| Obsessive - Compulsive Disorder NATIONAL INSTITUTE OF MENTAL HEALTH DECADE OF THE BRAIN MESSAGE FROM THE NATIONAL INSTITUTE OF MENTAL HEALTH Research conducted and supported by the National Institute of Mental Health brings hope to millions of people who suffer from mental illness and to their families and friends. During the past 10 years, researchers have advanced our understanding of the brain and vastly expanded the capability of mental health professionals to diagnose, treat, and prevent mental and brain disorders. Now, in the 1990s, which the President and Congress have declared the "Decade of the Brain," we stand at the threshold of a new era in brain and behavioral sciences. Through research, we will learn even more about mental disorders such as depression, bipolar disorder, schizophrenia, panic disorder, and obsessive- compulsive disorder. And we will be able to use this knowledge to develop new therapies that can help more people overcome mental illness. The National Institute of Mental Health is part of the U.S. Department of Health and Human Services. WHAT IS OCD? In the mental illness called obsessive compulsive disorder (OCD), a person becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. The following are typical examples of OCD: Troubled by repeated thoughts that she may have contaminated herself by touching doorknobs and other "dirty" objects, a teenage girl spends hours every day washing her hands. Her hands are red and raw, and she has little time for social activities. A middle-aged man is tormented by the notion that he may injure others through carelessness. He has difficulty leaving his home because he must first go through a lengthy ritual of checking and rechecking the gas jets and water faucets to make certain that they are turned off. Several times a day, a young mother is seized by the fearful thought that she is going to harm her child. However hard she tries, she cannot get rid of this painful and worrisome idea. She even refuses to touch the kitchen knives and other sharp objects because she is afraid that she may use them as weapons. If OCD becomes severe enough, it can destroy a person's capacity to function in the home, at work, or at school. That is why it is important to learn about the disorder and the treatments that are now available. HOW COMMON IS OCD? For many years, mental health professionals thought of OCD as a very rare disease because only a small minority of their patients had the condition. But it is believed that many of those afflicted with OCD, in efforts to keep their repetitive thoughts and behaviors secret, fail to seek treatment. This had led to underestimates of the number of people with the illness. However, a recent survey by the National Institute of Mental Health (NIMH)the Federal agency that supports research nationwide on the brain, mental illnesses, and mental healthhas provided new understanding about the prevalence of OCD. The NIMH survey shows that this disorder may affect as much as 2 percent of the population, meaning that OCD is more common than schizophrenia and other severe mental illnesses. KEY FEATURES OF OCD OBSESSIONS These are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminatedI must wash them"; "I may have left the gas on"; or "I am going to injure my child." These thoughts are felt to be intrusive and unpleasant. They produce anxiety. COMPULSIONS To deal with their anxiety, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking, as in the first two previous examples. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing) and endlessly rearranging objects in an effort to keep them in perfect alignment or symmetry with each other. These behaviors generally are intended to ward off harm to the person with OCD or others. They are usually quite stereotyped, with little variation from one time to the next, and are often referred to as rituals. Performing these rituals may give the person with OCD some relief from anxiety, but it is only temporary. INSIGHT People with OCD generally have considerable insight into their own problems. Most of the time, they know that their obsessive thoughts are senseless or exaggerated, and that their compulsive behaviors are not really necessary. However, this knowledge is not sufficient to enable them to break free from their illness. RESISTANCE Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their obsessive- compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the person's life and make it impossible for him or her to continue activities outside the home. SHAME AND SECRECY People with OCD generally attempt to hide their problem rather than seek help. Often they are remarkably successful in concealing their obsessive-compulsive symptoms from friends and coworkers. An unfortunate consequence of this secrecy is that people with OCD usually do not receive professional help until years after the onset of their disease. By that time, obsessive- compulsive habits may be deeply ingrained and very difficult to change. INTERFERENCE A person is not considered to have OCD unless the obsessive and compulsive behaviors are extreme enough to interfere with everyday life. People with OCD should not be confused with a much larger group of individuals who are sometimes called "compulsive" because they hold themselves to a high standard of performance in their work and even in recreational activities. This type of "compulsiveness" often serves a valuable purpose, contributing to a person's self-esteem and success on the job. In that respect, it differs from the life-wrecking obsessions and rituals of the person with OCD. LONG-LASTING SYMPTOMS OCD tends to last for years, even decades. The symptoms may become less severe from time to time, and there may be long intervals when the symptoms are mild, but generally OCD is a chronic disease. WHO GETS OCD? OCD strikes people of all ethnic groups. Both males and females are affected. Typically, the