What was once thought to be a rare mental disease is now known to be a more
common one. Approximately 2.3% of the population between ages 18-54 suffers from Obsessive Compulsive Disorder, which outranks mental disorders (“UOCD“ 1). Are we seeing an epidemic of OCD? No, not at all. OCD is not a rare disease. The mistaken rarity of OCD is due to the secrecy of people who have the disorder. Shame, guilt, and self-blame keep us from exposing our secret struggle with obsessive thoughts and compulsive rituals.
Obsessions are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause serious discomfort, anxiety, or distress. The patient recognizes that obsessions are products of his own mind and tries to ignore, suppress, or neutralize them. Compulsions are acts performed repeatedly to relieve obsessions. The patient recognizes that the obsessions and compulsions are excessive and unreasonable or inappropriate. They are distressing, or occupying more than an hour a day, or seriously interfere with work, social activities, and personal relationships (“Obsessive” 1).
There are many different theories about the cause of Obsessive Compulsive Disorder. The majority of researchers believe that there is some type of abnormality in the neurotransmitter serotonin; however, it is possible that this activity is the brain’s response to OCD, and not its cause (“Obsessive” 1). Serotonin is thought to have a role in regulating anxiety. It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential. Recent research has revealed a possible genetic mutation that could be the cause of OCD.
In the early 1910’s, Sigmund Freud attributes obsessive-compulsive behavior to unconscious conflicts which manifests as symptoms. Freud describes the clinical history of a typical case of “touching phobia” as follows:
“After it has started, in early childhood, the patient shows a strong desire to touch, the aim of which is of a far more specialized kind than one would have been inclined to expect. This desire is promptly met with an external prohibition against carrying out that particular kind of touching. The prohibition is accepted, since it finds support from powerful internal forces, and proves stronger than the instinct which is seeking to express itself in the touching. In consequence, however, of the child’s primitive physical constitution. The prohibition does not succeed in abolishing the instinct. It’s only result is to repress and not abolished, and the prohibition because if it ceased, the instinct would force its way through into consciousness and into actual operation. A situation is created which remains undealt with psychical fixation- and everything else follows from the continuing conflict between the prohibition and the instinct” (“What” 1-2)
At any given time, about 1% of Americans have Obsessive Compulsive Disorder; the lifetime rate is about 2.5% (“Obsessive” 2). It usually begins early in life; one-third to one-half of people with the disorder are under the age of fifteen. The disorder is more common in females than in males. OCD also occurs at a high rate in people with other anxiety disorders, especially simple and social phobias. Like most psychiatric disorders, OCD has a strong genetic basis. About 20% of the close relatives of a person with the disorder will also have OCD. Over 80% of patients develop symptoms by age 35.
The relationship between OCD and religiousness is complex. Some studies have found a correlation between religiousness and the severity of OCD, but most research to date suggests that religiousness is not casually linked with OCD. However, religious beliefs and practices can affect the content of obsessions and compulsions in religiously minded people with OCD. For example, Muslim and Jewish patients from the Middle East who have OCD have been found to engage in more compulsive religious rituals (usually related to cleanliness and purity) than other populations with OCD. “Their obsessions tend to focus more on themes of religion and cleanliness, as compared with themes of orderliness and aggression in Christian and Hindu samples” (qtd. in Miovic 1).
With the help of brain imaging and genetic technology, scientists may eventually identify endophenotypes. Endophenotypes are genetically based biological traits or markers that are common in the families of people with a psychiatric disorder and may be related to the manifested symptoms of more than one disorder (“Obsessive Compulsive Disorder: Part II” 4). One recent study suggests that low blood levels of serotonin and low serotonin receptor sensitivity may fit the description of an endophenotype for obsessions and compulsions.
OCD symptoms can be severe and time-consuming. For instance, someone who feels that his or hands have become contaminated by germs (an obsession) may spend hours washing them each day ( a compulsion). The focus on hand washing may be so great that he or she can accomplish little else. OCD symptoms include: 1) Fear of being contaminated by shaking hands or touching objects others have touched 2) Intense distress when objects aren’t orderly 3) Images of hurting one’s child 4) Counting in certain patterns 5)Washing hands until skin becomes raw. Sometimes symptoms can be traced to a traumatic event. “In a recently described case, a man witnessed a murder when the killer was forty-two years old, and now must return home and wash for hours every time he sees a license plate with the number forty-two” (“Obsession” 1).
Symptoms of OCD can occur inside the brain. “The malfunction is mainly in a circuit connecting the frontal lobes of the cerebral cortex which govern judgement, planning, and decision-making and the basal ganglia which filters messages to and from the cortex to regulate body movements and other functions” (“Obsessive-compulsive disorder: Part II” 3). Injuries and diseases that damage the basal ganglia can cause OCD symptoms as well.
There are various different treatments for Obsessive Compulsive Disorder. DBS (Deep Brain Stimulation) works by causing neurons to fire constantly, producing a stream of activity (Ainsworth 1). ERP (Exposure and Response Prevention) patients are exposed to the sources of their obsessions repeatedly and prevented from performing the rituals, until the obsessions lose their compelling quality (“Obsessive-compulsive disorder: Part II” 1). In behavioral terms, the conditioned pattern is extinguished. The treatment usually takes three of four months of weekly sessions. Patients practice daily and record the results to track their progress. Some patients can work alone with a manual or self-help book, or, according to one new study, a computer. Exposure is best done at the times and places where the symptoms are most likely to arise, which often means at home.
Cognitive techniques are sometimes added to help patients free themselves of obsessional doubt, an exaggerated sense of responsibility, and an excessive need for control. Some people with OCD cannot effectively practice behavior therapy because they are depressed or have personality disorders or serious family problems. Insight-oriented therapy may help them complete behavioral treatment, live more comfortably with the remaining symptoms, and find ways to occupy time no longer consumed by obsessions and rituals. Assertiveness training may help them reduce anxiety and guilt associated with obsessions. “Mutual-aid groups are also becoming more popular as a way people with OCD can exchange sympathy and ideas and help themselves by helping others” (“Obsessive-compulsive disorder: Part II” 2)Family support groups may be useful for them, especially if compulsive rituals have been monopolizing a household’s attention.
The main drug treatments for OCD are antidepressants that enhance the activity of the neurotransmitter serotonin. On average, OCD requires higher doses than depression; antidepressants take longer to start working- as long as three months. Some may prefer drug treatment because they find behavior therapy too expensive, too challenging, or unavailable. Others take drugs in the hope of reducing their fears and doubts enough to make behavior therapy tolerable. In several studies, the combination of drugs and behavior therapy has been found more effective than drugs alone.
Very rarely and as a last resort, when obsessive-compulsive symptoms are disabling and no other treatment works. A surgeon can interrupt targeted nerve circuits in the brain. Patients often take months to respond, which suggests that the brain is slowly substituting new connections for old. The surgery may lead to apathy or emotional unresponsiveness. OCD in adults can be managed with short-term cognitive behavior therapy (CBT) or medication with a type of drug known as a selective serotonin reuptake inhibitor (SSRI). CBT is a form of psychotherapy that helps patients change their thought patterns.