Obsessive-Compulsive Disorders Biology 202
2000 First Web Report
On Serendip

Obsessive-Compulsive Disorders

Hajira Amjad

Obsessive-compulsive disorder (OCD) was once considered to be a rare untreatable disease (2), which resulted from flaws in a person's personality and life experiences (1). It is now known that OCD is common, affecting almost one in every fifty adults and one in every two hundred children (3). It is estimated that approximately five million Americans suffer from OCD (1). OCD affects people regardless of race, gender, or age (2). A better understanding of the brain has lead researchers to the conclusion that chemical imbalances within the brain, in addition to environmental influences, are responsible for obsessive-compulsive disorders (2). This realization has lead to a better understanding of the disorder and possible ways to control the symptoms of this affliction.

Two components, which constitute OCD, are obsessions and compulsions, and help to define exactly what is entailed in this disease. Obsessions are defined as repetitive thoughts or impulses that are considered to be intrusive and disturbing to an individual (2). Some examples of this are fears of contamination, causing harm to others, and making mistakes (3). Compulsions are repetitious behaviors, which result as a response to the obsessions. Some examples of this include washing and checking (3). At times an individual suffering from OCD realize the excesses of their worries and behaviors and at other times they believe their behavior is completely justified (2). The obsessions and compulsions cause significant stress, occupy more than an hour a day, and interfere in an individuals social, work or academic activities (3). Some behavioral changes which may indicate the onset of OCD are constant questioning, need for reassurance, increased concern over minor details, and extreme emotional reactions to trivial events (1). There is no definite list of shifts in behavior that may be a result of OCD, but rather any significant alteration in behavior may be due to OCD (1).

As was mentioned earlier, OCD affects people of all ethnic groups, of either sex equally, and of all ages. The onset of OCD can occur at any time from early childhood to adulthood and usually occurs by the age of forty (3). One-third of adults with OCD reported that it started during childhood (2). There is also some indication that the onset of OCD during childhood may be an inherited trait from parents. This suggests that OCD may have a genetic basis although a gene for OCD has not been identified yet (3). A child with an affected parent has a more likely chance of also being affected by OCD, although the specific symptoms may differ (3).

It was once believed that OCD resulted from environment influences but a better understanding of the brain has overturned that thought. It is now believed that in addition to environmental influences, there is also a neurobiological basis of OCD (3). A decreased level of serotonin, which is a chemical used by the nerve cells of the brain to communicate with other brain cells, has been found in individuals afflicted by OCD and this is the basis for the medications that are prescribed for OCD (3). The positron emission tomography scanner has been used to study the brain of victims of OCD and it has been found that there is an increased activity in the frontal cortex. Magnetic resonance imaging has also shown that OCD patients have less white matter in the brain as compared with normal individuals (2). This shows that there is a biological basis for OCD, in addition to environmental influences.

Two types of treatment options exist for controlling the symptoms of OCD. One type of remedy is to use medications known as serotonin reuptake inhibitors (SRI), which increase the concentration of serotonin in the brain (3). The first SRI approved for the treatment of OCD was AnafranilR. This was followed by the selective serotonin reuptake inhibitors (SSRI) ProzacR, LuvoxR, PaxilR, and ZoloftR. These SSRI's differ from AnafranilR in that they only target serotonin, whereas AnafranilR also targets other neurotransmitters (3). These medications are shown to diminish the symptoms of OCD in about three-quarters of the patients by at least a little (2). These medications do not cure OCD, but rather lessen the severity of the symptoms. Therefore, many patients may have to remain on these medications for the rest of their lives, although after the symptoms have abated, the dosage may be decreased (2). If an individual does not respond favorably to one medication, then another medication should be administered to the patient.

Another treatment option that may be combined with the medication to reduce the symptoms of OCD is behavior therapy (3). One type of behavior therapy is the "exposure and response prevention" (2). In this form of therapy, the patient confronts the feared ideas and objects head on and is encouraged to abstain from carrying out the repetitious behaviors that they would have previously undertaken (3). For example if a patient has a fear of germs, then the patient is encouraged to touch "germy" things and they are then told to avoid washing their hands. Most patients exhibit less anxiety as the treatment progresses and they report a 50%-80% decrease in the symptoms of OCD after about three months (3). Behavior therapy also shows long lasting results, as long as follow-up sessions are included after the more intensive therapy. Undergoing behavior therapy along with medication, may help hinder the patient from relapsing, when the medication dosage is decreased or even stopped (3).

A better understanding of the brain has in turn lead to a better understanding of the nature of psychological disorders, such as obsessive-compulsive disorders. OCD, which was once considered to be untreatable, can now be treated to such an extent to almost cure an individual from the symptoms of OCD. A combination of behavior therapy and medication can be used to treat individuals afflicted with OCD and give them a chance to live a more complete life free of anxiety and distress.

WWW Sources

1) O.C.D. Resource Center

2)National Institute of Mental Health Library

3)Obsessive-Compulsive Foundation

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