence, vulgarities, harm to self or harm to others. Obsessions
may be of special numbers, colors, or single words or phrases . . . sometimes
Here are Some Examples.
Compulsions are Behaviors.
Repugnant Sexual Thoughts
Repugnant Religious Thoughts
Fear Of Forgetting
Fear That A Mistake Will Harm A Loved One
A compulsion is a repetitive behavior in response to an urge. It is
difficult to stop this behavior. Obsessions provoke compulsions. Examples
include washing the hands too many times, showering too frequently or washing
things about the home like clothes or floors or even groceries.
How much is too much? Many experts agree that engaging in more than an
hour a day raises suspicions of OCD. Compulsions are often performed repetitively
and in some stereotyped or ritualistic fashion. You may be bothered by
urges to perform rituals like repeatedly turning off and on a light switch
until it "feels right."
Here are Some More Examples.
Compulsions to repeatedly:
The list of all possible obsessions and compulsions is long and varied.
Fortunately OCD seems to bother each person with OCD in only a few particular
ways. We do not know why OCD bothers each person in a different way. It
does seem that it is almost as if OCD 'knows' what would bother you the
most and hones in on that. For example, if you are a particularly religious
person you might be plagued by repugnant religious OCD thoughts that are
a lot more upsetting to you than they would be to a person with below average
concern about religion.
Perform Silly Rituals Until It "Feels" Right.
Often the obsession comes first and the compulsion seems to be a response
to the obsession. For example, a person may have an obsessive fear of ingesting
or absorbing illegal drugs from indirect contact with people they suspect
to be taking illegal drugs. Such a person may obsessively fear losing his
mind from using a restaurant's public rest room after seeing someone they
suspect may be a drug addict using the facility. After leaving the restaurant,
he may have to throw away his shoes and floor mats in his car that may
have been "contaminated." He may have to scrub his hands in bleach exactly
ten times perfectly. Other articles of clothing may have to be washed repeatedly
or thrown away. He may be afraid to take medicine that has been touched
by a pharmacist who he thinks might be using marijuana after hours, fearing
that some of the residue might have contaminated
There is no pleasure in carrying out these rituals. There is only temporary
relief from the anxiety caused by the obsession.
Interesting Facts About OCD
Although adults realize in part that these obsessions and compulsions
are senseless, they have great difficulty stopping them. Children with
OCD may not realize their behavior is unusual.
Can I Be Helped?
- There is a link between serotonin and dopamine, brain neurotransmitter
chemicals, and OCD.
- Often OCD affects the family. Family members are sometimes drawn into
the OCD behavior. Disability may affect family finances.
- Medication for OCD should be tried 10-12 weeks before judging effectiveness.
- OCD affects men and women equally.
- OCD can start at any age. In one third of adult patients the symptoms
begin in childhood, adolescence or young adulthood.
- OCD afflicts approximately 2% of the population.
- The untreated symptoms may vary for years. The symptoms may go away,
remain the same or worsen.
- Evidence suggests that OCD runs in some families and may be genetically
- It is not uncommon for a person with OCD to also have clinical depression,
panic attacks, or both.
- Persons having OCD often cleverly hide their OCD successfully from
family and friends and coworkers
- Few OCD patients respond to placebos in contrast to 30 ­p; 40% of
- Persons having OCD often exhibit abnormal rates of metabolic activity
in the frontal lobe and the basal ganglia of the brain.
Yes! Up until a few years ago we did not have effective treatments for
OCD. New medications and behavior therapy now give many patients significant
relief. In behavior therapy, the patient faces squarely the OCD difficulties
either in a gradual step-by-step manner or in an aggressive one-step way.
The technical name for this process is exposure and response prevention.
Experts believe that behavior therapy is an effective treatment used by
itself in certain patients with OCD if done well and vigorously. Certain
other patients will only respond to medication. Many patients find the
combined use of medication and behavior therapy most effective.
Some Medications Used In The Treatment Of OCD:
Often the first medication tried will not work for a particular patient
with OCD. That should not discourage you or your doctor since another medicine
may work well. Side effects vary considerably depending upon which medicine
is being used. Experienced clinicians will
readily attest to the fact that each medicine is unique and may behave
differently especially with respect to side effects. ANAFRANIL, though
having perhaps slightly more chance of effectiveness, has more disruptive
side effects than the others listed. For that reason it is not used by
some clinicians as a first choice.
PROZAC, ZOLOFT, PAXIL and LUVOX are convenient remedies that usually have
minimal effects (about 10-20% of people have either nausea, headaches,
delayed orgasm or ejaculation, decreased sexual interest, or insomnia).
There are some prescription medicines that must not be used with LUVOX.
Sometimes a psychiatrist may advise adding a second medicine to your SSRI
to boost the power of treatment if your OCD is not responding. Neuroleptic
and benzodiazepine medicines are two commonly employed 'booster' medicines.
Other medicines used for this purpose are Buspar buspirone, Pondimin fenfluramine,
and the serotonin-2 antagonist/reuptake inhibitors: Desyrel trazodone and
If you have OCD, you would be wise to be treated by a specialist who is
well versed and experienced in using these medicines and behavior therapy
at least until you seem to be recovered.
Some patients actually need nothing more than the medication. They make
a full recovery and need no further treatment. Other OCD patients would
definitely benefit from behavioral treatment called exposure and response
Exposure and response prevention mean that you expose yourself to whatever
situation triggers the problem. You then prevent yourself from engaging
in your usual ritual. For example, suppose that you have OCD problems with
greasy substances. You might choose to allow yourself to become greasy
while adding oil to your lawnmower (exposure). Instead of washing immediately,
you prevent yourself from washing (response prevention).
By exposing yourself to your fear, anxiety increases temporarily. However,
by continuing to avoid your usual compulsive behavior response, your anxiety
is allowed to naturally diminish. The obsessive-compulsive cycle is broken,
and the obsessive thoughts weaken. Confronting such fears is not easy and
it may require special guidance from a trained professional.
In summary, if you have OCD you may be plagued by persistent, recurrent,
intrusive and unwelcome thoughts or images, or by an urgent need to engage
in silly or upsetting rituals. The problem is now treatable with medication
and special psychological techniques.
Reading List for Lay Persons
The Boy Who Couldn't Stop Washing.Judith Rapoport, Penguin
Books, New York, 1991.
Obsessive-Compulsive Disorder: A Guide. John Greist, OCIC,
Univ. of WI,
Madison WI 1991.
Stop Obsessing! Edina Foa PhD and Reid Wilson PhD, Bantam
Books, New York, 1991.
Brain Lock, J. Schwartz, Regan Books/Harper Collins, New
Getting Control - Overcoming Your Obsessions and Compulsions.
Baer, L. Little Brown & Company, Boston, 1991.
Professional Reading List
Essential Psychopharmacology. S. Stahl, Cambridge University
Press, New York, 1996.
Psychopharmacology The Fourth Generation of Progress. F.
Bloom & D. Kupfer, Raven Press, New York, 1995.
This material was prepared by Stephen M. Cox MD, President & Medical
Information provided by:
National Anxiety Foundation, 3135 Custer Dr., Lexington, KY 40517-4001
For more information call NAF at (606) 272-7166 or (800) 755-1576.