OBSESSIVE COMPULSIVE DISORDER

The National Institute of Mental Health estimates that more than 2 
percent of the U.S. population, or nearly one out of every 40 people, 
will suffer from OCD at some point in their lives. The disorder is two 
or three times more common than schizophrenia and manic depressive 
illness. 

WHAT IS OBSESSIVE COMPULSIVE DISORDER?

Obsessions are intrusive, irrational thoughts--un wanted ideas or
impulses that repeatedly well up in the victim's mind. Again and
again, the person experiences disturbing thoughts, such as "My
hands must be contaminated; I must wash them"; "I may have left
the gas stove on"; or "I am going to injure my child." On one
level, the sufferer knows these obsessive thoughts are
irrational. But on another level, he/she fears these thoughts
might be true. Trying to avoid such thoughts creates great
anxiety.

Compulsions are repetitive rituals such as hand washing,
counting, checking, hoarding, or arranging. An individual repeats
these actions, perhaps feeling momentary relief but without
feeling satisfaction or a sense of completion. OCD victims feel
they must perform these compulsive rituals or something bad will
happen.

Most people at one time or another experience obsessive thoughts
or compulsive behaviors. Obsessive-Compulsive Disorder occurs
when an individual experiences obsessions and compulsions for
more than an hour each day, in a way that interferes with his/her
life.

OCD is often described as "a disease of doubt." Sufferers
experience "pathological doubt," unable to distinguish between
what is possible, what is probable, and what is unlikely to
happen.

WHO GETS OCD?

People of all ages and from all walks of life can get OCD. It
strikes people of all ethic groups, and both males and females.
Symptoms typically begin during the teenage years or young
adulthood.

WHAT CAUSES OCD?

The preponderance of scientific evidence suggests that OCD results 
from a chemical imbalance in the brain For years, mental health 
professionals assumed OCD resulted from bad parenting or personality 
defects. This theory has been disproven over the last 20 years. OCD 
symptoms have not been relieved by psychoanalysis or other forms of 
"talk therapy". OCD patients can often articulate insight into "why" 
they have obsessive thoughts or why they behave compulsively. But the 
thoughts and the behavior continue. People whose brains are injured 
often develop OCD, suggesting that it's a physical condition. If a 
placebo is given to people who are depressed or who experience panic 
attacks, 40 percent will say they feel better. If a placebo is given 
to people who experience obsessive-compulsive disorder, only about 2 
percent say they feel better. This also suggests a physical condition. 
Brain scientists have identified the part of the brain that causes 
OCD. They have discovered a strong link between OCD and a brain 
chemical called serotonin. Serotonin is a neurotransmitter that helps 
nerve cells communicate. Scientists have also observed that people 
with OCD have increased metabolism in the basal ganglia and in the 
frontal lobes of the brain. This, scientists believe, causes 
repetitive movements, rigid thinking and a lack of spontaneity. 
People with OCD often have high levels of the hormone Vasopressin. In 
layman's terms, something in the brain is stuck, like a broken record. 
Judith Rapoport, MD, describes it in her book, The Boy Who Couldn't 
Stop Washing, as "grooming behaviors gone wild." 

HOW DO PEOPLE WITH OCD TYPICALLY REACT TO THEIR DISORDER?

People with OCD generally attempt to hide their problem rather than 
seek help. Often they are remarkably successful in concealing their 
obsessive compulsive symptoms from friends and co-workers. An 
unfortunate consequence of this secrecy is that people with OCD 
generally do not receive professional help until years after the onset 
of their disease. By that time, obsessive-compulsive habits may be 
deeply ingrained and very difficult to change. 

HOW LONG DOES OCD LAST?

For years, even decades. The symptoms may be come less severe
from time to time, and there may be long intervals when the
symptoms are mild, but generally OCD is a chronic disease.

IS AGE A FACTOR IN OCD?

OCD usually starts at an early age, often before adolescence. Left 
untreated, it usually grows worse with age. It may first manifest as 
autism, pervasive developmental disorder, or Tourette's Syndrome (in 
which the patient feels compelled to shout obscenities and insults at 
random). Or it can evolve into Tourette's Syndrome, depression and 
anxiety. Like depression, OCD tends to worsen with age. But 
scientists hope that if OCD patients are treated at an early age, 
their symptoms won't necessarily worsen as they age. 

WHAT ARE SOME MORE EXAMPLES OF PEOPLE WHO SUFFER FROM OCD?

People who:

-- repeatedly check things, perhaps dozens of times before feeling 
secure enough to go to sleep or to leave the house. Is the stove 
off? Is the door locked? Is the alarm set? 

-- fear they will harm others. Example:A man's car hits a pothole
on a city street and he fears it was actually a body. 

-- feel dirty and contaminated. Example: A women is fearful of
touching her baby because she might contaminate it. 

-- constantly arrange and order things. Example: A child can't go
to sleep unless he lines up all his shoes correctly. 

-- are excessively concerned with body imperfections (who insists
on numerous plastic surgeries or spend hours a day body-building). 

-- are ruled by numbers, believing that certain numbers represent
good and other numbers represent evil. 

-- are excessively concerned with sin or blasphemy.

IS OCD COMMONLY RECOGNIZED BY PROFESSIONALS?

Not nearly enough. OCD is often misdiagnosed and underdiagnosed.
Many people have dual diagnoses of OCD and schizophrenia, or OCD
and manic-depressive illness, but the OCD component is not diagnosed 
or treated. Researchers believe OCD, anxiety disorders and eating 
disorders like anorexia and bulimia can be triggered by the same 
chemical mal functioning of the brain. 

