A Look At OCD

  • Category: Psychology
  • Words: 2432
  • Grade: 99
Lather, Rinse, Repeat. Repeat. Repeat. This may sound like a skipping record, but it is not. Tragically, it is just one of the many intense rituals that may plague the mind of someone who has Obsessive-Compulsive Disorder, or OCD. Perhaps what is worse though is that these people are widely misunderstood, especially as children and teenagers. If the public was more educated about the causes, behaviors, and treatment of Obsessive-Compulsive Disorder, the people who suffer with it would not have to suffer in silence.
        The misconceptions about OCD are not all new. In the Middle Ages, for example, the Catholic Church thought that the symptoms of OCD were brought on by the devil. Unfortunately, things did not get any better as time progressed. Many years later in Victorian times, OCD sufferers were mocked as insane (Hollander, 1999). OCD even made an appearance in a classic piece of literature. In his play Macbeth, Shakespeare's Lady Macbeth was a textbook example of someone with OCD. Her character, however was a madwoman, whose compulsive handwashing gave her lines like "Out damn spot! Out I say!" (Hollander, 1999). This type of public ridicule only added to the pain of those with OCD.
        This disorder does not only plague adults, it can start very early in childhood, and it impacts every aspect of what we know as normal life. A few years ago, a young girl appeared on an episode of Oprah to tell her story.
"I get stuck in the mirror and have a hard time getting out" Darcie [an eleven-year old girl with OCD] said, fighting back tears. "I know I look okay, but I don't feel right. I don't feel comfortable if I leave. To people who hear this, it might sound strange. When you have OCD you know how it feels (Summers, 1999)."
To read what Darcie said about her life with OCD is tragic. In his book, Everything In Its Place, television show host Marc Summers talked about his own childhood with the disorder. He went into detail when he wrote about the cleaning rituals he performed every Sunday from the time he was eight to sixteen, later saying that just like Darcie, everything had to be in its place (Summers, 1999). OCD does not only hurt the people who have it; it causes damage to their whole family. In her groundbreaking book about people with OCD, psychologist Judith Rapoport told the stories of people that she treated, explaining how the disorder destroyed the ordinary routine, and "distorted the families whole life" (Rapoport, 1989). It is very painful to imagine what OCD doe to the life of someone who suffers from it.
        Until recently, not many people knew OCD was a treatable mental disorder. As of 1989, psychologists had only just learned the staggering number of people, both adolescents and adults who secretly suffered from OCD (Rapoport, 1989). Even ten years later the disorder was still new, but advances were being made in the understanding of it. According to Eric Hollander, a psychologist, they have only in the past fifteen years recognized the imbalance of neurotransmitters in the brains of OCD patients, and really seen it as a medical disorder, one that approximately six million Americans share (Hollander, 1999). Finally, at least those six million people know that they are not alone.
        Currently, there is no proven cause of OCD, but there are a few strong suggestions. One of them has to deal with a specific neurotransmitter called serotonin. In patients with OCD, there is a problem with the communication between the orbital cortex and the basal ganglia (OCF, 2000). Serotonin is a neurotransmitter that relays messages between these two parts of the brain. Many psychologists believe that it is low levels of serotonin that play a key role in the communication problem, and in turn OCD itself (OCF, 2000). Further evidence of this is what happens to the brains of those patients who saw their OCD fade after taking serotonin medication. Pictures of a working brain of one such patient "show that the brain circuits involved in OCD return to normal (OCF, 2000)." Unfortunately, an OCD diagnosis is not an easy one to make. The diagnosis must be made by a psychologist based on an understanding and analysis of the person's behaviors (OCF, 2000). While much headway has been made in recognizing OCD, it is a far cry from a one step process.
        One common misconception is that stress causes OCD. While stress can strengthen the symptoms of OCD, many people who have it say their symptoms have no trigger that makes them come or go (OCF, 2000). Another related misunderstanding is that OCD is caused by a traumatic event. This seems logical, since that is the case with a few mental disorders, but it is simply not true for OCD (OCF, 2000). Logic aside, research proves that stress does not usually influence OCD.
        A more concrete cause, however, is that OCD tends to run in families. Judith Rapoport, in writing her book found that some of her patients shared their disorder with their children (Rapoport, 1989). When Marc Summers founds out that he had OCD, and began to talk to his psychologist about it, he came to a startling realization. The neatness of his house and his grandmother's house was the result of the disorder that he shared with his mother, father, and grandmother (Summers, 1999). While gene research has come quite a long way recently, the innovations have done little to help isolate the genes that cause OCD. This is because there are different varieties of OCD, each caused by a different set of several genes. Even before the recent genetic advances, the influence of genetics in the cause of OCD was clear. Judith Rapoport stated that" There is no question that the disease runs in families", and she even went as far as to call it "hereditary" in some cases (Rapoport, 1989). Hopefully with more discoveries about the human gene being made every day, it will not be long before the genes that cause OCD can be isolated.
        OCD is characterized by two separate pieces, the first of which are obsessions. The word "obsession", however, does not carry the same meaning here as it does to a lovesick teenage girl. Rather, according to the Diagnostic and Statistical Manual (or the DSM) obsessions are "persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress (DSM, 1994)." There are many different types of obsessions. The obsession that most people imagine when they think of OCD is that of Jack Nicholson's character in the movie "As Good As It Gets"; which is a contamination obsession. Some common contamination obsessions are a disgust with sticky substances, concern with dirt or germs, concern when with animals, concern with household items, and disgust with bodily waste (Summers, 1999). Please note that all of these obsessions are extreme. A tendency to want to stay clean does not necessarily mean that you have OCD! Another type of obsession is an anger obsession. This type usually deals with the intense fear of doing something horrible such as harming, offending, or embarrassing you or someone else (Summers, 1999). Of course, there are many more obsessions, and some are less common than others. Other obsessions are religious, sexual, or somatic obsessions, and others involve a need for order and symmetry (Summers, 1999). The important thing to remember is that although "As Good As It Gets" is a comedy, there is not a one funny thing about obsessions. To someone who has OCD, obsessions are intrusions into their consciousness, and are intense, absurd, and even frightening (Rapoport, 1989). Perhaps obsessions are things that people who do not have OCD see as odd and abstract, but to the people with OCD, they are very real.
        The other half of the disorder is made up of compulsions. Compulsions are the response to the anxiety created by obsessions; they are the actual things or thoughts that a person with OCD does or thinks ritualistically in order to stop or prevent their anxiety (DSM, 1994). The compulsions that most people are familiar with are cleaning and checking compulsions. The compulsion to clean or wash or wash is that of Shakespeare's Lady Macbeth, and it involves cleaning ones self or inanimate objects excessively, usually following a set routine (Summers, 1999). This severely inhibits a person with OCD who must work or go to school because it may take hours for that person to get ready in the morning and go to bed at night. Some checking compulsions are compulsions to check locks, appliance, or to check that you have not made and will not make a mistake (Summers, 1999). This can also consume a large part of a person's life. Some people with OCD need to check things up to one hundred times before they are finished (Rapoport, 1989). As with obsessions, there are many other compulsions that people are not as familiar with. Some other compulsions are repeating certain rituals, arranging things in a certain way, or hoarding objects (Summers, 1999). People with OCD know their compulsions are absurd. At some point they realize that what they are doing is unnecessary, but they can not stop (DSM, 1994). That is why OCD is so serious to those who have it as well as their friends and family.
As bleak as the life of someone with OCD may sound, there is hope. While there is no cure for OCD or a way to prevent it, there are treatments for the symptoms. As with all mental illnesses, if you have OCD, the first step in treating it is learning about it and helping to teach your family and friends about what you are going through (OCF, 2000). It is important to have a group of people who will support you and understand. Within the last twenty years, scientists and psychologists have developed two successful treatments for OCD. These two treatments are cognitive-behavioral therapy (or CBT) and a medication that has a serotonin reuptake inhibitor, or SRI (OCF, 2000). When both are done together, the symptoms can almost completely vanish. Psychosurgery can also be done, but it is only done as an extreme last resort.
        Although it seems like it would be incredibly stressful, the first method has a high success rate with patients of all ages. Basically, CBT is psychotherapy to help correct the thoughts that trigger compulsions (OCF, 2000). While this is very difficult and causes much anxiety for the patient, there are two very good things about CBT. Those who complete treatment (twelve to twenty sessions) report a fifty to eighty percent loss of symptoms, and aside from anxiety, there are relatively no side effects (OCF, 2000). If the sufferer can get through it, CBT is a successful and side effect free way to tame the symptoms of OCD.
        Along with psychotherapy, medication is usually recommended, and it helps quite a bit. Without CBT however, fewer than twenty percent of OCD patients who are taking medication (an SRI) alone report no OCD symptoms, so its best to combine both methods (OCF, 2000). A SRI alone however, does work a little bit, but not much. Also, about twenty percent of people who take a SRI do not see improvement and need to try a different SRI (OCF, 2000). Luckily, there are many SRIs available, and most people are able to find one that works well for them. There are six well-known SRIs, five of which are available in the United States. Their commercial names are Luvox, Anafranil, Zoloft, Celexia, Paxil, and Prozac (OCF, 2000). Given the right treatment, the quality of life of someone with OCD can be greatly improved.
        By only knowing this brief background about Obsessive-Compulsive disorder, it is easy to see how difficult is for someone who suffers from it. While society has become more accepting over the past fifteen years, it has not always been that way, and it could still be a lot better. If everyone could understand what Darcie was going through each time she left her house, then they might not have taunted her at school. The life of someone with OCD must be terrifying, but at least today, there is treatment available that helps, and enough acceptance in society that someone who has OCD can take comfort in knowing that they are not alone.

