Why Do Some People Develop Obsessive-Compulsive Disorder?
As the child of a man whose acute Obsessive-Compulsive Disorder is the dominant force in his life, and consequently, having grown up in a very unnatural, controlled environment, when deciding on a top for this paper, I dared to delve into the enigmatic world of mental illness. I thought writing on this disorder would be both interesting and would help unlock the secret behind my father’s abnormal behavior. It would also help me understand why, up until now, I have exhibited only mild symptoms of this condition, and if the disorder is in fact hereditary, what this means for me in the future. In order to answer these questions, an in depth examination of the disease is needed.
Obsessive-Compulsive Disorder (OCD) is one of many anxiety disorders, mental conditions that result in chronic fear and uncertainty in the victims’ minds. Anxiety disorders plague 40 million American adults, while OCD alone affects 2.2 million Americans (1). If anxiety disorders are left untreated, which they often are, symptoms can become increasingly worse. People with OCD experience persistent upsetting thoughts or worries (obsessions) and use rituals or repetitive behaviors (compulsions) to relieve their anxiety (2). OCD patients often experience repeated thoughts and images where they feel out of control and may even worry that they have harmed another person (3). Depending on the person’s fears, OCD can manifest itself in different ways. The most common symptom is an obsession with germs or dirt that results in repeated hand washing. Paranoia about intruders can lead to locking and relocking of doors and windows. Other common signs include repeatedly checking things, counting things, doing things in a particular order, or hoarding and refusing to dispose of old possessions. However, a person with OCD doesn’t necessarily have to partake in any of these rituals. In the most extreme cases of OCD, victims are unable to attend to their responsibilities and perform the tasks of daily life because they are so preoccupied with their rituals. What makes OCD so unique is that, according to studies, people with the disorder do not get pleasure out of doing these rituals; they carry out these actions to placate their anxiety (3).
It’s interesting for me to read what all the medical journals and online sources say about OCD because I can imagine my father performing the described rituals in my head as I read. However, his case is one of the extreme ones that is more difficult for doctors to understand. For example, my father follows a very strict regime everyday, doing everything in the same exact order; any interference with his daily routine will send him into a state of shock. If a person interrupts him while he’s going through his routine, he becomes very angry, agitated, and uncomfortable. He prefers to be alone as much as possible and lives on an isolated farm, where he has minimal contact with other people. OCD and clinical depression often go hand-in-hand, so it is likely that my father’s antisocial behavior is partly due to depression. My father, interestingly, does not exhibit many of the typical symptoms of OCD, such as frequent bathing and hand washing, or a need to constantly count things in a certain order. However, he does hoard possessions and hasn’t thrown out anything in about 30 years. It is easy to see how OCD can be misdiagnosed since many of its symptoms are characteristic of other mental illnesses; it’s taken me my entire life to figure out what exactly makes my father behave the way he does.
How can someone with OCD be treated? According to the Obsessive Compulsive Foundation, OCD is “underdiagnosed” and “undertreated” because many doctors are unfamiliar with the symptoms of the illness (3). No laboratory test exists for this disorder . Moreover, people with OCD often have trouble admitting that they have extreme anxiety or are unaware that their behavior is abnormal (3). However, if someone is diagnosed with OCD, several different methods of treatment can be implemented. The first is Cognitive-Behavioral Psychotherapy through the use of a technique called Exposure and Ritual Prevention, where individuals gradually overcome their fears and learn that they do not need to perform certain rituals. The second method of treatment involves taking selective serotonin reuptake inhibitors (SSRIs) along with tricyclic antidepressants. Studies show that OCD is usually the result of communication problems between the orbital cortex and the basal ganglia, two parts of the brain that rely on the chemical messenger serotonin to transmit signals. With the help of SSRIs, the serotonin is able to bind to the neurons’ receptors so it can help regulate excess anxiety and obsessive thoughts. Studies show that, “SSRIs seem to be the most effective drug treatments for OCD, and help about 60% of OCD patients, but do not ‘cure’ OCD” (2). In other words, medications that increase one’s serotonin levels can address the symptoms of OCD, but can’t make the disorder go away. Although the use of SSRIs or Cognitive-Behavioral Psychotherapy seems to be an effective treatment for OCD, from doing research on this topic, it is clear to me that much about the disease is still unknown.
Why do some people develop this disease and not others? Is it genetic? Does the disease run in families? In my case, I wonder: Why did my dad develop this condition and not me? Will I acquire OCD in the future? Up until recently no specific genes for OCD had been identified, but scientists were looking for a link between genetics and OCD (3). However, two recent studies on the association between genes and OCD have illuminated a possible cause of the disease: a glutamate transporter gene called SLC1A1. This gene encodes a protein called EAAC1, which controls the flow of glutamate in and out of brain cells. According to an article in HealthDay News, “Variation in the SLC1A1 gene may cause changes in the flow of glutamate, which may put a person at increased risk of developing OCD” (4). The identification of the SLC1A1 gene marks a milestone in the search for the cause of OCD. If the close relationship between this gene and OCD is confirmed, dramatic improvements in the understanding and treatment of OCD can be made (4). With regard to the heredity of OCD, research shows that OCD does tend to run in families, though family members often times develop different symptoms from the disease (3). According to the HealthDay News article, “Close relatives of people with OCD are up to nine times more likely than other people to develop OCD” (4). Clearly, heredity plays an important role in the development of OCD. In my case, the fact that such a close relative of mine has OCD greatly increases my chances of getting it. Because symptoms can emerge at any time between age 3 and 40, I still have more than twenty years in which I am likely to develop the disorder (3).
Researching and writing this paper has helped elucidate a lot for me about Obsessive-Compulsive disorder. However, it has also made it apparent that much more research about this disease needs to be done before a foolproof method of prevention and treatment can be obtained. As of right now, scientists have only made ripples in the vast, dark ocean of mental illness, and nothing has been confirmed about the cause of OCD. I hope, for my own sake and for the sake of the millions of Americans who either have OCD or will be afflicted with it in the future, that the isolation of the SLC1A1 gene for OCD will lead to great strides in the study and treatment of this disorder.
World Wide Web Sources
1) http://www.nimh.nih.gov/healthinformation/ocdmenu.cfm The National Institute of Mental Health’s website with a special section on OCD
2) http://en.wikipedia.org/wiki/Obsessive-compulsive_disorder A Wikipedia Encyclopedia article, “Obsessive-Compulsive Disorder.”
3) http://www.ocfoundation.org/ The Obsessive-Compulsive Foundation website with a discussion of OCD
4) http://www.nlm.nih.gov/medlineplus/new/fullstory_36909.html A HealthDay News article entitled, “Genetic Findings Shed Light on OCD.”