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Biology 202, Spring 2005
Third Web Papers
Obsessive-compulsive disorder (OCD) was brought to the attention of many people my age by the movie As Good as it Gets. Before then I had never heard one of my peers use the term, but after I heard people always being referred to as being OCD. Usually they were just referring to a person's attention to detail or need to do things perfect. OCD, though, is much more than that. It is an anxiety disorder that affects men and women. It does not go away, but with constant treatment the symptoms can be alleviated.
OCD is an anxiety disorder where people have unwanted thoughts and therefore perform certain behaviors over and over again. The obsessions are the unwanted thoughts and the compulsions are the repeated actions. These thoughts and actions get in the way of the sufferers daily life. The afflicted person knows that the thoughts and actions make no sense yet still cannot ignore or stop them (1).
The thoughts OCD sufferers usually have make them nervous or scared. They can be anything from a fear of dirt and germs to fear of harming someone. The compulsions are an attempt to alleviate the thoughts. If a person is afraid of germs he will wash his hands over and over again to get rid of the germs (1).
For a person to be diagnosed with OCD there are certain criteria that must be met. There are four criteria the obsessions must meet and two for the compulsions. Also, the person must realize at some point that the obsessions or compulsions are unreasonable and must interfere with the person's daily life. One of the main ways to diagnose OCD is by taking a valid and in-depth history of the patient (7).
This may seem like something every normal person goes through. They get dirty so they wash their hands. You have a feeling the stove is still on so you check multiple times before leaving the house just to be sure. But a person suffering from OCD checks more than just a couple of times. They have a ritual that they go through to make sure that things are as they should be. They start off small and soon grow as the doubt becomes greater (2).
One such example is a man named Michael Dunn. He is a 30 year-old father of two. He has had obsessive and compulsive thoughts for nine years. He has an intense fear that things have been left on, like the stove, and that not all the doors and windows have been locked. He is scared that there may be fire or that his children will be abducted. It used to be that he could just check a few times to make sure things were off and locked, but his fear grew over the years. Now he has to go through a ritual every night and every morning. He stares at each knob to make sure it is in the off position. Then he places his hand on each hot plate and counts to ten to make sure it is cold. If he gets distracted he must start over again. He does this to all the appliances. Some days this takes him upwards of an hour and makes him late for work. As a result he was fired. The thoughts did not suddenly appear when his children were born. When he was a child he would sometimes call home to ask his family to make sure all the appliances were switched off. When he got married and had children he acknowledges, though, that that was when the thoughts intensified (5).
His treatment consisted of being exposed to things that would cue obsessional thoughts. He made a list of all his rituals and thoughts associated with them and rated how anxious he would be if he personally did not check everything on the list. He was then forced to very slowly change his rituals. He was not allowed to check the toaster, and so on. Eventually rules were implemented where instead of checking he would just turn off the appliance after using it and not turning back to check that it was off. After treatment he was resisting the urge to check everything before going to bed and leaving the house. And, at a follow up six months later he was still resisting the urge (5).
Michael's story is a common one in the treatment of OCD. Up until recently OCD was thought to be an uncommon disease, but it has become known that 3.3 million Americans between the ages of 18 and 54 suffer from OCD (9). Since most people are ashamed of and find thoughts they have irrational they hide their actions. Because of this it made it difficult to accurately determine the number of sufferers in the past (1).
OCD also has a high prevalence of comorbidity with other diseases. There are many cases of it existing with anorexia, ADHD, depression, and Tourette syndrome. There is a certain case of a young girl who was diagnosed with anorexia after her freshmen year of high school. She took part in therapy of all sorts, but her weight still dropped. Eventually her weight became 83 pounds, less than 75% her normal body weight. Doctors had tried everything, including intravenously tube feeding her. Eventually a doctor realized she exhibited sings of OCD as well. She had to count and arrange her food in a certain way, for example. She was put on medication and put into behavioral therapy to treat the OCD, and her weight climbed to 100 pounds (4).
This study suggests a relation between anorexia and OCD, but there is no definitive link as of yet. There is also a link between Tourette Syndrome and OCD. OCD often has its onset in childhood, and this is the only time that there is a difference of who is affected. When OCD appears in children it is more likely to appear in males and is sometimes accompanied by Tourette Syndrome and ADHD (7).The lingering question is what causes OCD? There is no definite cause known, but there are many elements that could have a hand in causing it. Sometimes OCD arises in children and young adults after having a strept infection and even sometimes herpes simplex. The infection triggers an immune response. In this case, antibiotics are a sufficient treatment (7).
One other theory is that there is a gene in the brain that is mutated and causes OCD. Serotonin is a messenger in the brain that that helps keep people from repeating actions over and over again. Some think that OCD sufferers may not have enough serotonin in the brain. Another similar finding is that the serotonin transporter is mutated. There are two variants within the gene that have been found to change the regulation of serotonin in the brain. Scientists performed tests and found that six of the seven people they tested with the mutation also had OCD. Some even had other disorders like anorexia, and of course stress has been found to worsen the symptoms of OCD (7).
Treating OCD is usually handled in a manner similar to Michael's story, but there are other ways. There is behavior therapy, pharmacotherapy, interventions, and sometimes even neurosurgical techniques. Pharmacotherapy is a process in which a medication is taken to treat the symptoms. Behavioral therapy is what was used on Michael. It is when the patient is exposed to things that trigger their obsessive thoughts and are taught techniques to resist the compulsions. Eventually the triggers increase in severity until the patient can resist fully. Neurosurgical treatment of OCD is uncommon and is only for patients with extreme symptoms (7).
It is because people use the term OCD in a bad connotation that for a long time people would not admit their problems. OCD is horrible to live with because people who suffer from it know that they are being unreasonable. Yet because the compulsions they feel are necessary are sometimes so odd others, who do not understand the thoughts going through the sufferers mind, automatically think the person is just crazy. OCD, though, affects normal people. They are unfortunately just victims of a brain abnormality.