One of the most interesting illnesses I encountered as a psychiatric nurse was obsessive-compulsive disorder (OCD). It is actually a type of anxiety disorder. It is not your typical feeling of fear, worry or anxiety; people with obsessive-compulsive disorder will have these normal emotions but take them to extreme. For example, people with OCD might have thoughts about bad things that could happen. In addition, OCD patients will have upsetting or scary thoughts or images in their head (obsessions) that are hard to shake. They may also worry about things being ‘out of order’ or not ‘just right’. The compulsions enter into the picture when patients feel strong urges to do things repeatedly. These compulsions give persons with OCD a brief sense of relief. If you saw the movie “As Good As It Gets”, you may recall Jack Nicholson repeatedly washing his hands, locking the door and stepping over cracks to avoid them. Often times, the compulsions, or rituals, seem rather odd even to the person with OCD. For this reason, many people with the disorder try to hide their symptoms from others.
Although everyone with OCD has obsessions and/or compulsions, they vary from person to person. In one-third of obsessive-compulsive individuals, onset of the disorder occurs by the age of 15. A second peak of incidence occurs during the third decade of life. Once established, obsessive-compulsive disorder is likely to persist throughout life with varying degrees of severity. Some people with OCD have only one type of obsession or compulsion; others have several types of obsessions and compulsions. The illness only occurs in 1-3 percent of the population. Obsessive-compulsive disorder can affect people of all ages, although its onset is typically found in adolescence or young adulthood. However, it can start as early as childhood and the course is usually chronic. As many as 1 in 100 children have OCD. Diagnosing the disorder does not mean that a person is crazy – just like going to the doctor when you have the flu is not embarrassing, neither is seeking treatment if you think you may have the illness.
Obsessive-compulsive disorder is not a person’s fault. Like asthma, diabetes or any other illness, OCD can be treated so that people can get relief from the symptoms. Doctors used to think the disorder was rare and untreatable, but now much more is known. The exact cause of OCD is still unknown. Doctors and scientists believe the disorder tends to run in families. Many people with the illness have one or more family members who also have it or other anxiety disorders influenced by the brain’s serotonin levels. Experts now believe that OCD is related to levels of serotonin in the brain and have come to believe that the tendency for someone to develop the serotonin imbalance that causes OCD can be inherited through a person’s genes. When the proper flow of serotonin is blocked, the brain’s “alarm system” overreacts and misinterprets information. Danger messages are mistakenly triggered like “false alarms.” Instead of the brain filtering out these unnecessary thoughts, the mind dwells on them – and the person experiences unrealistic fear and doubt. Having the genetic tendency for OCD doesn’t mean people will develop OCD, but it means there is a stronger chance they might. An imbalance of serotonin levels can also result in other types of anxiety or depression.
The good news about the disorder is that there are treatments that really work. Once a doctor has diagnosed the illness, treatment can begin. Many mental professionals are trained in treating OCD and it may be a little overwhelming at first, but most people find they are relieved when treatment begins. A certain kind of talk therapy, called cognitive-behavioral therapy (CBT), is usually started and offers specific methods (exposure and ritual prevention) that work for people with OCD. They meet with a therapist to learn how to use the power of their own behavior to change thoughts and feelings for the better. The patient learns how OCD works – how resisting compulsions actually makes OCD weaker. Therapists who treat OCD teach people new ways to react to worries and fear without doing rituals. Further, pharmacotherapy with serotonin reuptake inhibitors, such as clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro) have helped thousands of people with OCD feel much better.