Obsessive-Compullsive Disorder Essay, Research Paper

What is Obsessive-Compulsive Disorder?

Have you ever known somebody who washes their hands excessively are constantly checking to see if the doors are locked? This may be the cause of low serotonin levels in the brain. Serotonin is responsible in helping nerve cells communicate. More plainly, they may be symptoms of the all-unbearable anxiety disorder known as obsessive-compulsive disorder. Although about 5.5 million people in the U.S. are affected by OCD not all of them are aware or just are too embarrassed by their peculiar behaviors to get help. In approximately 80% of all cases [of OCD] persons performing these rituals are painfully aware that their behavior is unreasonable and irrational (n.d., Phillipson).

Worries, doubts, superstitious beliefs all are the common in everyday life. However, when they become so excessive such as hours of hand washing or make 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 won t let go. People with OCD often say the symptoms feel like a case of mental hiccups that won t go away. OCD is a medical brain disorder that causes problems in information processing. ( OCF 1998)

Obsessive-Compulsive Disorder symptoms can occur in people of all ages from preschool age to adulthood usually by age 40. About one third to one half of adults diagnosed with OCD say that it started during their childhood and it went unnoticed until adulthood. Approximately one million children and adolescents in the United States suffer from OCD, which, means three to five youngsters per average sized elementary school and about twenty teenagers in a large high school (NAMI 2001). On average, people with OCD see about three to four doctors and spend over nine years seeking treatment before they receive the right diagnosis. Studies have also found that it takes an average of seventeen years from the time OCD begins for people to obtain appropriate treatment. OCD tends to be under diagnosed and under treated for a number of reasons. People with OCD may be secretive about their symptoms and cleverly hide obsessions and compulsions from family members and coworkers or they may just lack the insight of their anxiety disorder. This is because many healthcare providers are not familiar with the symptoms or are not trained in providing the appropriate treatments. Then there are just some people who do not have the access to treatment resources such as medication or behavior therapy. This can be unfortunate since earlier diagnosis of OCD and the proper treatment, including finding the right medications, can help people avoid other sufferings associated with OCD and lessen the risk of developing other complications such as, depression, or marital and work problems. (OCF 1998)

OCD can take so many different forms and there are two characteristics associated with the anxiety disorder. They are the obsessions and the compulsions. Obsessions are thoughts, images, of impulses, which are often intrusive and upsetting. These things occur over and over again to the point where it is out of one s control. The person does not want to have these ideas or the disturbing and intrusive images but they can t help it. They know that these thoughts are irrational and ridiculous but they can t stop their anxieties. Some the thoughts or mental images that can be associated with obsessions are:

Germs

Dirt

Doubt

Order

Symmetry

repugnant sexual thoughts

Excessive religious/moral doubt

Horrific/violent images

Forbidden thoughts

Fear of forgetting

Need to tell/confess

Fear that a mistake will harm a loved one

Someone that worries excessively about dirt and germs is usually obsessed with idea that they are contaminated or may contaminate others. Or they can have an obsessive fear of hurting somebody else maybe while they are pulling their car out of the driveway (OCF 1998). These obsessions are usually accompanied by an uncomfortable feeling, such as fear, disgust, doubt, or sensation that things need to be done in a way that is .just so. x

On the other hand compulsions are done in reaction to obsessions in an attempt to relieve their anxieties such as, fear of harm or germs. Compulsions are characterized by a repetitive behavior in response to an urge or anxiety. They are provoked by obsessions in order to make the obsessions go away. These rituals are performed again over and over again and become difficult to stop. Like someone who is obsessed with germs and contamination may wash his hands constantly to the point where their hands are raw and red (OCF 1998). Or somebody who locks and relocks their doors everyday before going to work for an hour and a half (OCDRESOURCE 2001). Some examples of compulsions include:

Washing hands

Checking locks

Checking stoves

Touching things

Counting things

Ordering things

Cleaning things

Performing silly rituals until it feels right

Hoarding/saving

Praying

When a person uses up more than an hour a day devoted to washing their hands, showering, ect, repeatedly it can be considered OCD. Remember that the individual does not have any pleasures in carrying out these so-called rituals. They only give them temporary relief from the anxiety caused by there overpowering obsessions (NAF1999). For example a person may have an obsessive fear of ingesting or absorbing illegal drugs from indirect contact with people they think are taking illegal drugs. Such a person may obsessively fear losing his mind from using a restaurant s public restroom after seeing somebody they suspect is a drug addict using the facility. So after leaving the restaurant, he may have to throw away his shoes and floor mats in his car that may have been .contaminated x. He may also have to scrub his hands in bleach exactly ten times perfectly. His other articles of clothing may have to be washed repeatedly or thrown away. He maybe afraid to take medicine that has been touched or prepared by a pharmacist who he thinks might be using marijuana after hours, fearing that some of the residue might have contaminated the medicine. (NAF1999)

