What is Obsessive Compulsive Disorder? (cont.)

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 for most individuals with OCD, the symptoms are chronic. Symptoms of both obsessions and compulsions include:

Obsessions

These are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable belief that one has a terrible illness, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated--I must wash them"; "I may have left the gas on"; or "I am going to injure my child." These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Often the obsessions are of a violent or a sexual nature, or concern illness.

Compulsions

In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.

Causes

The old belief that OCD was the result of life experiences has given way before the growing evidence that biological factors are a primary contributor to the disorder. The fact that OCD patients respond well to specific medications that affect the neurotransmitter serotonin suggests the disorder has a neurobiological basis. For that reason, OCD is no longer attributed to attitudes a patient learned in childhood--for 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.

OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Co-existing disorders can make OCD more difficult both to diagnose and to treat.

Treatment

Most people with OCD benefit from a combination of behavioral therapy and medication. A specific behavior therapy approach called "exposure and response prevention" can be especially effective for treating this disorder. In the safe, comforting and confidential setting of therapy the person is deliberately and voluntarily exposed to the feared object or idea, either directly or through 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 person gradually experiences less anxiety from the obsessive thoughts and becomes able to do without the compulsive actions for extended periods of time.

Studies of behavior therapy for OCD have found it to produce long-lasting benefits. To achieve the best results, a combination of factors is necessary: The therapist should be well trained in the specific method developed; the person with OCD must be highly motivated; and the OCD sufferer's family must be cooperative. In addition to visits to the therapist, the person must be faithful in fulfilling "homework assignments." For those who complete the course of treatment, the improvements can be significant.

OCD affects not only the sufferer of the disorder but the whole family. The family often has a difficult time accepting the fact that the person with OCD cannot stop the distressing behavior. Family members may show their anger and resentment, resulting in an increase in the OCD behavior, or, in an attempt to keep the peace, they may assist in the rituals or give constant reassurance. Education about OCD is important for the family.

Families can learn specific ways to encourage the person with OCD by supporting the medication regime and the behavior therapy. Some families seek the help of a family therapist who is trained in the field. Also, many families have joined one of the educational support groups that have been organized throughout the country.