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Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a psychiatric disorder, specifically, an anxiety disorder. OCD is manifested in a variety of forms, but is most commonly characterized by a subject's obsessive drive to perform a particular task or set of tasks, compulsions commonly termed rituals. more...

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OCD should also be distinguished from the similarly named but notably different obsessive-compulsive personality disorder, which psychiatric guidelines define as a personality characteristic rather than an anxiety disorder.

The phrase "obsessive-compulsive" has worked its way into the wider English lexicon, and is often used in an offhand sense to describe someone who is meticulous or absorbed in a cause. Such casual references should not be confused with obsessive-compulsive disorder; see clinomorphism. It is also important to distinguish OCD from other types of anxiety, including the routine tension and stress that appear throughout life. A person who shows signs of infatuation or fixation with a subject/object, or displays traits such as perfectionism, is not necessarily stricken with OCD, a specific and well-defined disorder.

Symptoms and prevalence

Modern research has revealed that OCD is much more common than previously thought. An estimated two to three percent of the population of the United States is thought to have OCD or display OCD-like symptoms. Because of the condition's personal nature, and the lingering stigma that surrounds it, there may be many unaccounted-for OCD sufferers, and the actual percentages could be even higher.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsessions. To others, these tasks may appear simple and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways for fear of dire consequences and to stop the stress build up. Examples of these tasks: repeatedly checking that one's parked car has been locked before leaving it; turning lights on and off a set number of times before exiting a room; repeatedly washing hands at regular intervals throughout the day.

OCD rituals are often bound up with intricate detail — detail that may seem arbitrary to outsiders. Smokers with OCD, for instance, may argue with themselves that quitting cigarettes is possible only on the 13th or 27th of a month, and only when they are in possession of four cigarettes at noon.

Obsessions are thoughts and ideas that the sufferer cannot stop thinking about. Common OCD obsessions include fears of acquiring disease, getting hurt, or causing harm to someone. Obsessions are typically automatic, frequent, distressing, and difficult to control or put an end to by themselves. People with OCD who obsess over hurting themselves or others are actually less likely to do so than the average person.

Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. For an OCD sufferer who obsesses about germs or contamination, for example, these compulsions often involve repeated cleansing or meticulous avoidance of trash and mess. Most of the time the actions become so regular that it is not a noticeable problem. Common compulsions include excessive washing and cleaning; checking; hoarding; repetitive actions such as touching, counting, arranging and ordering; and other ritualistic behaviors that the person feels will lessen the chances of provoking an obsession. Compulsions can be observable — washing, for instance — but they can also be mental rituals such as repeating words or phrases, or counting.

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Time Out - Julian Swartz and obsessive-compulsive disorder - Brief Article
From Current Science, 9/28/01 by Darren Sechrist

College basketball star Julian Swartz talks to Current Science about the emotional problem that sidelined him for a year.

Hours after his teammates had left for home, 18-year-old Julian Swartz would stand alone in his high school gym, draining three-pointer after three-pointer. He would make seven in a row, miss one, make another eight, miss one. Not until sinking ten treys in a row would he finally go home.

That kind of persistence made Swartz the star of his high school basketball team in Waukesha, Wis. From there, it led him to the University of Wisconsin basketball team, which reached the final four of the NCAA tournament in 2000. It also led him to write these words in his journal:

"I cannot, nor anyone, take away the sadness, pain, and indescribable feelings I battle every second of every minute of every hour of every day."

Strange Thoughts

Swartz suffers from a condition called obsessive-compulsive disorder (OCD). People who have OCD are plagued by repeated disturbing thoughts. Such nagging, unwanted thoughts are called obsessions. In an effort to deal with those thoughts, many people with OCD perform certain tasks again and again. Such behaviors are called compulsions.

Swartz, now 21, experienced his first symptoms of OCD in the first grade. He would have repeated thoughts that something awful was going to happen to him or someone close to him. By eighth grade, Swartz's obsessions had led to compulsions. "As I grew up, I guess so did the OCD," Swartz told Current Science. Obsessed with germs, Swartz washed his hands until they were raw. Obsessed that he had left the stove on, Swartz got up many times each night to check it.

A Question of Perfection

Two more years passed before Swartz sought professional help. A therapist helped him by using behavior therapy.

Behavior therapy for OCD involves a technique called exposure and response prevention. Patients are exposed to situations that trigger their obsessions and are then prevented from performing their usual compulsions. For example, a person who has an unreasonable fear of germs might be asked to handle money without washing hands afterward. After repeated exposure to the money, the patient realizes that nothing bad has happened.

Because Swartz was obsessed with being perfect in his schoolwork, he was allowed to do homework for only a certain length of time each night, Because he was obsessed with germs, Swartz was told to go as long as he could without washing his hands.

The therapy helped Swartz get some of his obsessions under control. However, a new obsession had emerged. Swartz felt he had to practice basketball constantly or face unbearable shame and embarrassment.

In his junior and senior years of high school, Swartz's obsession with basketball ruled his life. At the University of Wisconsin, the pressures of college life pushed him over the edge. He wrote in his journal about the relief that he imagined suicide would bring him. Finally, realizing that his life had spun out of control, he quit college after freshman year.

Getting Help

Back home, Swartz sought professional help again. This time, Swartz's doctor recommended continuing behavior therapy with a drug program.

The drugs most often used to treat OCD are antidepressants, such as Prozac, Zoloft, Paxil, and Luvox, which regulate neurotransmitters in the brain. Neurotransmitters are chemicals that carry messages between neurons (nerve cells). The antidepressants prescribed for people who have OCD increase the concentration of the neurotransmitter serotonin in certain areas of the brain. (See "A Brain Short Circuit.") That allows the brain to think an unpleasant thought, such as "My hands are dirty" and then move on, rather than dwell on the thought.

Comeback

Swartz takes an antidepressant every day but has discontinued behavior therapy. He says his religious beliefs and talking to other people about OCD have been more effective than behavior therapy for him.

This month, Swartz returned to the University of Wisconsin, planning to play basketball again. "I'm aware that OCD is chronic, and I know very well that there will be relapses" he said. "But I'm very excited to attack those. What I've overcome so far has been so much bigger than what I will face in the future."