Obsessive Compulsive Disorder: The Causes, Symptoms, and Treatments
Theresa Ensign
Burlington County College

ABSTRACT

Obsessive Compulsive disorder (OCD) is a mental illness that effects nearly 5 million Americans, and half a million children. OCD is a disease that many people know of, but few people know about. Many people associate repeated washing of hands, or flicking of switches, and even cleanliness with OCD. However there are many more symptoms, and there are also explanations for those symptoms. In this paper, I will describe what obsessive compulsive disorder is, explain some of the effects of it, and some of the treatments to control it.

OCD is a disease that fills the brain with unwanted ideas and worries. It is a disease that effects the cerebral frontal cortex and can start developing as early as age five. It affects both males and females, but males start to show signs of OCD at an earlier age, between the ages of six and fifteen, while in females, it tends to occur later. It is an illness that knows no barriers affecting two to three percent of the U.S. population in any income bracket, of any race, gender, or ethnic group and in any occupation.
OCD is characterized by either obsessions or compulsions. Obsessions are recurrent thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause marked stress or anxiety. Compulsions are defined as repetitive behaviors, such as handwashing, or mental acts, such as counting or checking, that one feels driven to perform in response to an obsession. At some point during the course of the disorder, the adult has recognized that the obsessions or compulsions have become excessive and/or unreasonable. The obsessions or compulsions cause marked distress, become time consuming (they can take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities or relationships. If another disorder is present, the content of the obsessions or compulsions is not restricted to it. This is not due to the direct physiological effects of a substance (e.g., drug abuse, medication) or a general medical condition. In most cases OCD controls your life. The prime feature that differentiates OCD from other obsessive or compulsive disorders is that the sufferer understands the irrationality or excess of the obsessions and compulsions, but is unable to stop them. OCD causes people to suffer in silence and secrecy and can destroy relationships and the ability to work. People who have obsessive-compulsive disorder can have one or more compulsions, which vary from person to person. It may bring on shame, ridicule, anger, and intolerance from friends and family. They may be upset often and have unreasonable thoughts, worries, or fears. Symptoms are numerous and can include repeated touching, checking or counting; avoidance to certain numbers; and excessive washing or cleaning. The Harvard Mental Health Letter (1998) notes that: “The most common obsessional theme is cleanliness (dirt and germs), followed by aggression and sex, safety, and order or symmetry. Obsessions may take the form of doubts (has something happened to my child?); fears (something might happen to the child); images (I see the child drowning); or impulses (I fear that I am going to harm the child)”.
The obsessive thoughts and compulsive rituals performed by those with OCD can often be alienating in nature. They may find it difficult to maintain romantic relationships and friendships. Another alienating factor of this condition is the fact that many people don't know or fully understand what OCD is or what it looks like. They may witness an OCD sufferer performing rituals and think he or she is just crazy. They don't realize that a sufferer from this disorder literally does not have control of their thoughts and cannot just simply make the decision to stop their compulsions. OCD will interfere with daily life, as sufferers can sometimes spend many hours completing their rituals. A good example of OCD can be viewed in the movie “As Good As It Gets.” In this movie, Jack Nicholson plays a character who uses a bar of soap once, then throws it away, constantly checks the locks on doors to make sure they’re locked before leaving, among other things.
Although the cause of OCD is ultimately unknown, experts argue the true origin of the disorder and whether it is psychological or biological. Those who believe it is psychological in nature claim that those with the condition feel like they are personally to blame for their obsessive thoughts. They believe that the anxiousness that OCD sufferers have comes from this enormous feeling of albatross, which heightens their obsessions. In turn, they perform their compulsions in an attempt to reduce the responsibility that they feel The majority of experts now believe, however, that abnormalities within the brain are the cause of OCD. Recent research shows that the disorder is somehow connected to abnormal amounts of the brain's naturally produced chemicals: Serotonin. This natural neurotransmitter is thought to be a part of regulating things such as anxiety, memory, and sleep. Sufferers of OCD are believed to have a blockage of serotonin flow, resulting in the brain misinterpreting information and focusing on unrealistic fear and worry.
