The doubting disease
I worked in a pizza store and was put in charge of closing the place down at night. I found myself checking the ovens, the locks, the safe and ALL appliances (even the refrigerator doors) several times over. This was very aggravating for the person closing with me and very embarrassing for me, but I just couldn’t help it. I would often get home and then drive back to the restaurant to check the door to make sure that I locked it, get in my car, sit there for a few minutes and get out and check the door again. I would do this over and over a few more times before I could finally go home. At home, the rituals continued. I had to check the curling iron, all the knobs on the stove, the front and back door locks and my daughter’s breathing several times before going to bed.
This first-hand account by “Hillary” is on a Web site devoted to obsessive-compulsive disorder. “Hillary” belongs to the 2.5 percent of Americans currently suffering from OCD, according to the Diagnostic and Statistical Manual of Mental Disorders. In other words, the disease affects one in 40 Americans.
In OCD, the brain gets stuck on one particular thought and can’t let go. Diagnosed patients describe their condition as “mental hiccups that won’t go away.” OCD sufferers cannot accept uncertainty.
“Obsessive-compulsive disorder is a combination of obsessive thoughts, intrusive thoughts, that you can’t get out of your mind,” said Dr. Kristi Weiner, a psychological resident at the Department of Psychology at USF. “These obsessions make the person perform compulsions, or rituals, to decrease the anxiety. If they get interfered with in their compulsion, they have to go back and start all over. The anxiety can manifest itself as worry, concern, even a full-blown panic attack.”
Obsessions are thoughts, images or impulses that occur over and over and feel out of control. OCD sufferers don’t want to have these thoughts and know they don’t make sense. The obsessions are accompanied by uncomfortable feelings: fear, disgust, doubt, or having to have things “just so.”
OCD sufferers attempt to make their obsessions go away by doing certain acts over and over according to certain “rules.” For example, they repeatedly wash their hands, check the stove or count objects.
“OCD is the doubting disease,” Weiner said. “How do you know? Are you sure? That’s why they have to keep checking on things.”
In extreme cases, the hand washing goes to the point where the skin begins chafing and infections occur, the exact opposite of what the person intended by obsessively washing. Hand washing is a common compulsion related to obsessions about contamination, or fears of dirt, feces and germs.
The scene in 1997’s As Good as it Gets where Jack Nicholson washes his hands with a brand new bar of soap under searing hot water is highly stereotypical, Weiner said.
There are a number of other common obsessions that correspond with certain compulsions.
Another first-hand account on the Web site tells the story of a woman who drove around her block up to five times to be sure she didn’t run over anyone when she felt a bump in the road. Imagining having hurt someone or oneself leads to endless repetitions of a particular act.
“There are patients who hoard,” Weiner said. “They will have years and years of newspapers at home.” Hoarding and saving is related with a need to have things “just so.”
Other common obsessions include imagining losing control of excessive urges, having intrusive sexual thoughts or urges and feeling the need to tell, ask or confess.
The corresponding compulsions include checking, touching, ordering, arranging, counting and praying.
“We had a patient who, once he had his room in what he considered perfect condition, he could not go back in it,” Weiner said. “Some have an extreme need for symmetry or order.”
So what about those who arrange their CDs in alphabetical order?
“We all have tendencies of OCD,” Weiner said. “And you can have an obsessive-compulsive personality, but that doesn’t mean you have the disorder. If I went over to your CDs and moved one of them, you would be bothered to the point where you have to go and put it back before you could go on with your life.”
The difference between an obsessive-compulsive personality and OCD is that, in the disease, the obsession severely interferes with one’s life. The OCD symptoms cause stress, take up lots of time and thus hinder a sufferer’s work, social life and relationships.
The threshold, however, is not well-defined, according to Weiner.
“We don’t know where it begins or how that happens,” she said.
For years, OCD was thought to be untreatable, and until recently, few psychologists were able to recognize the disease.
OCD can start at any time, but usually sets in before age 40. One third of all sufferers report the onset during childhood. People spend an average of nine years before receiving a correct diagnosis and an average of 17 years before receiving appropriate treatment, according to the Obsessive-Compulsive Foundation. OCD often kicks in during adolescence. In a period in one’s life marked by stress and transitions, a single stressor can push a person over the edge.
“With OCD, we don’t diagnose it until it interferes with the patient’s life,” Weiner said.
There is no one proven cause, but many scientists suspect a strong genetic link.
“I believe it’s highly genetic,” Weiner said. “There is a lot of looking into genetics right now. If it’s in your family, you naturally have a genetic predilection for it, but that doesn’t mean that you’ll get it.”
Doctors administer the Yale-Brown Obsessive-Compulsive Scale test, or YBOCS, to suspected OCD sufferers to determine the severity of their illness.
OCD has been identified as a medical brain disorder. Insufficiencies of the chemical messenger serotonin cause communication problems between the frontal part of the brain (the orbital cortex) and deeper structures (the basal ganglia).
This insufficiency can be combated with a serotonin reuptake inhibitor (SRI), but combinations of medicinal treatment and cognitive behavioral psychotherapy (CBT) achieve the best results.
“CBT tends to be longer-lasting,” Weiner said. “These are hard things we’re asking the patients to do. It’s not easy. It has good outcomes, but it’s not easy. The medication helps lower the anxiety to go through therapy. The medication allows more serotonin to be free-flowing.”
One aspect of CBT is exposure-response prevention therapy. Patients are put into situations where their obsessive-compulsive behavior would normally kick in and are encouraged to suppress their compulsions.
A patient compelled to repeatedly check her shoes before getting up and doing anything was encouraged to avoid the compulsion and get up without it, Weiner said.
“We have to have them realize that they can live with anxiety,” Weiner said. “We have to teach them that there are healthier ways to deal with stress. We have to teach them relaxation techniques. They have to understand that they can feel stress and that that’s OK.”
For some OCD sufferers, colors are difficult. Red, for example, is often associated with blood and black or brown with feces and dirt. Weiner said she will wear clothes of the problem color on days when her patients confront particular obsessions about that color.
People who complete CBT report a 50-percent to 80-percent reduction in symptoms after 12 to 20 sessions.
The first step in treating OCD is education. Sufferers, as well as people close to them, should find out as much as they can about the disorder. It is important to know that family problems don’t cause the disease and negative criticism only worsens OCD. Praise for small steps in the healing process are much more helpful, the Obsessive Complusive Foundation says.
Contrary to their beliefs, OCD sufferers are not alone. There are countless support groups for people with OCD.
In Tampa, the Depression & Bipolar Support Alliance offers support groups that are confidential and free. There are also thousands of resources about OCD online. A recent Internet search for OCD returned 290,000 results.
For USF students and others in the community, Dr. Weiner is available by appointment.
“The goal is to teach lifelong skills to deal with their anxiety,” Weiner said.
Contact Alexander Zeschat email@example.com