Obsessive-Compulsive Disorder Medication
Shame and Secrecy
OCD sufferers often attempt to hide their disorder rather than seek help. Often they
are successful in concealing their obsessive-compulsive symptoms from friends and
coworkers. An unfortunate consequence of this secrecy is that people with OCD usually do
not receive professional help until years after the onset of their disease. By that time,
they may have learned to work their lives--and family members' lives--around the rituals.
Long-lasting Symptoms
OCD tends to last for years, even decades. The symptoms may become less severe from
time to time, and there may be long intervals when the symptoms are mild, but for most
individuals with OCD, the symptoms are chronic.
WHAT CAUSES OCD?
The old belief that OCD was the result of life experiences has been weakened before the
growing evidence that biological factors are a primary contributor to the disorder. The
fact that OCD patients respond well to specific medications that affect the
neurotransmitter serotonin suggests the disorder has a neurobiological basis. For that
reason, OCD is no longer attributed only to attitudes a patient learned in childhood--for
example, an inordinate emphasis on cleanliness, or a belief that certain thoughts are
dangerous or unacceptable. Instead, the search for causes now focuses on the interaction
of neurobiological factors and environmental influences, as well as cognitive processes.
OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder,
a personality disorder, attention deficit disorder, or another of the anxiety disorders.
Co-existing disorders can make OCD more difficult both to diagnose and to treat.
In an effort to identify specific biological factors that may be
important in the onset or persistence of OCD, NIMH-supported investigators have used a
device called the positron emission tomography (PET) scanner to study the brains of
patients with OCD. Several groups of investigators have obtained findings from PET scans
suggesting that OCD patients have patterns of brain activity that differ from those of
people without mental illness or with some other mental illness.
Brain-imaging studies of OCD showing abnormal neurochemical activity in regions known to
play a role in certain neurological disorders suggest that these areas may be crucial in
the origins of OCD. There is also evidence that treatment with medications or behavior
therapy induce changes in the brain coincident with clinical improvement.
Recent preliminary studies of the brain using magnetic resonance imaging showed that
the subjects with obsessive-compulsive disorder had significantly less white matter than
did normal control subjects, suggesting a widely distributed brain abnormality in OCD.
Understanding the significance of this finding will be further explored by functional
neuroimaging and neuropsychological studies (Jenike et al, 1996).
Symptoms of OCD are seen in association with some other neurological disorders. There
is an increased rate of OCD in people with Tourette's syndrome, an illness characterized
by involuntary movements and vocalizations. Investigators are currently studying the
hypothesis that a genetic relationship exists between OCD and the tic disorders.
Other illnesses that may be linked to OCD are trichotillomania (the repeated urge to
pull out scalp hair, eyelashes, eyebrows or other body hair), body dysmorphic disorder
(excessive preoccupation with imaginary or exaggerated defects in appearance), and
hypochondriasis (the fear of having--despite medical evaluation and reassurance--a serious
disease). Genetic studies of OCD and other related conditions may enable scientists to
pinpoint the molecular basis of these disorders.
Other theories about the causes of OCD focus on the interaction between behavior and
the environment and on beliefs and attitudes, as well as how information is processed.
These behavioral and cognitive theories are not incompatible with biological explanations.
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