The most common compulsions among children and adolescents are repetitive rituals such as cleaning or washing, touching, counting, repeating, arranging or organizing, checking or questioning, and hoarding. The most common obsessions among children and adolescents are contamination or a serious illness, fixation on lucky/unlucky numbers, fear of danger to self and others, need for symmetry and exactness, and excessive doubt. OCD affects children and adolescents during a very important period of social development. Schoolwork, home life, and friendships are often affected. Some children are often too young to realize that their thoughts and actions are unusual. They might not understand or be able explain why they must go through their rituals. But the older children may feel embarrassed they don t want to be .different x from their peers and may worry that they are .going crazy x. Fearing ridicule, children may hide their rituals when in front of friends at school or at home and become mentally exhausted from the strain. Other children find their rituals so time consuming that they are too tired to play with friends or concentrate in school. (NAMI 2001)

Adult OCD and child and adolescent OCD differ for one simple reason. Although children and adults may experience many of the same obsessions and compulsions, children will often express their anxieties in special ways (NAMI 2001). Children don t realize that their obsessions are senseless and that their compulsions are excessive. Children and adolescents with OCD also more often involve family members in their rituals. For example, they may insist that their laundry be washed multiple times, demand that their parents check their homework repeatedly, or become outraged if household items are in disarray. Also, OCD in children often exists along with motor tics and or Tourette s syndrome.

Right now, there really is no known cause of obsessive-compulsive behavior but research suggests that OCD involves problems in communication between the frontal part of the brain (the orbital cortex) and the deeper structures such as the basal ganglia. These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are prominently involved in OCD. Drugs that increase the brain concentration of serotonin often help to improve OCD symptoms. Getting pictures of the brain while its working, of course, help show that the brain circuits in OCD return to normal in those who improve after taking a serotonin medication or receiving cognitive-behavioral psychotherapy. Although it may seem clear that the reduced levels of serotonin found in OCD patients play a role in their odd behaviors there really is no lab test for OCD. (OCF1998)

There is a study that shows OCD may start suddenly in childhood in association with strep throat where an autoimmune mechanism may be involved. The research of the connection has been done by Dr. Susan Swedo, the scientific director at the National Institute of Mental Health (NIMH) and head of the NIHM section on behavioral pediatrics. In the article .Obsessive Compulsive and Tics Linked to Sore Throats x by Pauline Anderson, Dr. Swedo states:

Our studies and others on obsessive-compulsive disorder are truly

proof that these are neurobiological illnesses, that what was

previously thought to be due to punitive toilet training is now

known to associated with changes in your brain chemicals, patterns

of responsiveness of glucose metabolism, and now perhaps to be

triggered by an autoimmune reaction.

The evidence shows in susceptible children, where strep throat triggers the autoimmune response, which in turn affects the basal ganglia and can lead to symptoms of OC or a tic disorder like Tourette s syndrome. Dr. Swedo also mentioned that it may be difficult to make the connection between strep throat and the onset of OC symptoms because of the .dramatic explosion of symptoms x may not occur until one or two weeks after their strep throat. Her classic example is of a little girl whose compulsive fear of AIDS began when she saw a wrapped hypodermic needle while visiting the doctor. When her medical records were examined it turned out the reason she was at her pediatrician in the first place was because she had strep throat. Now the risk of OC after an alleged strep infection may be linked to several factors such as, genetics, neurodevelopment, immunological factors, or even just mutated strep bacteria. (Anderson 1996)

There are many disorders that may closely resemble OCD, which also under go some of the same treatments. These would include Trichotillomania compulsive hair pulling, body dysmorphic disorder, which is imagined ugliness, and then there are habit disorders such as, biting of the nails or skin picking. But the most common conditions that resemble OCD are the tic disorders, Tourette s and other motor and vocal tic disorders. Tics are involuntary motor behaviors or vocal behaviors like snorting that often occur in response to feeling of discomfort. There are more complex tics like touching or tapping tics that resemble the compulsions associated with OCD. Tics and OCD can occur together and they usually do in the onslaught of childhood. (OCF 1998)

It is also believed that OCD runs in families. About 30% of teenagers with OCD have a relative in their immediate family with OCD or some signs of OCD. When OCD appears early in childhood, it is even more likely that there will be family members with the disorder. Other studies have not found as much OCD as this in relatives, but have found lots of other anxiety disorders besides OCD in the relatives. In families where OCD seems to be inherited, often times tic disorders are found, too. The usual pattern is for the males in the family to be more likely to have tic disorders and the females to be more likely to have OCD. However, the opposite is not uncommon. These studies show that OCD runs in families, but it doesn’t point to an exact cause. (1998 Biederman)

There are a couple of different ways to try to treat OCD patients. These treatments include medications such as, potent serotonin inhibitors: one product is a tricyclic antidepressant and the others are selective serotonin reuptake inhibitors (SSRIs). These medications may help normalize the brain’s balance of serotonin. Beneficial effects of SSRI (selective serotonin reuptake inhibitors) are documented by research. While the relationship of serotonin to OCD is not entirely understood, the condition seems to be linked to low levels of this substance in the brain. SSRI therapy is helping a growing number of OCD sufferers. LUVOX (fluvoxamine maleate) tablets are an SSRI that, since its approval by the Food and Drug Administration, has become one of the top prescribed medications for OCD. (n.d., ocdresource.com) But also effective are Prozac, Paxil, Clomipramine, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram and Zoloft as well as the tricyclic Anafranil for treating OCD.

