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OCD...It's Easy as 1..2..3..
by Lisa Barroilhet

I think I went four years straight without stepping on the crack of a sidewalk. For some reason, I had decided that this simple action somehow prevented most major calamities, not the least of which was breaking my mother's back. After that phase ended (age twelve, I believe) I became obsessed with doing things in groups of twenty-four.

If I was clapping at the end of a performance, I refused to clap more than twenty-four times in succession. I would set my alarm clock to go off at 6:24 every morning. I was infatuated with Joshua Durkin, second string quarterback of our Jr. High football team, who wore the number 24 across the chest of his orange mesh jersey. There were several other phases that followed, but they were less noticeable, and eventually this part of my personality seemed to give way to more rational thought processes.

Now I realize I was lucky. Things could have ended up very differently for me. I'm not sure when I heard the phrase "Obsessive-Compulsive Disorder" or "OCD" used for the first time. Initially, I associated this disorder with "germophobia," since handwashing and fear of contamination were common indicators of this much-discussed psychological malady. OCD actually encompasses a much wider range of behaviors than those that immediately spring to mind.

"Obsessions" include recurrent and persistent thoughts and impulses that are often inappropriate and are intrusive and disruptive to daily functioning. "Compulsions" involve repetitive behaviors or mental acts, that could include counting, praying, arranging things to be symmetrical, or repeating words under one's breath.

Research is beginning to show that OCD, like many mental illnesses, exists on a continuum. Many people (including myself) have more mild symptoms, that include obsessions and compulsive behaviors, yet do not occur with the level of frequency and intensity to become disruptive to daily life. Those who suffer from more serious degrees of OCD often cannot avoid the recurrent and persistent thoughts, impulses or images and will engage in ritualistic behavior often founded on irrational superstition. For example, much as I refused to step on cracks for most of my adolescence, a person suffering from OCD may be convinced that the failure to engage in specific behavior (i.e. repeating lengthy prayers from childhood each night before bed) will have devastating consequences.

What exactly is OCD?

Despite huge variations in the manifestation of OCD, there is a diagnostic consistency in the presence of anxiety, fear, and acknowledgement that the compulsions (i.e. washing one's hands over and over) are the only actions that relieve the obsessive thoughts, even though this relief is only temporary. In most cases of Obsessive-Compulsive Disorder, the patient possesses some level of insight that his behavior is irrational, although he may remain unable to control it. In a small minority of cases this insight is absent. The latest figures from the National Institute of Mental Health indicate that about 3.3 million Americans suffer from OCD in a given year. It affects men and women equally with the first symptoms usually appearing during adolescence.

What causes OCD?

If only we knew. Fortunately, a lot of progress has been made in the last decade, although no decisive conclusions have been made. Numerous brain imaging studies have indicated that OCD represents some type of abnormal function of brain circuitry, most likely in a part of the brain called the striatum. The striatum is the area of the brain involved in the preparation of appropriate behavioral responses. A damaged striatum could cause the aggressive or inappropriate thoughts that most people keep under control to "leak out." Most mental health experts agree that OCD is not caused by family problems or attitudes learned in childhood. (So, no blaming Mom for making you clean your room twice a day).

How Can OCD be treated?

The treatments for OCD vary even more than the behaviors with which it is associated. Because OCD is often linked with depression, many people respond to anti-depressants, more specifically selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine) and Zoloft (sertraline). Other medications that have proven effective include clomipramine, fluvoxamine and paroxetine--drugs known to psychiatrists as "tricyclics". These drugs are all linked to the functionality of serotonin, further implicating this neurotransmitter's role in the development of Obsessive Compulsive Disorder.

A form of behavioral therapy known as "exposure and response prevention" has also proven effective in the treatment of OCD. The patient is exposed to anxiety-producing circumstances in a controlled environment, beginning with situations they may consider low stress (like touching a doorknob that other people have touched) and working their way up to higher stress situations (sharing food from the same plate as another person).

Obsessive-Compulsive disorder rarely remits completely. Even patients who are treated successfully may experience lingering obsessive problems or rituals. Because OCD is often accompanied by other mental disorders, ranging from substance abuse to attention deficit disorder, it can be difficult to treat effectively. Much has been learned about the neural pathways associated with OCD and this fundamental research will pave the way for future studies, and hopefully, a definitive cure.

Carson, Butcher and Mineka. "Abnormal Psychology and Modern Life." HarperCollins Publishers, New York. 1996.

National Institute of Mental Health. "Facts about Obsessive-Compulsive Disorder" Accessed on-line: February 2001.

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The Boy Who Couldn't Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder
by Judith L Rapaport
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"The first book to bring OCD to public attention tells the stories of those who are afflicted, often in their own words, and describes the successes doctors and patients have had with both experimental and existing treatments." -- Synopsis

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