Biology 103
2000 Third Web Report
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Imagine yourself being trapped in a repetitious cycle of having certain thoughts and performing specific actions over and over again, which you have absolutely no control over. Obsessive-Compulsive Disorder (OCD) is still not well known in comparison to other illnesses such as schizophrenia, bipolar disorder or panic disorder even though its occurrences are more common. (1) Thus, questions form in our minds about such a strange phenomenon. Is OCD a reflection of our obsession with perfection in order to please? Or is it a result of the praise we get at our organizational skills or even our own need for some comforting habit that we create in order to feel better about ourselves?

Although it seems more like a scene out of a horror movie than real life, this illness is only too real for millions. The fact that it is overlooked by many mental health professions and mental health advocacy groups results in many blaming themselves for their suffering as a result of this inexplicable behavior. Many do not realize that it is a biological disorder. Aside from being an illness that can be detrimental to oneās way of living, OCD is seen by many as an intriguing disease since it reveals the intricacies of the human brain.

OCD is defined as "an anxiety disorder where a person has recurrent and unwanted ideas or impulses (called obsessions) and an urge or compulsion to do something to relieve the discomfort caused by the obsession." (1) The disorder is composed of torturous rituals where the mind cannot soothe without this repetitious self-harm. Like most mental disorders, OCD affects a personās ability to function in everyday activities, oneās work, oneās family as well as oneās social life.

DIAGNOSING OCD:

People may see the symptoms of OCD in themselves or in others when they realize that certain actions are being repeated several times. But this is where people do not realize that OCD behavior far exceeds the normal routines that we feel that we are bound by. For example, a woman washing her hands several times before every meal is not considered to have OCD whereas a woman who has to wash her hands exactly 17 times every time she leaves her house is far likely to be considered as a sufferer of OCD.

To further understand OCD, we must split the disorder into two parts: obsessions and compulsions. Obsessions are unwanted ideas or impulses that repeatedly enter the personās mind. Examples of these are having the need to do things correctly or perfectly, unreasonable concern with becoming contaminated or fears that harm may come to self or a loved one or even imagining harming loved ones. (3)

While obsessions are mental acts, often intrusive and upsetting, compulsions are behaviors. Compulsions in response to obsessions, are repetitive behaviors. Common behaviors that are repeated include washing and checking, counting, repeating, hoarding and endlessly rearranging objects. Cognitive problems such as mentally repeating phrases, listmaking or checking are also common. 90% of people with OCD have both obsessions and compulsions. (1)

The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; American Psychiatric Association, 1994) cites that thoughts, impulses or images in the personās mind are not simply excessive worries about real-life problems. (3) The manual also lists OCD as on of the most prevalent of anxiety disorders. Anxiety disorders are a group of psychological problems whose key features include excessive anxiety, fear, worry, avoidance, and compulsive rituals. (5)

Behavior can differ as some OCD patients have regimented rituals while others have complex and changing rituals.(4) OCD is also common in children but whereas adults, at some point during course of the disorder, recognize that obsessions or compulsions are excessive or unreasonable, children usually fail to do so.

Also, another sign that OCD is present in a person is if he/she performs activities that are time consuming (i.e. more than one hour per day), cause marked distress, significantly interfere with normal routine, occupational/academic functioning or usual social activities or relationships. (3) Through these repetitious actions, the individual may feel relief but it is only a temporary one. (2) Hence, the need to repeat these rituals. Individuals who are not able to complete their rituals usually experience severe anxiety and so the vicious cycle continues.

