by Martin Sodomsky, M.D., Scripps Memorial Hospital La Jolla
It’s happened to most of us. We leave the house, then turn around and go back to make sure we’ve turned off the oven or unplugged the iron. For most of us, checking once is enough to reassure ourselves that all is well. For people with Obsessive-Compulsive Disorder (OCD), however, once is not nearly enough. People with OCD are literally compelled to check 50 or 100 times—or even more.
OCD is a type of anxiety disorder characterized by obsessions and/or compulsions. Obsessions are intrusive, unwanted repetitive thoughts or urges that are difficult or impossible to stop. These obsessions lead to anxiety, which in turn leads to a compulsive, ritual-like behavior that helps relieve the anxiety. Among the most common obsessions are thoughts or fears of contamination; for example, people may touch common objects such as doorknobs, telephones or steering wheels and become obsessed with the thought that they have been contaminated by germs. As a result, they engage in the compulsive behavior of repeatedly washing their hands.
Other common obsessions include invasive thoughts that appliances have not been turned off, doors have not been locked, items are not symmetrical, or someone has been injured. In some cases, people with OCD will hit a bump in the road while driving, and become obsessed with having injured someone or something. They return to the scene to check, see that all is ok, and drive away only to come back and check again and again—often more than 100 times in a day.
According to the OCD Foundation, one in 50 people have OCD at a given time, and it will affect two in 50 at some point in their lives. OCD can affect anyone regardless of age, gender or ethnicity, but it commonly begins in childhood. Research suggests that there may be a genetic link; if a parent has OCD, there is a slightly greater risk of a child having it, although the symptoms may manifest differently (e.g., the parent may be obsessed with contamination, while the child’s focus is on symmetry or counting).
In addition, OCD can affect people differently. People can have both obsessive thoughts and compulsive rituals, or just one of the two. Symptoms range from mild to severe and can fluctuate over time. It’s no surprise that the more severe forms can be extremely debilitating; in addition to causing anxiety and stress, OCD can be very time-consuming and significantly interfere with work, family, and leisure activities. Although most people with OCD are aware that their obsessions and compulsions are unreasonable, they feel powerless to control them.
They needn’t, though. OCD is highly treatable with medication, cognitive therapy, or both. Selective serotonin reuptake inhibitors (SSRIs) such as Zoloft, Paxil, Prozac and Lexapro, increase the level of serotonin in the brain. Serotonin is a neurotransmitter, which is a type of chemical that helps relay signals from one area of the brain to another. SSRIs are also used to treat depression, but the dosage for treating OCD is slightly higher. Clominipramine, an older type of antidepressant in the tricyclic family, is also very effective for OCD.
Cognitive behavior therapy, also known as exposure/response prevention, can also be effective. Behavior therapy exposes the person to the situation that causes the obsession, and then prevents the compulsive ritual associated with it. For example, when working with people who are obsessed with thoughts of contamination, we would have them put their hands in dirt, then prevent them from washing their hands. By interfering with the response and blocking the ritual on a consistent basis, we are often able to eliminate the obsession. If patients have obsessions but no related compulsions, they may be able to eradicate their obsessive thoughts by repeating them into a tape recorder.
Behavior therapy is extremely effective in many cases, but it needs to be done consistently and under the care of a professional therapist for weeks or months. Often, behavior therapy is combined with medication, but if patients refuse medication, it can be used alone.
Martin Sodomsky, M.D., is a psychiatrist at Scripps Memorial Hospital La Jolla. For more information, please call 1-800-SCRIPPS (1-800-727-4777).