DO I HAVE OCD?

A person with OCD has obsessive and compulsive behaviors that are extreme enough to interfere with everyday life. People with OCD should not be confused with a much larger group of individuals who are sometimes called "compulsive" because they hold themselves to a high standard of performance and are perfectionistic and very organized in their work and even in recreational activities. This type of "compulsiveness" often serves a valuable purpose, contributing to a person's self-esteem and success on the job. In that respect, it differs from the life-wrecking obsessions and rituals of the person with OCD.

(OMITTED: A two-part screening test for Obsessive-Compulsive Disorder. Part A requires a yes/no response to 20 questions about repeated thoughts, images, urges, or behaviors. Part B requires response to the frequency of the repeated thoughts, images, urges, or behaviors in Part A. Copyrighted by Wayne K. Goodman, M.D., University of Florida College of Medicine, 1994.)

TREATMENT OF OCD; PROGRESS THROUGH RESEARCH

Clinical and animal research sponsored by NIMH and other scientific organizations has provided information leading to both pharmacologic and behavioral treatments that can benefit the person with OCD. A combination of the two therapies is often an effective method of treatment for most patients. Some individuals respond best to one therapy, some to another.

Pharmacotherapy

Clinical trials in recent years have shown that drugs that affect the neurotransmitter serotonin can significantly decrease the symptoms of OCD. Two serotonin reuptake inhibitors (SRIs), clomipramine (Anafranil) and fluoxetine (Prozac), have been approved by the Food and Drug Administration for the treatment of OCD. Other SRIs that have been studied in controlled clinical trials include sertraline (Zoloft) and fluvoxamine (Luvox). Paroxetine (Paxil) is also being used. All these SRIs have proved effective in treatment of OCD. If a patient does not respond well to one SRI, another SRI may give a better response. For patients who are only partially responsive to these medications, research is being conducted on the use of an SRI as the primary medication and one of a variety of medications as an additional drug (an augmenter). Medications are of great help in controlling the symptoms of OCD, but often, if the medication is discontinued, relapse will follow. Most patients can benefit from a combination of medication and behavioral therapy.

Behavior Therapy

Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not helpful for OCD. However, a specific behavior therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, the patient is deliberately and voluntarily exposed to the feared object or idea, either directly or by imagination, and then is discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand washer may be urged to touch an object believed to be contaminated, and then may be denied the opportunity to wash for several hours. When the treatment works well, the patient gradually experiences less anxiety from the obsessive thoughts and becomes able to do without the compulsive actions for extended periods of time.

Studies of behavior therapy for OCD have found it to produce long-lasting benefits. To achieve the best results, a combination of factors is necessary: The therapist should be well trained in the specific method developed; the patient must be highly motivated; and the patient's family must be cooperative. In addition to visits to he therapist, the patient must be faithful in fulfilling "homework assignments." For those patients who complete the course of treatment, the improvements can be significant.

With a combination of pharmacotherapy and behavioral therapy, the majority of OCD patients will be able to function well in both their work and social lives. The ongoing search for causes, together with research on treatment, promises to yield even more hope for people with OCD and their families.

HOW TO GET HELP FOR OCD

If you think that you have OCD, you should seek the help of a mental health professional. Family physicians, clinics, and health maintenance organizations usually can provide treatment or make referrals to mental health centers and specialists. Also, the department of psychiatry at a major medical center or the department of psychology at a university may have specialists who are knowledgeable about the treatment of OCD and are able to provide therapy or recommend another doctor in the area.

WHAT THE FAMILY CAN DO TO HELP

OCD affects not only the sufferer but the whole family. The family often has a difficult time accepting the fact that the person with OCD cannot stop the distressing behavior. Family members may show their anger and resentment, resulting in an increase in the OCD behavior. Or, to keep the peace, they may assist in the rituals or give constant reassurance.

Education about OCD is important for the family. Families can learn specific ways to encourage the person with OCD by supporting the medication regime and the behavior therapy. Self-help books are often a good source of information. Some families seek the help of a family therapist who is trained in the field. Also, in the past few years, many families have joined one of the educational support groups that have been organized throughout the country.