OCD

Obsessive-compulsive disorder (OCD) cost the United States $8.4 billion in 1990 in social and economic losses, nearly 6% of the total mental health bill of $148 billion. (1) Such a staggering statistic necessitates that individuals be accurately diagnosed and be given effective treatment for this debilitating condition.

Definition and Classification

OCD falls under the broad category of anxiety disorders, which encompasses conditions such as panic disorder, social phobia, and posttraumatic stress disorder (DSM-IV). A person with OCD usually has obsessions and compulsions (~90%), but sometimes may only have one or the other.

Obsessions are recurrent intrusive thoughts, impulses, or images that are perceived as inappropriate, grotesque, or forbidden. They are not simply excessive worries about real-life problems. The person usually recognizes that the obsessions are excessive or unreasonable and fears he or she will lose control or act upon such thoughts or impulses. One metaphor likens OCD symptoms to a case of mental hiccups that won't go away.

Some common obsessions include:

* Fear of dirt or germs

* Disgust with bodily waste or fluids

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* Concern with order, symmetry (balance) and exactness

* Worry that a task has been done poorly, even when the person knows this is not true

* Fear of thinking evil or sinful thoughts

* Thinking about certain sounds, images, words or numbers all the time

* Need for constant reassurance

* Fear of harming a family member or friend

Compulsions are repetitive behaviors (rituals) or mental acts that reduce the anxiety that accompanies an obsession. The person feels driven to perform them in response to their obsession, or according to rules that must be rigidly applied.

Some common compulsions include:

* Cleaning and grooming, such as washing hands, showering or brushing teeth over and over again

* Checking drawers, door locks and appliances to be sure they are shut, locked or turned off

* Repeating, such as going in and out of a door, sitting down and getting up from a chair, or touching certain objects several times

* Ordering and arranging items in certain ways

* Counting over and over to a certain number

* Saving newspapers, mail or containers when they are no longer needed

* Seeking constant reassurance and approval

These obsessions or compulsions cause marked distress, are time consuming (>1 hour a day), or significantly interfere with the person's normal routine, occupation (or academic) functioning, or usual social activities or relationships.

There is no single, proven cause of OCD. Experts today believe that a number of intertwined and complex factors are responsible for OCD, such as genetics, different brain activity patterns or insufficient neurotransmitters, personality development, and how a person reacts to the environment around them. It certainly isn't a sign of a character flaw or personality weakness.

Prevalence and Diagnosis of OCD

Approximately 3.3 million American adults ages 18 to 54, or about 2.3% of people in this age group in a given year, have OCD. (2) It affects men and women equally and knows no geographic, ethnic, or economic boundaries. Typically, OCD begins in adolescence to young adult life, but at least a third of cases of adult OCD start in childhood. For the most part, onset is gradual. Most people have a chronic waxing and waning course, with an exacerbation of symptoms that may be related to stress.

Interestingly, about 20-30% of OCD patients report a past history of tics, and approximately 25% of these people meet the full criteria for Tourette's disorder (DSM-IV). (3) Conversely, up to 50% of people with Tourette's disorder develop OCD in their lifetime.

On average, people with symptoms of OCD see three to four doctors and spend over nine years seeking treatment before they receive a correct diagnosis. (4) Moreover, studies have shown individuals with OCD suffer for an average of 17 years from the time the disorder manifests until proper treatment is obtained.

It's unfortunate that OCD tends to be under diagnosed and under treated. People who experience symptoms of OCD need to open up and discuss their situation with their healthcare providers. On the other side, doctors need to be familiar with how to recognize OCD and prescribe appropriate therapy.

Treatments

OCD was once thought to be untreatable, but today's medicine can help most individuals achieve meaningful long-term symptom relief. Some individuals have even reported being cured of OCD. Individuals whose symptoms persist, make no sense, cause much distress, or interfere with functioning, need to seek clinical help. Once the diagnosis is made, appropriate treatment can be prescribed.

It is important for someone with OCD to be treated early because approximately 70% of adults with the disorder have an episode of major depression at some point in their lives. Prescription medication is an option for some individuals. Drugs like clomipramine (Anafranil), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine (Luvox), can be tried, but they can cause side effects like dry mouth, nausea, drowsiness, and decreased sexual performance. Furthermore, individuals often have to take the drugs for a minimum of several weeks before they can tell if the medications are helping.

An alternative treatment for OCD is behavioral therapy. In one type called exposure and response prevention, individuals under the guidance of a trained therapist are deliberately and voluntarily exposed to whatever triggers their obsessive thoughts. They are then taught techniques to avoid performing the compulsive rituals, and to deal with the anxiety. It is especially helpful for patients whose compulsions focus on situations that can be easily re-created. Various studies indicate that behavioral therapy has a 50-70% success rate with OCD. (5)

Homeopathy--Using the Power of the Vital Force

A popular non-invasive therapeutic option for many ailments is homeopathy. This "energetic" type of medicine helps the body re-establish balance and homeostasis. With the growing interest in complementary medicine, homeopathy may help people manage their mental or physical complaints. In fact, Todd Rowe, MD, a psychiatrist who incorporates homeopathy into his practice in Phoenix, has found it to be more effective than conventional drugs in the treatment of OCD.

"Not only does homeopathy treat the existing symptoms, but it also offers the possibility of a permanent cure," comments Dr. Rowe. "This is not to say that it is easy to treat. I would say that I am successful in about two-thirds of my cases."

As a recent naturopathic college graduate, I asked Dr. Rowe for advice he would give to new practitioners of homeopathy or experienced clinicians who aren't getting desired results.

"It is important to remember that in treating OCD, as in any condition, not to overly focus on the common symptoms of the disorder, but to focus on what is individuating in the case," advises Dr. Rowe. "This means that the homeopath must be aware of the common symptoms of OCD."

Furthermore, Dr. Rowe tells practitioners and patients not to be discouraged with the pace of healing. He says it is often slow in OCD and the possibility of a cure may take as long as a year.

Although OCD interferes with a person's life, fortunately there are many available options that can help those afflicted. Homeopathy is worth considering since it is safe, effective, and inexpensive.

For more information:

National Institute of Mental Health

1-866-615-6464 (toll-free)

nimhinfo@nih.gov

Obsessive-Compulsive Foundation

203-401-2070

info@ocfoundation.org

References

1. http://www.nmha.org/pbedu/anxiety/ocd.cfm

2. Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on US Census estimated residential population age 18 to 54 on July 1, 1998. Unpublished.

3. Pitman RK, Green RC, Jenike MA, Mesulam MM. Clinical comparison of Tourette's disorder and obsessive-compulsive disorder. Am J Psychiatry. 1987 Sept; 144(9):1166-71.

4. http://www.ocfoundation.org/ocf1010a.htm

5. http://www.psych.org/public_info/ocd.cfm

Daniel Ko, ND

COPYRIGHT 2004 The Townsend Letter Group
COPYRIGHT 2004 Gale Group