Obsessive Compulsive Disorder

Have you ever had the nagging feeling that you've left the gas on or forgotten to lock the door, and felt that you have to go back and check, even if you're already far from the house? Once you'd checked that everything was in order, you probably got on with your day without a second thought. But in obsessive compulsive disorder, rituals like double checking can come to take over a person's whole life.

Obsessions

Obsessions are recurrent, persistent, unwanted and upsetting thoughts. They often involve things like neatness, fear of dirt and germs, repeated doubts, violent images and sexual acts.

Compulsions

Compulsions are activities that people feel driven to repeat over and over, in an attempt to control the anxiety stemming from obsessions. For example, an obsession about dirt and germs may lead to compulsive and excessive handwashing, which doesn't stop even when hands become chapped and raw. An obsession about gas leaks may lead to such compulsive, repetitive checking that a person never manages to leave the house for the day. Counting in specific patterns, extreme neatness and hoarding with inability to never throw things away are also common. The compulsions aren't enjoyable, and the relief they provide from anxiety is usually transient.

Obsessive Compulsive Disorder

If you're a neat, orderly person, or fastidious about germs, you don't need to worry that you have OCD. OCD is very different from being a perfectionist. By definition, the obsessions and compulsions interfere significantly in everyday life, impeding normal functioning. Rituals like washing hair three times before leaving the house, putting on every item of clothing in a certain order, and making sure that every item in a room is perfectly lined up, may become so all consuming that the OCD sufferer doesn't even manage to leave the house to go to work or school. A new mother may become so overwhelmed by repeated images of harming her child that she becomes unable to care for it at all. People with obsessive worries about social embarrassment may end up unable to move from the mirror, repeatedly rearranging their hair.

All of these things severely impede the ability to lead a normal life. People with OCD usually realize that their behaviour is senseless and unreasonable, but are unable to prevent it. It's a chronic condition, and there can be ups and downs in severity, but usually it gets gradually worse, and harder to control as time goes by. Because many sufferers have an insight into the fact that their feelings and behaviour are unreasonable, they often attempt to conceal it at first. This may get harder as it takes over more and more of their life. Some people have only obsessive thoughts, while others have only compulsive behaviour.

Who Gets it?

OCD usually starts around the age 20, but it can also start in childhood, or up to about age 35. The cause is unknown. To some degree, OCD runs in families, but no specific genes have been pinpointed yet as causing the disorder. Stressful life events can trigger symptoms and so can pregnancy and early motherhood. There have been suggestions that one of the types of bacterial infection that causes sore throats can predispose to later OCD development. OCD was once thought to be quite rare, but it's now recognized to be commoner than many other well known psychiatric conditions, like schizophrenia and manic depression. OCD is thought to affect about 2% of the population.

What's Happening Inside the Brain?

PET (positron emission tomography) brain scans of people with OCD seem to show that there are differences in brain activity patterns compared to scans of people without the condition. It's been suggested that there's an underlying lack of the neurotransmitter (chemical messenger) called serotonin.

Coping with OCD

Both medication and psychotherapy usually help people with OCD to control their symptoms. The most effective drugs are antidepressants like fluoxetine (prozac) and paroxetine. They act by increasing the levels of brain serotonin. It usually takes a few weeks for their effects to kick in. A type of therapy called cognitive behavioural therapy is also effective. This involves retraining of basic thought and behaviour patterns and responses to anxiety. Effective techniques involve gradual, controlled exposure to whatever triggers anxiety, followed by therapy aimed to teach positive, rather than compulsive responses. For example, a compulsive hand washer with an extreme fear of germ contamination may be gradually encouraged to touch a dirty object then discouraged from washing. Most people with OCD benefit, though in some this type of therapy can be stressful.

Even people who've hidden their symptoms and suffered in silence with OCD for many years can find that the right combination of medicines with or without therapy lead to significant improvements.