www.ocfoundation.org/ocf1010a.htm
If you or someone you care about has been diagnosed with Obsessive-Compul sive Disorder (OCD), you may feel you are the only person facing the dif ficulties of this illness. In the United States, 1 in 50 adults currently has OCD, and twice that many have had it at som e point in their lives. Fortunately, very effective treatments for OCD a re now available to help you regain a more satisfying life. Here are ans wers to the most commonly asked questions about OCD. Worries, doubts, superstitious beliefs all are common in everyday life. H owever, when they become so excessive such as hours of hand washing or m ake no sense at all such as driving around and around the block to check that an accident didn't occur then a diagnosis of OCD is made. In OCD, it is as though the brain gets stuck on a particular thought or urge and just can't let go. People with OCD often say the symptoms feel like a c ase of mental hiccups that won't go away. OCD is a medical brain disorde r that causes problems in information processing. It is not your fault o r the result of a "weak" or unstable personality. Before the arrival of modern medications and cognitive behavior therapy, OCD was generally thought to be untreatable. Most people with OCD contin ued to suffer, despite years of ineffective psychotherapy. Today, luckil y, treatment can help most people with OCD. Although OCD is usually comp letely curable only in some individuals, most people achieve meaningful and long-term symptom relief with comprehensive treatment. OCD usually involves having both obsessions and compulsions, though a per son with OCD may sometimes have only one or the other. CAPTION: Table 1 Typical OCD SymptomsCommon Obsessions: Common Compulsio ns: Contamination fears of germs, dirt, etc. Washing Imagining having harmed self or others Repeating Imagining losing control or aggressive urges Checking Intrusive sexual thoughts or urges Touching Excessive religious or moral doubt Counting Forbidden thoughts Ordering/arranging A need to have things "just so" Hoarding or saving A need to tell, ask, confess Praying OCD symptoms can occur in people of all ages. Not all Obsessive-Compulsiv e behaviors represent an illness. Some rituals (eg, bedtime songs, rel igious practices) are a welcome part of daily life. Normal worries, such as contamination fears, may increase during times of stress, such as wh en someone in the family is sick or dying. Only when symptoms persist, m ake no sense, cause much distress, or interfere with functioning do they need clinical attention. Obsessions are thoughts, images, or impulses that occur over and over aga in and feel out of your control. The person does not want to have these ideas, finds them disturbing and intrusive, and usually recognizes that they don't really make sense. People with OCD may worry excessively about dirt and germs and be obsessed with the idea that they are contaminated or may contaminate others. Or they may have obsessive fears of having inadvertently harmed someone else (perhaps while pulling the car out of the driveway), even though they usually know this is not realistic. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust, doubt, or a sensation that things have to be done in a way that is "just so." People with OCD typically try to make their obsessions go away by perform ing compulsions. Compulsions are acts the person performs over and over again, often according to certain "rules." People with an obsession about contamination may wash constantly to the point that their hands become raw and inflamed. A person may repeatedly check that she has turned off the stove or iron because of an obsessive fear of burning the house down. She may have to count certain objects over and over because of an obsession about losing them. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure. Rather, the rituals are performed to obtain relief from the discomfort caused by the obsessions. When someone with OCD does not recognize that their beliefs and actions are unreasonable, this is called OCD with poor insight. OCD can start at any time from preschool age to adulthood (usually by age 40). One third to one half of adults with OCD report that it started during ch ildhood. On average, people with OCD see three to four doctors and spend over 9 ye ars seeking treatment before they receive a correct diagnosis. Studies h ave also found that it takes an average of 17 years from the time OCD be gins for people to obtain appropriate treatment. OCD tends to be underdiagnosed and undertreated for a number of reasons. People with OCD may be secretive about their symptoms or lack insight ab out their illness. Many healthcare providers are not familiar with the s ymptoms or are not trained in providing the appropriate treatments. This is unfortunate since earlier diagnosis and proper treatment, includi ng finding the right medications, can help people avoid the suffering as sociated with OCD and lessen the risk of developing other problems, such as depression or marital and work problems. No specific genes for OCD have yet been identified, but research suggests that genes do play a role in the development of the disorder in some ca ses. Childhood-onset OCD tends to run in families (sometimes in associat ion with tic disorders). When a parent has OCD, there is a slightly incr eased risk that a child will develop OCD, although the risk is still low . When OCD runs in families, it is the general nature of OCD that seems to be inherited, not specific symptoms. Thus a child may have checking r ituals, while his mother washes compulsively. Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures use the chemical messenger serotonin. It is believ ed that insufficient levels of serotonin are prominently involved in OCD . Drugs that increase the brain concentration of serotonin often help im prove OCD symptoms. Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in those who improve after taking a serotoni n medication or receiving cognitive-behavioral psychotherapy. Although it seems clear that reduced levels of serotonin play a role in O CD, there is no laboratory test for OCD. Rather, the diagnosis is made b ased on an assessment of the person's symptoms. When OCD starts suddenly in childhood in association with strep throat, an autoimmune mechanism may be involved, and treatment with an antibiotic may prove helpful.
This guide was prepared with the help of the Obsessive-Compulsive Foundat ion and includes recommendations contained in the Expert Consensus Treat ment Guidelines For Obsessive-Compulsive Disorder. The following participants in the Expert Consensus Survey were identified from several sources: participants in a recent NIMH consensus conferenc e on OCD; participants in the International Obsessive Compulsive Disorde rs Conference (IOCDC); members of the Obsessive-Compulsive Foundation Sc ientific Advisory Board; Of th e 79 experts to whom we sent the obsessive-compulsive disorder survey, 6 9 (87%) replied. The recommendations in the guidelines reflect the aggre gate opinions of the experts and do not necessarily reflect the opinion of each individual on each question. New York Katharine A Phillips, MD Butler Hospital Teresa A Pigott, MD University of Texas Medical Branch-Galveston C Alec Pollard, PhD St.
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