Help is available for obsessive-compulsive disorder
Checkup on Health
By Donald M. Hilty, M.D.
Everyone is occasionally plagued by disturbing thoughts or finds comfort in small routines. But for some people, such thoughts turn into obsessions that they can’t get out of their minds – and small routines that are performed repetitively to relieve the worries become compulsive acts. Such obsessions and compulsions may become an overwhelming part of one’s life, occupying hours per day.
Dr. Hilty is an adult psychiatrist at UC Davis Medical Center in Sacramento.
Obsessive-compulsive disorder or OCD is a recognized psychiatric disorder found in about 2 to 3 percent of the population. Obsessions are unpleasant ideas, thoughts or images that manifest themselves repeatedly. They may include fears of contamination by dirt or germs, or terrors that loved ones will be harmed, either by others or by one’s own hand. Sexual images, which are perceived as sinful or disgusting, and a need for things to be exactly orderly (at least to them) are also common.
Obsessions are usually extremely anxiety-provoking and are experienced as an intrusion beyond personal control. A well-known movie depicting cleanliness is “As Good as It Gets” with famous actor Jack Nicholson.
Compulsions are behaviors that are performed over and over again in an attempt to relieve the anxiety generated from the mental obsessions. They may include frequent hand-washing or teeth-brushing to control germs or repeatedly checking that doors are locked, drawers are shut or appliances are turned off.
Some people repetitively count small objects or place them in special arrangements. Many people engage in mental routines that aren’t noticeable to others, such as turning appliances on and off, as well as repeating prayers, number sequences or certain phrases.
Such compulsive routines may occupy an hour or more of a person’s time each day, and may significantly interfere with work, social activities or other aspects of a normal life. Some individuals spend hours per day on the thoughts and compulsions.
OCD is a medical problem, with a biological basis
OCD is a medical problem: a biological basis exists for it — it is not something that can simply be controlled or that can be “toughed” out.
OCD is usually diagnosed during young adulthood, although many report that the tendency was apparent since childhood. People with OCD usually know that their thoughts and actions are irrational, and are therefore reluctant to seek help, fearing that others will think they are crazy.
But OCD is a medical problem: a biological basis exists for it — it is not something that can simply be controlled or that can be “toughed” out. Chemical studies link it to changes in brain messengers that transmit information, mainly serotonin. Brain scans of individuals with OCD have also detected abnormalities in metabolic activity in certain areas of the brain associated with anxiety and maintaining habits. This abnormal brain activity tends to normalize when a patient is being successfully treated by medication, therapy or both.
OCD often runs in families and is likely to be genetically influenced. Interestingly, Tourette’s disorder, a quite different problem involving involuntarily physical and vocal tics and unusual mannerisms, tends to be found in the same families, strengthening the theory for a genetic basis for both problems.
Medications and therapy are effective against OCD
Medication doses tend to be higher for OCD than for those used against depression. If side effects are intolerable, switching to another medication or trying a combination can be tried.
Medications that are effective against OCD act by increasing the availability of serotonin, a neurotransmitter closely tied to depression and anxiety disorders. Several different drugs are available, belonging to two different classes of drugs:
- selective serotonin reuptake inhibitors (SSRIs; e.g. Fluoxetine or Prozac); and
- tricyclic antidepressants (TCAs).
While the TCAs are associated with more side effects than the SSRIs and have become a second-line medication against depression and OCD, one TCA, clomipramine (Anafranil), is particularly effective in treating OCD.
The medication is managed in a few key steps. It is started lower to avoid side effects, which usually go away (e.g., headache, upset stomach). There is a range of doses that work, such that if it does not seem to be working, increasing the dosage may be helpful.
Dosages of these medications tend to be higher for OCD than for those used against depression. If side effects are intolerable, switching to another medication or trying a combination can be tried.
One medication, sertraline (Zoloft) has been FDA-approved for treating OCD in childhood. Medication is commonly used with self-help tips, exercise and therapy.
Therapy is helpful
Most sufferers can bring their symptoms under control with medications and/or cognitive-behavioral therapies. The important thing is to not be afraid to seek professional help.
Cognitive-behavioral therapies can also reduce the symptoms of OCD and may be used in conjunction with or instead of medications. A typical behavioral approach is to gradually bring the person into contact with fears, either through actual or imaginary exposure. Compulsive but unproductive comforting behaviors are prevented or postponed little by little until they are no longer needed.
Cognitive therapy helps one learn about the vicious cycles of emotion and thinking initiated by a negative thought, as well as how to train the mind to avoid such unproductive and anxious cycles. Cognitive-behavioral therapy should be undertaken only with a professional who has experience with treating such problems, as it may be extremely anxiety-provoking.
OCD is a difficult problem that is rarely completely cured. However, most sufferers can bring their symptoms under control with medications and/or cognitive-behavioral therapies. The important thing is to not be afraid to seek professional help, whether it is for the first time or during exacerbations of the problem. Doctors usually can help people with OCD cope with their problems and get on with a happy and productive life.
Other tips for patients
Many options aid in managing anxiety, though alone, will not suffice.
- First, reading about OCD is helpful for some on a “good” website like the Anxiety Disorders Association of America (http://www.adaa.org/).
- Second, there are workbooks that a trained therapist may recommend to do ‘homework’ assignments.
- Third, exercise and limitations of caffeine to 2 servings per day reduce tension—by the way, those are not the ‘jumbo’ cups of coffee!
- Finally, having a family member or close friend assist with homework or provide feedback is good.