Facts About Mental Health:
Obsessive Compulsive Disorder

Did you know? Obsessive-compulsive disorder (OCD) affects approximately one million children and adolescents, and about 2.4% of adults in the United States.
 
Obsessive-compulsive disorder is a diagnosis of degree.  This means that some features of the disorder are very common (probably in most of us), but it’s only when symptoms begin to interfere with daily life that the medical diagnosis can be established.  These symptoms are well known and varied:  Obsessions with numbers, with counting things, or with neatness or symmetry, are often expressions of the disorder.  There are milder forms which may go unnoticed.  For example, children may feel the need to avoid walking on cracks in the sidewalk, or to count the pickets in a fence.  Such distractions are usually harmless, but when the child loses track of time or has difficulty concentrating on schoolwork, these behaviors begin to have clinical significance.  Seriously affected children may spend as much effort and time trying to hide their rituals as they do in the rituals themselves.  The obsessions can be physically exhausting, so that they are too tired to play with friends or get schoolwork done.  Other common features of OCD are:  Extreme fear of intruders, or of disease, of someone’s death (when this is unrealistic), hoarding items, and intense concerns with cleanliness, such as repetitive hand-washing.  Having to check and re-check work being done, with resulting loss of time, is a very common feature in both children and adults who are affected.  In some cases the repetitive behaviors can involve one’s own body in a destructive way, such as pulling one’s hair, picking at fingernails, or even opening up a wound.  But uncontrollable physical behaviors are not the only result of OCD.  Repetitive, unwanted thoughts that keep intruding on consciousness can be seriously damaging to well-being and destructive to lives that otherwise would be very productive.  

How does OCD develop?  The usual explanation is that there is an underlying fear, or anxiety, which the ritual behavior alleviates, at least temporarily.  In fact, OCD is technically classified as one of many types of anxiety disorder.  So, for example, a homeowner who must return again and again to make sure the gas stove was turned off before leaving—even though this task was never previously forgotten—may be trying to deal with some deep sense of guilt, or feeling of insecurity—or even, perhaps, with secret but embarrassing destructive urges.  These are complex matters that are best dealt with by a psychiatrist or therapist, who can help the affected person work through the underlying causes.   
 
Treatment differs somewhat, depending on the age of persons affected.  Very young children (ages 3 to 4) may not be fully aware of their compulsions, and parents may not recognize their expression.  Older children may be painfully aware of their condition, feeling embarrassed or worrying that they are going crazy.  Because of this difference in awareness, behavior therapy is generally recommended for older children.  With these persons, as with adults, awareness can be turned into insight and strategies for overcoming the rituals.  However, behavior therapy is not easy, and requires dedication, patience, and hard work on the part of the patient.
 
Medicine can greatly help.  Luvox (Fluvoxamine) is an approved drug that is fairly safe (as long as the doctor’s instructions are followed!) and often very effective in easing disturbances; but Prozac, Paxil, Zoloft and others have helped also.  Since behavior therapy is difficult, and not all patients are willing to do the hard work involved, a professional will probably recommend one of these medicines.  A combination of medicine with some behavioral therapy can usually result in the disappearance of most symptoms for 80 to 90% of sufferers. 
 
Do you suspect that you or someone you know may have the disorder?  NIMH (the National Institute of Mental Health) has an excellent screening test, consisting of a simple 20-question questionnaire that may help you decide whether to seek professional help (see web site below).   A more scientific test is the YBOCS, or Yale-Brown Obsessive Compulsive Scale.  This is a well known questionnaire which your doctor or therapist may use to grade the severity of OCD.
 
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