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OCD

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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OCD & PANDAS
From Townsend Letter for Doctors and Patients, 10/1/04 by Jule Klotter

In an article published in Latitudes (Vol 6, Issue 2), Aristo Vojdani, PhD, MT, discusses the difference between nonautoimmune obsessive compulsive disorder (OCD) and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with Group A streptococcal infection). Obsessive Compulsive Disorder involves an unintentional and uncontrollable replay of thoughts or actions. In an attempt to reduce the anxiety that arises when the obsession cannot be stopped, people with OCD develop a set of actions or rituals that involve washing and cleaning, checking (i.e., that the stove is off), symmetry, counting, repeating, redoing, and hoarding in order to hold their fear at bay. In many cases, OCD is preceded by a major stressor, such as a family member's illness or job loss. Children with OCD tendencies have linked hearing bad news about war or terrorism or seeing frightening movies to their developing "full-blown" OCD. The rituals that OCD patients use to calm their fears do not always have a noticeable link to the obsessive thought(s) plaguing them, and scientists do not understand why some have a compulsion to clean and others turn to hoarding--or why these symptoms may change. Scientists have discovered that adults with OCD have more activity in the caudate nucleus, orbital frontal regions of the brain, and basal ganglia. Basal ganglia, "the thought-filtering station," has many serotonin receptors. OCD patients respond to selective serotonin reuptake inhibitors and to behavior therapy, according to research by Dr. J. Schwartz and colleagues at UCLA.

About 25% to 30% of children with OCD may actually have PANDAS, a disorder in which the body's immune cells attack its own B-cells or the basal ganglia while fighting streptococcus. Chiildren who develop OCD, tic disorders, or anorexia nervosa after a streptococcal infection need to be checked for serum antibodies against streptococcal antigens and their cross-reactive epitopes on B-cells and nerve cells. (Immunosciences Lab, phone 310-657-1077 or 800-950-4686, offers a PANDAS panel.) In contrast to non-autoimmune OCD which may take years to develop, PANDAS symptoms appear quickly. Also, OCD symptoms increase and decrease sharply in PANDAS while changes in OCD symptoms among non-autoimmune OCD patients are more gradual. In addition to OCD, children with PANDAS may display numerous other symptoms that include tics, trembling, twitches, grimacing, clumsiness, loss of math skills, sensitivity to touch and clothing tags, poor attention span, distractibility, irritability, impulsivity, separation anxiety, and bedtime fears. Dr. Vojdani says that PANDAS treatments being investigated include plasmapheresis to remove autoantibodies reacting to B-cell receptors and basal ganglia cells, intravenous immunoglobulin, and daily doses of amoxicillin as a prophylactic measure.

Vojdani, Aristo, PhD, MT. Obsessive Compulsive Disorder and Differentiation between Non-Autoimmune OCD and the Autoimmune version of the disease called PANDAS. Latitudes, Vol. 6, Issue 2, 2003.

COPYRIGHT 2004 The Townsend Letter Group
COPYRIGHT 2004 Gale Group

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