Annotated Bibliography
        Hollander, E. (1999). Foreword. In M. Summers, Everything in its Place: My Trials and Triumphs with Obsessive-Compulsive Disorder. (pp XIII - XXI). New York: Penguin.
(This is the foreword written in Marc Summers' Book about him growing up with OCD. It provided me with some beneficial historical information on OCD.)
Obsessive-Compulsive Foundation: How is OCD Treated? [On-line]. Available: http://www.ocfoundation.org/ocf1030.htm> (2000, December 6).
(This source gave me information on some of the treatments for OCD. It also gave me the list of prescription drugs used to treat OCD.)
        (1994). Obsessive-Compulsive Disorder. In the DSM-IV (pp417-423). Washington, DC: American Psychiatric Association.
(The Diagnostic and Statistical Manual (DSM) helped in defining what OCD is, and it also gave clear explanations of obsessions and compulsions.)
        Obsessive-Compulsive Foundation: What is OCD? [On-line]. Available http://www.ocfoundation.org/ocf1010a.htm> (2000, December 6).
(This is a different part of the OCF website. This page was also helpful in defining exactly what OCD is.)
        Summers, M. (1999). Everything in its Place: My Trials and Triumphs with Obsessive-Compulsive Disorder. New York: Penguin
(A very interesting book written by Marc Summers. This gave me insight on what It is like to live with OCD. It also made me understand that OCD can run in the family.)
        Rapoport, J.L. (1989). The Boy Who Couldn't Stop Washing. New York: Penguin.
(A book written by psychologist Judith Rapoport about some of the patients she treated that had OCD. She helped me understand how OCD can ruin not only the lives of the people who suffer from it, but also their family and friends.)

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