Obsessive–Compulsive Disorder

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Many of us, at times experience persistent worries that seem not entirely sensible, even to ourselves.  We use the words "obsessive" and "compulsive" loosely to describe people who worry too much, spend too much time on details, or specific ways of doing a specific task. However, a true Obsessive - Compulsive Disorder is a mental and emotional condition that becomes time consuming and destructive to one’s life.  It is disruptive to one’s work, family, and intimate relationship and social life.  
As the name implies, OCD (Obsessive - Compulsive Disorder) is characterized by two hallmark symptoms, obsession and compulsion symptoms.  Obsessions are recurring, persistent, and disturbing thoughts, impulses, or images that cause significant anxiety or distress. People may try unsuccessfully to ignore or suppress their obsessions, or they may feel a kind of relief from compulsive rituals.  Compulsions are feelings of being driven to repeat behaviors, usually following rigid rules (such as washing hands multiple times, giving orders, and checking things).  The acts of compulsion ­­­­­­­–rigidly repetitive acts-– aimed at relieving tension and anxiety which resulted by obsessive thoughts and images, and preventing the imagined harm suggested by the obsessions.

Studies have estimated the life time OCD occurrence rate of a 2.5% among general population.   Although it usually begins in adolescence or early adulthood, it may begin in childhood in some families.  The rate of OCD condition is equally common in adult males and females.  Like many other mental health problems, OCD runs in the family, which indicates a partially genetic basis.  About 20% of the close relatives of a person with OCD will also have some forms of OCD.  Cases have reported that sometimes the symptoms can be traced to traumatic events.    

OCD often causes suffering for years before it is treated correctly – both because of delays in diagnosis and because patients may be reluctant to seek help. In most cases adults with OCD at some point recognize the obsessions or compulsions are excessive or unreasonable.   This insight will help individuals in seeking help and benefit from treatment.  Although OCD tends to be a chronic condition, symptoms may flare up and subside over a patient’s lifetime. Only about 10% of patients recover completely, but 50% improve with treatment

Treatment
The first step is that the person with OCD symptoms decides to seek help.  The person needs to recognize and accept that one’s OCD symptoms not only is distressing to overall one’s health but also to loved ones who are important to one’s life.  The second step is a through assessment of the condition by a mental health professional.  This is crucial to the successful treatment. There are personality traits, like preoccupation with orderliness, perfectionism, and control, that might result in behaviors that look or feel like some of the OCD symptoms.  These personality traits have to be differentiated by a mental health professional through careful clinical interview.  The third step is to commit oneself to follow through the treatment.  Behavioral treatment is said to be the most effective treatment.  However a combination of behavioral, cognitive, and insight-oriented therapy can be used to help the client.

Medication may be helpful in some patients.  The therapy alone may be an option for patients with mild symptoms of OCD or for those who don’t want to take medications. The goal is to gradually extinguish a conditioned behavior pattern. About half of the patients with OCD may get some relief from medication, but almost all relapse quickly when they stop taking the drug unless they have used combination of therapy and medication.  Medication in severe cases may help to reduce fear and anxiety enough to make the patient follow through the therapy.  
Harvard Mental Health Letter, 2005 and 2009
I will write about OCD in children in the next issue.

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