Causes & Treatment of Obsessive-Compulsive Disorder
OCD
Causes and related disorders
Recent research has revealed a possible genetic mutation that could be the cause of OCD. Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD.
Violence is rare among OCD sufferers, but the disorder is often debilitating to the quality of life. Also, the psychological self-awareness of the irrationality of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. To avoid perceived obsession triggers, they also often avoid certain situations or places altogether.
Sufferers are generally of above-average intelligence, as the very nature of the disorder necessitates complicated thinking patterns.
Some people with OCD also suffer from conditions such as Tourette syndrome, compulsive skin picking, body dysmorphic disorder and trichotillomania.
Some cases are thought to be caused at least in part by childhood streptococcal infections and are termed PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcus). The streptococcal antibodies become involved in an autoimmune process.
OCD in men at least may be partially caused by low oestrogen levels.
Treatment for OCD
OCD can be treated with behavioral therapy (BT) or Cognitive therapy (CBT) and with a variety of medications. According to the Expert Consensus Guidelines for the Treatment of Obsessive-Compulsive Disorder (Journal of Clinical Psychiatry, 1995, Vol. 54, supplement 4), the treatment of choice for most OCD is behavior therapy or cognitive behavior therapy. Medications can help make the treatment go faster and easier, but most experts regard BT/CBT as clearly the best choice. Medications generally do not produce as much symptom control as BT/CBT, and symptoms invariably return if the medication is ever stopped.
The specific technique used in BT/CBT is called Exposure and Ritual Prevention (also known as Exposure and Response Prevention) or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school). That is the "exposure." The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the (formerly) anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all — again, without performing the ritual behavior of washing or checking.
Medication treatments include selective serotonin reuptake inhibitors such as paroxetine (Paxil, Aropax), sertraline (Zoloft), fluoxetine (Prozac), and fluvoxamine (Luvox) as well as the tricyclic antidepressants, and in particular clomipramine (Anafranil). Some medications like Gabapentin have also been found to be useful in the treatment of OCD. Symptoms tend to return, however, once the drugs are discontinued.
Recent research has found increasing evidence that opioids may significantly reduce OCD symptoms, though the addictive property of these drugs likely stands as an obstacle to their sanctioned approval for OCD treatment. Anecdotal reports suggest that some OCD sufferers have successfully self-medicated with opioids such as Ultram and Vicodin, though the off-label use of such painkillers is not encouraged, again because of their addictive qualities.
Hallucinogens, such as psilocybin (an active ingredient in "magic mushrooms") and LSD, have also shown promise — reducing symptoms for up to several months after ingestion in some people. The US FDA has approved a study to determine their effectiveness that is being conducted at the University of Arizona.
Lisa Angelettie, M.S.W., is a psychotherapist, author, and an online advice expert. She has been helping people make smarter life choices since 1998. Visit her for Advice & Counseling, or take a free Depression Screening today.
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