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What is Obsessive/Compulsive Disorder?
by Daniel B. Pearson, III, Ph.D., M.D.
Until the middle part of the 1980's, Obsessive/Compulsive Disorder, the disorder in which
people had intrusive, bothersome thoughts and/or compulsive, almost ritualistic behaviors,
was thought to be quite rare. At about that time in the United States, medications were
first introduced that had a significant therapeutic effect on these symptoms. Since that
time, there have been large, wide- spread studies that look at a great variety of
illnesses and conditions, among which is the National Epidemiologic Catchment Area survey.
This extensive study indicated that Obsessive/Compulsive Disorder (OCD) has a lifetime
prevalence of 2 to 3%; of the general population. This is significantly greater than the
rate for schizophrenia. Indeed, it is the fourth most common psychiatric disorder.
The Diagnostic and Statistical Manual of Mental Disorders lists the
symptoms of the obsessions of OCD as "recurrent and persistent ideas, thoughts,
images or impulses that are ego-dystonic." Ego-dystonic means that these thoughts are
not intentional and indeed are often intrusive and unpleasant. Often a person attempts to
suppress them in a variety of ways. The most common obsessions pertain to violence, often
to a family member, contamination, and doubt.
The compulsions of OCD are repetitive, often complex behaviors that
are often almost ritualistic, that is, they obey rigid "rules" and are almost
identical each time they are performed. The person suffering with the compulsive behavior,
especially, can sometimes resist the urge to perform the behavior, but develops an
increasing tension- one relieved by the compulsive behavior. The most common compulsive
behaviors are checking, counting, hand washing, and touching.
A person can have either obsessions or compulsions or both. OCD can
be associated with other mental disorders, probably most often with depression and
anxiety, and panic attacks. Other conditions that may be associated with OCD, or may even
be variants of the disorder include Tourette's Syndrome, Trichotillomania (hair pulling)
and Body Dysmorphic Disorder. The symptoms of OCD usually begin in the teen years, but can
be seen in children, as well.
It seems to occur about equally in males and females, and is usually
a chronic illness, though it may be more bothersome at sometimes than others.
Before the mid-1980's, and prior to the introduction of medications
effective for OCD, the main treatment modality was psychotherapy. With the introduction of
Anafranil in 1989, the first medication specifically indicated for OCD, pharmacologic
treatment of this disorder proved to be effective. Since that time, two other medications
have been approved by the FDA for this indication, Prozac and Luvox. Though Prozac was
approved by the FDA for depression in 1986, it was not FDA indicated for OCD until 1994.
It was, however, used extensively for the treatment of OCD from the time it was first
introduced in the U.S. It had been extensively used in other countries (as has Anafranil
and Luvox) for both depression and OCD.
All of these medications are specifically indicated for OCD, but
other of the Serotonin Specific Reuptake Inhibitor antidepressant medications (SSRI's) may
also be effective.
The medications begin showing salutary effects usually by about 4
weeks of therapy and may continue to improve for several more weeks or months. In studies
of Luvox, for example, almost half of subjects indicated that they were much improved or
very much improved versus less than a tenth who felt similar improvement on placebo.
Most of the studies of medication in OCD have been fairly short
term. Whether treatment of the disorder should be continued for the long term currently is
not clear. The current trend in treating depression is toward long-term, chronic
treatment; the treatment of OCD may very well prove to be long-term as well.
Interestingly, some studies suggest that certain intensive forms of psychotherapy may
bring about both behavior and physical changes in the brain similar to those seen in
medication treatment.
Copyright 1995 by Daniel Pearson, M.D. All rights reserved. For more
articles by Dr. Pearson, visit http://www.cybercouch.com.
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