Holiday 2003/2004

What is an obsessive-compulsive disorder?

People with obsessive-compulsive disorder (OCD) experience frequent, recurrent, and unwanted thoughts, mental images, or impulses (obsessions). Common preoccupations are with contamination or "germs," violence towards others, safety, sex, or fear of making a mistake. Compulsions include both covert and overt behaviors, such as excessive hand washing, bathing, grooming, and/or counting; hoarding; checking; and repeatedly cleaning a room. Approximately 3 million Americans have the disorder, but millions more have OCD characteristics that compromise their ability to function in their personal and professional lives. OCD is equally common in women and men but childhood-onset OCD is more common in males than females and generally starts in adolescence.

 

There is no clear cut etiology for OCD, but growing evidence indicates that OCD represents abnormal functioning of brain circuitry, probably involving a part of the brain called the striatum. OCD probably has a strong familial component because it occurs more often in certain families. For a very small subset of children, OCD is associated with Group A betahemolytic streptococcal infection scarlet fever and strep throat. Stress can precipitate OCD symptoms. OCD is often associated with depression, eating disorders, substance abuse, learning disorders, disruptive disorders, attention deficit hyperactivity disorder, and/or other anxiety disorders. When a person also has other disorders, OCD is often more difficult to diagnose and treat. Symptoms of OCD can also coexist and may even be part of a spectrum of other brain disorders, such as Tourette's syndrome. Left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a chronic, relapsing illness.

Diagnostic Criteria (DSM IV) for Obsessive-Compulsive Disorder

A. Either obsessions or compulsions

Obsessions as defined by 1, 2, 3, and 4:

1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
2. the thoughts, impulses, or images are not simply excessive worries about real-life problems
3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
4. the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

Compulsions as defined by 1 and 2

1. repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2. the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.

C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.

What Can Families/Teachers/Friends Do To Help?

1. Help the youth view OCD as a medical illness, not as a personal failing.
2. Modify expectations during stressful times.
3. Do not compare the child with others.
4. Recognize all improvements.
5. Create a supportive environment.
6. Do not get involved in the person's rituals-if at all possible.
7. Keep up "normal" routines.

  (Suggestions 2-7 by Health Education Consultants at 913-831-1393)

What Can Mental Health Providers Do To Help?

1. A type of behavioral therapy known as "exposure and response prevention" is very useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts and then is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety.
2. Cognitive behavioral therapy, which includes psychoeducation, anxiety management training, and parent training is useful.
3. Several medications have been proven effective in helping people with OCD: clomipramine, fluoxetine, fluvoxamine, sertraline, and paroxetine. If one drug is not effective, others should be tried.