Obsessive-compulsive disorder has no known cure. However, if people recognize the symptoms and seek treatment, OCD can be controlled. There are treatments available that have proven to be successful to help manage it. Early steps in the treatment of OCD are based around medication and therapy. Two kinds of treatments are available to help individuals with OCD. The first is medication, and the second is cognitive behavioral therapy (CBT). The types of medication are based on the hypothesis that the major cause may be a reduction in the levels of serotonin. Serotonin is synthesized in brain neurons and stored in vesicles. It has been found to be involved in the control of appetite, sleep, memory and learning, mood, behavior, muscle contraction, endocrine regulation, depression, and temperature regulation. Serotonin is released as a neurotransmitter and is metabolized, diffused, or taken back into the pre-synaptic neuron through specific amine membrane transport systems. Thus, for individuals who have OCD, an increase in serotonin is needed, and the most successful pharmaceutical drugs are serotonin reuptake inhibitors (SRIs). SRIs, which include common antidepressant drugs such as Fluoxetine, Fluvoxamine, Sertraline, and Citalopram, are antidepressants used to treat OCD. They help in balancing out serotonin levels and regulating obsessive thoughts and excessive anxiety. SRI's inhibit the uptake of serotonin back into the pre-synaptic neuron by "clogging" up the passages. In this manner, there is an increased amount of serotonin in the synaptic cleft between the pre-synaptic and post-synaptic neurons, and every once in a while, serotonin will be absorbed by the post-synaptic neuron. In general, these medications take two to three months to work in OCD patients, and the symptoms rarely go away completely, but rather tend to fade to the point that the patient can resume a normal life. However, once the patient stops using the medication, the symptoms reappear.
Another effective form of therapy is known as Cognitive-Behavioral Therapy (CBT). This form of psychotherapy focuses on teaching people how to use their behaviors to change the harmful, negative feelings or thoughts that they experience, into positive ones. It is a conceptual process in which the individual must have faith in his own rationalization skills. This method is known as “exposure and ritual prevention”. It uses small steps to help people confront and manage their fears, without performing compulsions. By going through these steps, little by little, exposure and ritual prevention assists in readjusting the brain, reducing obsessions and compulsion triggers. The principle behind CBT is to help the patient decipher what is rational and what is irrational. Rational refers to an individual's reasoning ability, and irrational relates to an automatic instinctive response to certain events. An example of an irrational response would be the belief that by touching a door knob one may contract AIDS. The rational side would point out that it is impossible to simply touch a door knob and get AIDS. In this case, CBT deals directly with the individual's choice in response to the obsession: "should I, or should I not touch the door knob." In examining the basis behind the therapy and disorder, the obsessions stem from the irrational, or primitive, part of the brain and not from the forebrain which is the rational portion. Thus, it is conceivable that the individual may realize that what he is doing is an unreasonable mannerism. The consequence would be to substitute the irrational form of thinking with the rational form.
Recovering from OCD can be difficult at times, because the whole family is affected. Often times, family members have trouble understanding what an OCD sufferer goes through and why they can't just stop their compulsions; this is a feeling that the someone with OCD knows well. In fact, OCD sufferers and their family usually share feelings of despair and vexation, although they may not realize it. Some family members may feel angry and show resentment, which only succeeds in making the OCD behavior worsen. Others may modify their schedule or avoid certain activities to help accommodate the sufferer. At times they may feel it is easier just to let them perform their compulsion, or even help carry out the ritual, in order to minimize conflict. It is natural for a family member to want to comfort their loved one when in distress, but it is more important that they learn how encourage positive behaviors and educate themselves about the condition, rather than constantly giving in to it. It is also essential that they support the behavioral therapy and pharmacotherapy once it has begun.
Obsessive-compulsive disorder is a difficult condition to overcome. The most successful way to overcome OCD has proven to be a careful combination of both medication and therapy. It can take months or years, to get OCD under control and may never go away. However, celebrities such as Howard Hughes, Howie Mandel, and David Beckham all suffer from this disorder. They are able to keep it under control and seem to maintain successful careers and live a relatively normal life. They are proof to the millions of OCD stricken Americans that the counting, the cleaning, and the hoarding, can eventually be controlled.