Living With Obsessive-Compulsive Disorder

Imagine checking the stove to make sure it is turned off before leaving the house. It is a natural precaution everyone has done at one time or another.

Now imagine being so overwhelmed with anxiety that you do it 20 times a day, sometimes returning home during the day, to the point where it disrupts your life and the lives of those around you. Worst of all, you know this repetitive action makes no sense but you feel as if you have to do it.

"People with obsessive-compulsive disorder know full well what they are doing," says Dr. Robert W. Guynn, chairman of the psychiatry and behavioral sciences department at The University of Texas-Houston Medical School. "They are overwhelmingly anxious and the rituals help them assuage the anxiety."

Obsessive-compulsive disorder, known as OCD, can surface as repetitive, unwanted, and many times, distressing thoughts (obsessions) or rituals (compulsions). Someone with OCD may have an obsession with germs, for example, a behavior conveyed by Jack Nicholson's character in the movie As Good As It Gets. As a result, the person may wash his or her hands constantly. The obsessions or compulsions can take so much time out of their day and become so debilitating that it can affect the person's ability to work, to function in social situations and to maintain relationships, says Dr. Guynn, executive director of The University of Texas-Houston Harris County Psychiatric Center.

People with obsessive-compulsive disorder are not alone in their struggle. According to the National Institute of Mental Health (NIMH), approximately 1 in 50 people have OCD and it affects men and women equally. About 2 percent of the U.S. population has OCD in a given year. OCD can strike at any age, though it usually begins in the teen and early adulthood years. The symptoms may lessen at times and be more heightened at other points throughout a person's life.

Not all obsessive-compulsive rituals are external manifestations like repeatedly checking the stove or the handwashing. A person with OCD may perform counting rituals throughout the day, every day in their mind. They may be plagued by persistent thoughts that are not in accordance with their values or their religious beliefs.

A person with OCD may try to hide their rituals and keep their thoughts internalized out of shame. Many times OCD is accompanied by bouts of depression, or may be cloaked behind other disorders like Tourette's syndrome, making diagnosis a challenge.

The cause of OCD is unknown. However, there is evidence to suggest that OCD has a biological component and can run in families. "From neuroimaging studies - this includes positron emission tomography (PET) and new imaging modalities such as functional MRI (magnetic resonance imaging) - we are beginning to understand the neural network that underlies OCD," says Dr. Kathryn Kotrla, a psychiatrist at Baylor College of Medicine. PET scans enable researchers to assess brain metabolism or blood flow, while functional MRIs are noninvasive tests that can be repeated to observe changes in brain activity.

According to Dr. Kotrla, the neuroanatomy of OCD involves a network in the brain that links the prefrontal cortex with a part of the brain called the striatum. It is here that the brain forms memories for habits, especially motor activity. This network then extends from the striatum to the thalimus and back to the cortex. "The expression of OCD-like symptoms is thought to be due to the disregulation within this network," says Dr. Kotrla, also chief of psychiatry at Ben Taub General Hospital.

Many people with OCD can find relief from their disruptive thoughts and rituals, or a lessening in their severity, with the help of medication and behavioral therapy. It is believed that people with OCD may have an imbalance of the brain chemical serotonin. A class of drugs known as selective serotonin reuptake inhibitors (SSRIs) has shown to be effective in treating that imbalance. Drugs in this group include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox).

Psychologists may also use a type of behavioral therapy to reduce someone's propensity for performing the rituals or thoughts at times of anxiety. For example, a person's OCD may cause them to want to clean the kitchen floor every time someone walks on it. This type of therapy would expose them to that situation and not allow them to perform the action of cleaning. The psychologist would simultaneously work with the patient to encourage conscious control over the ensuing anxiety, emphasizing what he or she already knows -- that nothing bad happens when they do not clean the floor.

"Eventually, your anxiety remits just because your body can only stay that anxious for so long," says Dr. Kotrla.

It is easy for many people to relate to the habit of checking the stove because it is common to do so. A diagnosis of OCD comes when these obsessions or compulsions are upsetting to the person, consume an hour or more of the person's time each day and are disruptive to his or her life. The road to treatment begins with an evaluation and diagnosis by a mental health professional.

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©2006 Texas Medical Center

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