Fluoxetine, fluvoxamine, paroxetine, citalopram, and sertraline are called selective serotonin reuptake inhibitors (SSRIs) because they primarily affect only serotonin. Clomipramine is a nonselective SRI, which means that it affects many other neurotransmitters besides serotonin. This means that clomipramine has a more complicated set of side effects than the SSRIs. For this reason, the SSRIs are usually tried first since they are usually easier for people to tolerate.

In general, the SRIs are well tolerated by most people with OCD. The four SSRIs (fluoxetine, fluvoxamine, paroxetine, and sertraline) have similar side effects. These include nervousness, insomnia, restlessness, nausea, and diarrhea. The most common side effects of clomipramine are dry mouth, sedation, dizziness, and weight gain. While all five drugs can cause sexual problems, on average these are a bit more common with clomipramine. Clomipramine is also more likely to cause problems with blood pressure and irregular heart beats, so that children and adolescents and patients with preexisting heart disease who are treated with clomipramine must have electrocardiograms before beginning treatment and at regular intervals during treatment. Remember that all side effects depend on the dose of medication and on how long you have been taking it. If side effects are a big issue, it is important to start with a low dose and increase the dose slowly. More severe side effects are associated with larger doses and a rapid increase in the dose. Tolerance to side effects may be more likely to develop with the SSRIs than with clomipramine, so that many patients are better able to tolerate the SSRIs than clomipramine over the long term. All SRIs except fluoxetine should be tapered and stopped slowly because of the possibility of the return of symptoms and withdrawal reactions.

Another effective treatment for OCD is cognitive-behavioral psychotherapy (CBT). There are two parts to this treatment the behavior therapy (BT) and cognitive therapy (CT). The behavior therapy helps people to learn to change their thoughts and feelings by first changing their behavior. This part of treatment involves exposure and response prevention (E/RP). Exposure is based on the fact that anxiety usually goes down after long enough contact with something they fear. Thus people with obsessions about germs are told to stay in contact with “germy” objects (e.g., handling money) until their anxiety is extinguished. The person’s anxiety tends to decrease after repeated exposure until he no longer fears the contact. For exposure to be of the most help, it needs to be combined with response or ritual prevention (RP). In RP, the person’s rituals or avoidance behaviors are blocked. For example, those with excessive worries about germs must not only stay in contact with “germy things,” but must also refrain from ritualized washing. Exposure is generally more helpful in decreasing anxiety and obsessions, while response prevention is more helpful in de creasing compulsive behaviors. Despite years of struggling with OCD symptoms, many people have surprisingly little difficulty tolerating E/RP once they get started.

Combined with the behavior therapy is cognitive therapy. CT is often added to E/RP to help reduce the catastrophic thinking and exaggerated sense of responsibility often seen in those with OCD. Like how a teenager with OCD may believe that his failure to remind his mother to wear a seat belt will cause her to die that day in a car accident. CT can help him challenge the faulty assumptions in this obsession. Armed with this proof, he will be better able to engage in E/RP, for example, by not calling her at work to make sure she arrive safely. Other techniques, such as thought stopping and distraction, suppressing or “switching off” OCD symptoms, satiation, prolonged listening to an obsession usually using a closed-loop audiotape, habit reversal, replacing an OCD ritual with a similar but non-OCD behavior, and contingency management, using rewards and costs as incentives for ritual prevention, may sometimes be helpful but are generally less effective than standard CBT. People react differently to psychotherapy, just as they do to medicine. CBT is relatively free of side effects, but all patients will have some anxiety during treatment. CBT can be individual like you and your doctor, a group with other people, or a family. A physician may provide both CBT and medication, or a psychologist or social worker may provide CBT, while a physician man ages your medications. Regardless of their specialties, those treating you should be knowledgeable about the treatment of OCD and willing to cooperate in providing your care.

It takes about two months of CBT to show the reduction of OCD symptoms when on a weekly basis. But, intensive CBT that involves two to three hours a day of therapist assisted E/RP daily for three weeks is the fastest treatment available, right now, for OCD. Those who have gone through CBT say there has been a 50% to 80% reduction in OCD symptoms after about twelve to twenty sessions. Oh, and when somebody also takes medication while going through CBT it may help prevent any relapse when the medication is stopped.

Most patients do well with gradual weekly CBT, in which they practice in the office with the therapist once a week and then do daily E/RP homework. Homework is necessary because the situations or objects that trigger OCD are unique to the individual’s environment and often cannot be reproduced in the therapist’s office. In intensive CBT, the therapist may come to the patient’s home or workplace to conduct E/RP sessions. On occasion, the therapist may also do this in gradual CBT. In some very rare cases, when OCD is particularly severe, CBT is best conducted in a hospital setting. (2000 OCF)