IS HEREDITY A FACTOR IN OCD?

Yes. Heredity appears to be a strong factor. If you have OCD, there's 
a 25 percent chance that one of your immediate family members will 
have it. It definitely seems to run in families. 

CAN OCD BE EFFECTIVELY TREATED?

Yes, with medication and behavior therapy. Medication can
regulate serotonin, reduce obsessive thoughts and compulsive
behavior. In the last few years, several medications have been
developed that relieve many of the symptoms of OCD.

THREE ARE PARTICULARLY RECOMMENDED AS "SEROTONIN SELECTORS":

Clomipramine (brand name: Anafranil): This medication has been
used in Europe for more than 20 years, and is now available in
the United States. There is little evidence that clomipramine has
adverse long term negative effects, particularly no increased rate of 
birth-defects. But it can produce side effects: dry mouth, 
constipation, tiredness, fatigue, slight hand trembling, sexual 
dysfunction, severe weight gain. There is also the possibility of 
seizures in high dos ages. 

Fluoxetine (brand name: Prozac) and Sertraline (brand name:
Zoloft) are viewed as effective in some OCD patients but with far
fewer side-effects for most patients. Fluoxetine occasionally
causes nausea, weight loss, insomnia.

Despite sensationalized re ports that fluoxetine causes violent
behavior, the drug has been examined on numerous occasions by the
US Food and Drug Administration, and is deemed safe and
effective.

Sertraline is a relatively new drug that so far has shown fewer
side effects than fluoxetine and is substantially cheaper.

HOW LONG SHOULD AN INDIVIDUAL TAKE MEDICATION BEFORE JUDGING ITS 
EFFECTIVENESS? 

Some physicians make the mistake of prescribing it for only three
or four weeks. That really isn't long enough. Medication should
be tried consistently for 10 or 12 weeks before judging its
effectiveness.

WHAT IS "BEHAVIOR THERAPY" AND CAN IT EFFECTIVELY RELIEVE SYMPTOMS OF 
OCD? 

Behavior therapy is not traditional psychotherapy. It is
"exposure and response prevention," and has been found to be effective 
for many people with OCD. Patients are deliberately exposed to a 
feared object or idea, either directly or by imagination, and are then 
discouraged or prevented from carrying out the usual compulsive 
response. For example, a compulsive hand-washer may be urged to touch 
an object believed to be contaminated, and then may be denied the 
opportunity to wash for several hours. When the treatment works well, 
the patient gradually experiences less anxiety from the obsessive 
thoughts and becomes able to refrain from the compulsive actions for 
extended periods of time. 

Several studies suggest that medication and behavior therapy are
equally effective in alleviating symptoms of OCD. About half the
patients improve substantially with behavior therapy; the rest
improve moderately with it.

IF MY RELATIVE WITH OCD REFUSES TO TAKE MEDICATION AND WON'T
PARTICIPATE IN BEHAVIORAL THERAPY, ARE THERE ANY OTHER
TREATMENTS?

Your relative could be a candidate for brain surgery. Neurosurgeons 
in recent years have developed a finely-tuned procedure with Magnetic 
Resonance Imaging to identify the part of the brain that may be 
involved in expressing OCD. A surgeon can make microscopic cuts in the 
brain, which often lead to a decrease in OCD. 

WILL OCD SYMPTOMS GO AWAY COMPLETELY WITH MEDICATION AND BEHAVIOR
THERAPY?

Response to treatment varies from person to person. Most people
treated with effective medications find their symptoms are
reduced by about 40 percent or 50 percent. That can often be
enough to change their lives, to transform them into functioning 
individuals. Some people are fortunate enough to go into total 
remission when treated with effective medication and/or behavior 
therapy. Unfortunately, some people find neither medication nor 
behavior therapy has positive effects. 

For Further Information

Rapoport, Judith L. The Boy Who Couldn't Stop Washing. New York,
E.P Dutton: 1988. The chief of child psychiatry at the National
Institute of Mental Health reports on 20 years of observation and
research on OCD, and states that OCD is a brain disorder best
treated by drugs and behavior therapy.

Griest, John H. Obsessive Compulsive Disorder. Revised Edition.
Madison, WI., Univ. of WI. Lithium Information Center: 1990. This
booklet is a useful overview of symptoms (with a checklist),
medications and other treatments.

OCD Foundation. Living With OCD. OCD Foundation, P.O. Box 70,
Milford, DE 06460, (203) 878-5669. This booklet is an upbeat
first-step in developing support systems for families and for OCD
sufferers. The foundation has other helpful materials, including
a newsletter.

Information for this brochure was excerpted from a workshop at
the 1992 NAMI Convention led by Teri Pigott, MD, medical director
of the OCD program at Georgetown University in Washington, DC and
former head of the Obsessive Compulsive Disorder Research Unit at
the National Institute of Mental Health in Rockville, MD.

Information was also excerpted from materials written by Mary
Lynn Hendrix, science writer in the Office of Scientific
Information at the National Institute of Mental Health.

Feel free to copy this publication in any quantity you wish.

NAMI's Medical Information Series is a collection of brochures
written to provide families and consumers with the most accurate
and current information available on a wide variety of mental
illnesses and treatment modalities. Each publication in this
series is reviewed by a scientist who specializes in the subject
covered.

The sole purpose of the NAMI Medical Information Series is to
provide information. NAMI does not endorsee or advocate any
treatment form.

For further information about NAMI or to find out about other
brochures in this series, please tear off, fill out and mail this
form to:
The National Alliance for the Mentally Ill 2101 Wilson Blvd.,
Suite 302
Arlington, VA 22201