Obsessive Compulsive Disorder
Think you have Obsessive Compulsive Disorder… like me?
(Boy, if you only knew how much time I spent fiddling with this website!)
Ask yourself the following questions:
1. Do you have a strong fear of contamination, especially germs?
2. Are you unusually afraid of harming yourself or others?
3. Do you imagine losing control of your aggressive urges?
4. Are you having intrusive sexual thoughts or urges (or other ‘forbidden’ thoughts) that you know are ‘wrong’?
5. What about excessive religious or moral doubt?
6. Are you strongly compelled to have everything ‘properly placed’?
7. Must you tell or confess things that aren’t necessary?
These are all signs of obsessive behavior.
Along with these mental obsessions come the physical actions, or compulsions, of
- washing yourself repeatedly,
- constantly checking up on things,
- endlessly counting, hoarding, or rearranging objects,
- touching others,
- and/or perhaps praying excessively.
Obsessive compulsive disorder, or OCD, involves having worries, doubts, fears or faulty beliefs that qualify as:
2. lacking logic and reason,
3. causing distress in your life,
4. interfering with the daily functioning of your routine, and
5. usually taking up more than one hour per day.
It’s like your brain gets stuck on a thought and won’t let go, and thus you get caught in a ‘tape loop’.
The breakdown in the processing of information
Current research indicates a communication problem exists between the front of the brain (the orbital cortex) and the deeper parts of the brain (the basal ganglia), which leads to obsessions and compulsions. The obsessions usually manifest as thoughts, images and/or impulses that occur repeatedly and appear to be out of your control.
The compulsions basically involve rules created in a failed attempt to make the obsessions go away.
Characteristics of Obsessive Compulsive Disorder
- Those suffering from OCD usually know what they’re thinking and doing are not ‘right’. They usually know what’s real and what’s not. (Unless they have ‘OCD with poor insight’.) The problem comes with the apparent inability to control the errant thoughts and actions.
- While we all have neurotic thoughts from time to time, with OCD these thoughts become too loud and too strong. They can’t be dismissed with logic and reason.
- Unlike events such as compulsive gambling or sexual disorders, no pleasure comes from acting out the obsessive compulsive behaviors.
- About one in fifty people, or 2% of the population, suffers from OCD at any given time.
- Symptoms of obsessive compulsive disorder wax and wane, meaning that sometimes they appear strong and quite present, while other times they seem to be absent or less intrusive.
- Often times, OCD starts in childhood or adolescence, although it may take many years to correctly diagnose.
- While no specific genes have been identified to cause or contribute to OCD, the tendency exists for obsessive compulsive behavior to run in families. (Most likely it’s a product of shame.)
Problems Similar to Obsessive Compulsive Disorder
The following conditions, while similar, are not OCD.
- Trichotillomania - compulsive hair pulling.
- Body dismorphic disorder - imagined ugliness.
- Tic disorders - Involuntary motor behaviors as a response to some form of social discomfort.
- Obsessive compulsive personality disorder, or OCPD – defined by:
1. preoccupation with rules, schedules, and lists.
3. excessive devotion to work.
Traditional Treatments for Obsessive Compulsive Disorder
The first and least effective treatment involves taking drugs, usually antidepressants. With depression medication alone, there runs less than a 20% chance of ending the symptoms of OCD. (According to one antidepressant manufacturer.)
Also, it usually takes a minimum of two months to notice any improvements at all.
About half the people who opt for drug treatment alone will need to continue taking antidepressants indefinitely as a prophylactic (preventative) medication.
If you do go the drug route, the drugs most effective at masking symptoms are the selective serotonin reuptake inhibitors, or SSRI’s. These include such antidepressants such as Luvox, Zoloft, Paxil, Celexa, and Prozac.
Another antidepressant (a tricyclic, rather than an SSRI) sometimes used for OCD is Anafranil.
Other tricyclic drugs that don’t mask the symptoms of OCD and are thus largely ineffective include Tofranil and Elavil.
Antipsychotic drugs (neuroleptics) generally tend to make the symptoms of obsessive compulsive disorder worse. Common examples are Haldol, Thorazine, Mellavil and Stelazine.
Two exceptions – Clozaril and Risperdal – are sometimes added to an SSRI, as a ‘drug cocktail‘. Higher doses are usually required, so expect to pay more, while increasing the risk of side effects and withdrawal symptoms. Another point worth mentioning: neuroleptics stand as some of the most damaging drugs in existence.
Other ineffective drugs for OCD include Buspar, Eskalith, Klonopin, Ritalin, Pondamin, Trazodore, Bupropion, and Desipramine.
Another class of antidepressant medication, the monoamine oxidase inhibitors (MAOI’s) are sometimes used for OCD. The two most popular are Nardil and Parnate.
Generally considered the drug cocktail of last resort, Anafranil is sometimes added to an SSRI. This choice is not recommended for pregnant women, and requires monitoring with lab tests for all who choose this option.
A more promising approach to working with obsessive compulsive disorder involves Cognitive Behavioral Psychotherapy, or CBT.
Traditional psychotherapy helps patients gain insight into their problems, hopefully to resolve those problems. This approach needed to be modified to work with OCD, and the result is CBT.
CBT challenges the faulty assumptions, with the goal of reducing the anxiety and the obsessions, and thus to reduce the compulsive behavior. It involves a two-step approach called ‘exposure‘ and ‘response prevention‘ or E/RP.
The patient is first exposed to whatever triggers the OCD, such as touching a ‘contaminated’ object. The second step is to have the patient not perform the usual reaction, in this case, to have the patient not wash their hands.
CBT produces on average a 50 – 80% reduction in symptoms after 12 to 20 sessions. Generally it takes about two months for the full effects of therapy to manifest.
An alternative route consists of intensive therapy of two or three hours a day for three weeks, which can produce equivalent results.
The good news is that the results are usually permanent. The bad news is qualified psychotherapists are in short supply, and usually don’t come cheap. Also, it can be a slow and painful journey.
The last resort in treating OCD is electroconvulsive therapy, or ECT. If you or someone you know is considering this option, I would strongly suggest renting the movie, “One Flew Over The Cuckoo’s Nest”.
Since all three of these treatment options are long, drawn-out, time-consuming and expensive affairs, you may wish to try a different approach altogether.
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