CAUSES:

Most of the frustration of having such an illness generates from not knowing what its origins are. As a result, most people suffering from OCD do not speak of their symptoms and instead complain only of anxiety or depression. (2)

Enough research exists to suggest that behavioral disorders may have genetic roots. What role serotonin, a naturally occurring chemical that sends impulses from one nerve cell to another, plays in the onset of OCD is not entirely understood but conditions seems to be linked to low levels of this substance in brain. (2)

Biological theorists minimize importance of psychological variables and describe OCD as being cognitive manifestations of a primarily biological process. Biologists use research as support for this view as there is evidence showing differences between those with and without anxiety disorders on a variety of biological variables (e.g.; brain imaging, hormone levels, biological challenges, neurochemical levels, and genetics). Cognitive and Behavior theorists on the other describe their findings about OCD as being biological manifestations of a primarily cognitive or behavioral phenomenon, and often cite studies demonstrating that these biological findings can be influenced by psychological variables. (5)

The main problem with these two opposing views is that the two sides do not work with each other. At present, a more multidimensional approach has been taken where there is an integration of the two views as well as an approach intertwining several complex factors which include genetics, biology, and environment or personality development. (5)

Thus, the growing evidence of research such as showing relationship between brain chemistry and individual behavior offer hope for suffers since it makes it clearer to them that this disorder has far more complex origins that cannot be prevented but can be treated as a result of investigation.

TREATMENT:

The best treatment at the moment seems a combination of two treatments: behavior therapy and medication. One of the main goals of therapy is to make the person realize that no harm is done when a ritual isnāt completed as well as to reassure them that OCD is not a sign of character flaw or personal weakness. (2)

Sometimes, medication alone can help a person make full recovery. Other OCD patients would definitely benefit from behavioral treatment called exposure and response prevention. (4) An obstacle with OCD is frustration, as both relatives and patient both do not understand that incomprehensible forces that are beyond his/her control enslave the person. (3)

Overall, there is evidence that OCD can be effectively treated with a variety of medications, especially serotonin specific agonists such as clomipramine, sertraline, fluvoxamine and fluoxetine. (5). The use of Luvox tablets (fluvoxamine maleate), a selective serotonin reuptake inhibitor (SSRI) for treatment has been proven effective as it significantly reduces symptoms and is found to be safe and effective for both adults and children. (3)

Behavior therapies are more successful in comparison to psychoanalytical methods since the treatment is requires small specific steps geared to the exact obsessions and compulsions involved in individual case. The methods used include systematic desensitization and flooding. The first method, systematic desensitization involves gradually exposing the client to ever-increasing anxiety-provoking stimuli but this is only after the client has successfully learned relaxation skills and can demonstrate their use to the therapist. Flooding allows patient to face the most anxiety-provoking situation, while using the relaxation skills learned. Flooding is used only in rare cases since its potential harm outweighs its potential benefits (e.g.; traumatizing individual further). (2)

By exposing yourself to your fear, anxiety increases temporarily. However, by continuing to avoid your usual compulsive behavior response, your anxiety is allowed to naturally diminish. The obsessive-compulsive cycle is broken, and the obsessive thoughts weaken. (4) Confronting such fears is difficult for the patient and it is necessary that the therapist is well trained and has good knowledge of this specific disorder.

CONCLUSION:

Although OCD is a serious mental disorder, it is now more treatable than ever. An average person can expect improvement in 3 months. Medication for OCD should be tried 10-12 weeks before judging effectiveness. (4) Thus, if one medicine does not work, there is always another option.

The major focus of OCD sufferers should be in treatment of this disorder since untreated symptoms may vary for years. The symptoms may go away, remain the same or worsen. Also, early detection is vital since symptoms can be detected in children as the disorder usually begins in adolescence or early adulthood. (6) Although prevention of OCD is not possible at the moment, due to the uncertainty of the causes of the problem, being aware of the symptoms means early detection is possible and treatment can begin as soon as possible. There is much to be learned but so far, there has already been significant improvement in treatment methods, which is the biggest concern for people who have to live with this disorder.

WWW Sources

2) Mental Health Net , Features of OCD (Defining OCD)

3) OCD Resource Center , Clarifying and Informing about Treatment

4) OCD, National Anxiety Foundation , Lots of Facts on Medication

5) Anxiety Disorders: Future Directions for Research and Treatment , OCD as an anxiety disorder and diagnosis

5) Recognition and Treatment of OCD (AMERICAN ACADEMY OF FAMILY PHYSICIANS) , Information including Early Detection

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