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An Introduction to Obsessive-Compulsive Disorder
-- "I couldn't do anything
without rituals. They transcended every aspect of my life.
Counting was big for me. When I set my alarm at night,
I had to set it to a number that wouldn't add up to a
"bad" number. If my sister was 33 and I was
24, I couldn't leave the TV on Channel 33 or 24. I would
wash my hair three times as opposed to once because three
was a good luck number and one wasn't. It took me longer
to read because I'd count the lines in a paragraph. If
I was writing a term paper, I couldn't have a certain
number of words on a line if it added up to a bad number.
I was always worried that if I didn't do something, my
parents were going to die. Or I would worry about harming
my parents, which was completely irrational. I couldn't
wear anything that said Boston because my parents were
from Boston. I couldn't write the word "death"
because I was worried that something bad would happen."
"Getting dressed in the morning was tough because
I had a routine, and if I deviated from that routine,
I'd have to get dressed again. I knew the rituals didn't
make sense, but I couldn't seem to overcome them until
I had therapy."
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The disturbing thoughts or images are called obsessions,
and the rituals
performed to try to prevent or dispel them are called
compulsions. There is no pleasure in carrying out the
rituals you are drawn to, only temporary relief from the
discomfort caused by the obsession.
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Obsessive-compulsive disorder is characterized by anxious thoughts
or rituals you feel you can't control. If you have OCD, as it's
called, you may be plagued by persistent, unwelcome thoughts
or images, or by the urgent need to engage in certain rituals.
You may be obsessed with germs or dirt, so you wash your hands
over and over. You may be filled with doubt and feel the need
to check things repeatedly. You might be preoccupied by thoughts
of violence and fear that you will harm people close to you.
You may spend long periods of time touching things or counting;
you may be preoccupied by order or symmetry; you may have persistent
thoughts of performing sexual acts that are repugnant to you;
or you may be troubled by thoughts that are against your religious
beliefs.
The disturbing thoughts or images are called obsessions, and
the rituals that are performed to try to prevent or dispel them
are called compulsions. There is no pleasure in carrying out
the rituals you are drawn to, only temporary relief from the
discomfort caused by the obsession.
A lot of healthy people can identify with having some of the
symptoms of OCD, such as checking the stove several times before
leaving the house. But the disorder is diagnosed only when such
activities consume at least an hour a day, are very distressing,
and interfere with daily life.
Most adults with this condition recognize that what they're
doing is senseless, but they can't stop it. Some people, though,
particularly children with OCD, may not realize that their behavior
is out of the ordinary.
OCD strikes men and women in approximately equal numbers and
afflicts roughly 1 in 50 people. It can appear in childhood,
adolescence, or adulthood, but on the average it first shows
up in the teens or early adulthood. A third of adults with OCD
experienced their first symptoms as children. The course of
the disease is variable--symptoms may come and go, they may
ease over time, or they can grow progressively worse. Evidence
suggests that OCD might run in families.
Depression or other anxiety disorders may accompany OCD. And
some people with OCD have eating disorders. In addition, they
may avoid situations in which they might have to confront their
obsessions. Or they may try unsuccessfully to use alcohol or
drugs to calm themselves. If OCD grows severe enough, it can
keep someone from holding down a job or from carrying out normal
responsibilities at home, but more often it doesn't develop
to those extremes.
Research by NIMH-funded scientists and other investigators
has led to the development of medications and behavioral treatments
that can benefit people with OCD. A combination of the two treatments
is often helpful for most patients. Some individuals respond
best to one therapy, some to another. Two medications that have
been found effective in treating OCD are clomipramine and fluoxetine.
A number of others are showing promise, however, and may soon
be available.
Behavioral therapy, specifically a type called
exposure and response prevention, has also proven useful for treating
OCD. It involves exposing the person to whatever triggers the
problem and then helping him or her forego the usual ritual--for
instance, having the patient touch something dirty and then not
wash his hands. This therapy is often successful in patients who
complete a behavioral therapy program, though results have been
less favorable in some people who have both OCD and depression.
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-excerpted from the National Institutes of Health, Publication
97-3879
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