symptoms begin during the teenage years or young adulthood. TREATMENT OF OCD: PROGRESS THROUGH RESEARCH Clinical and animal research sponsored by NIMH and other scientific organizations is yielding treatments that can help the person with OCD. Descriptions of two of these therapies follow: TREATMENT USING MEDICATIONS A medication called clomipramine can relieve the symptoms of OCD in many people. Clomipramine belongs to a group of medications called the tricyclic antidepressants, which are widely used for the treatment of depressive illness. Several studies have shown, however, that clomipramine can be of benefit to sufferers of OCD who are not depressed as well as those who are. Two other medicationsfluvoxamine and fluoxetinemay also be effective in the treatment of OCD. These medications, like clomipramine, enhance the brain's ability to utilize the naturally occurring brain chemical serotonin. Scientists on the staff of NIMH and others receiving grant support from the Institute are among those investigating medications to treat OCD. BEHAVIOR THERAPY Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not effective against OCD. However, a behavior therapy approach called "exposure and response prevention" has been found to be effective for many people with OCD. In this approach, the patient is deliberately exposed to the feared object or idea, either directly or by imagination, and then is discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand washer may be urged to touch an object believed to be contaminated, and then may be 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 do without the compulsive actions for extended periods of time. In research supported by NIMH, investigators at Temple University in Philadelphia evaluated their own version of this method and found that three- fourths of the patients enrolled in the study improved. CAUSES OF OCD The fact that OCD patients respond well to specific medications suggests the disorder has a neurobiological basis. For that reason, OCD is no longer attributed to attitudes a patient learned in childhoodfor example, an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. Instead, the search for causes now focuses on the interaction of neurobiological factors and environmental influences. It is believed that people who develop OCD have a biological predisposition to react strongly to stress, that this reaction takes the form of intrusive, distressing thoughts, and that these thoughts lead to more anxiety and stress, eventually creating a vicious circle the person cannot escape without help. In an effort to identify specific biological factors that may be important in the onset or persistence of OCD, NIMH- supported investigators have used a device called the positron emission tomography (PET) scanner to study the brains of patients with OCD. Several groups of investigators have obtained findings from PET scans suggesting that OCD patients have patterns of brain activity that differ from those of people without mental illness or with some other mental illness. Brain imaging studies of OCD showing abnormal neuro-chemical activity in regions known to play a role in certain neurological disorders suggest that these areas may be crucial in the origins of OCD. Symptoms of OCD, although not the full syndrome, are seen in association with some other neurological disorders. These include Tourette's syndrome, a condition that runs in families and is characterized by rapid, involuntary, repetitive movements and vocalizations. Genetic studies of OCD and other related conditions may someday enable scientists to pinpoint the molecular basis of these disorders. The ongoing search for causes, together with research on treatment, promises to yield even more hope for people with OCD and their families. Congress has designated the 1990s as the Decade of the Brain to make improved prevention, diagnosis, treatment, and rehabilitation of brain and mental disorders a national research priority. HOW TO GET HELP FOR OCD If you think that you have OCD, you should seek the help of a mental health professional. Family physicians, clinics, and health maintenance organizations usually can provide referrals to mental health centers and specialists. Also, the department of psychiatry at a major medical center or the department of psychology at a university may have specialists who are knowledgeable about the treatment of OCD and able to provide therapy or recommend another doctor in the area. For help in locating a medical center or specialist who is experienced in treating OCD, you may wish to contact the following organizations: OCD Foundation, Inc. P.O. Box 9573 New Haven, CT 06535 Anxiety Disorders Association of America 6000 Executive Blvd., Suite 200 Rockville, MD 20852 FOR FURTHER INFORMATION Barlow, D.H. Anxiety and Its Disorders. New York: The Guilford Press, 1988. Jenike, M.A., Baer, L., and Minichiello, W.E. Obsessive-Compulsive Disorders: Theory and Management, 2nd ed. Chicago: Year Book Medical Publishers, 1990. Perse, T. Obsessive-compulsive disorder: A treatment review. Journal of Clinical Psychiatry 49: 48-55, 1988. Rapoport, J.L. The Boy Who Couldn't Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder. New York: E.P. Dutton, 1989. Zohar, J., and Insel, T.R. Diagnosis and treatment of obsessive-compulsive disorder. Psychiatric Annals 18: 168-171, 1988. Zohar, J., Insel, T.R., and Rasmussen, S. Psychobiology of Obsessive-Compulsive Disorder. New York: Springer Publishing Co., 1991. This booklet was written by Mary Lynn Hendrix, science writer in the Office of Scientific Information, National Institute of Mental Health (NIMH). Scientific review was provided by the following NIMH staff members: Thomas R. Insel, M.D.; Dennis L. Murphy. M.D.; Teresa A. Pigott, M.D.; Judith L. Rapoport, M.D.; Barry Wolfe, Ph.D.; and Joseph Zohar, M.D. | |
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