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obsessive compulsive disorder

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obsessive compulsive disorder

ocd...obsessive compulsive disorder... ocd

People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.

i.e., if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over & over again. If they develop an obsession with intruders, they may lock & relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get "caught" in the mirror & can't move away from it. Performing such rituals isn't pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence & harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order & symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.

Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life & they find the repetition distressing.

Although most adults with OCD recognize that what they're doing is senseless, some adults & most children may not realize that their behavior is out of the ordinary.

OCD affects about 2.2 million American adults,1 & the problem can be accompanied by eating disorders,6 other anxiety disorders, or depression.2,4 It strikes men & women in roughly equal numbers & usually appears in childhood, adolescence, or early adulthood.2

1/3 of adults with OCD develop symptoms as children & research indicates that OCD might run in families.3

The course of the disease is quite varied. Symptoms may come & go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.4,5

OCD usually responds well to treatment with certain medications &/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety & become less sensitive (desensitized) to them. NIMH is supporting research into new treatment approaches for people whose OCD doesn't respond well to the usual therapies. These approaches include combination & augmentation (add-on) treatments, as well as modern techniques such as deep brain stimulation.

source: NIMH

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obsessive compulsive disorder

obsessive compulsive disorder

What are obsessions?

Obsessions are ideas, images & impulses that run thru the person's mind over & over again. A person with OCD doesn't want to have these thoughts & finds them disturbing, but he or she can't control them. Sometimes these thoughts just come once in a while & are only mildly annoying. Other times, a person who has OCD will have obsessive thoughts all the time.

What are compulsions?

Obsessive thoughts make people who have OCD feel nervous & afraid. They try to get rid of these feelings by performing certain behaviors according to "rules" that they make up for themselves. These behaviors are called compulsions. (Compulsive behaviors are sometimes also called rituals.)

i.e., a person who has OCD may have obsessive thoughts about germs. Because of these thoughts, the person may wash his or her hands repeatedly after using a public toilet. Performing these behaviors usually only makes the nervous feelings go away for a short time. When the fear & nervousness return, the person who has OCD repeats the routine all over again.

source: familydoctor.org

obsessive compulsive disorder

obsessive compulsive disorder

Obsessive-Compulsive Disorder

Everyone double-checks things sometimes-i.e., checking the stove before leaving the house, to make sure it's turned off. But people with OCD feel the need to check things over & over, or have certain thoughts or perform routines & rituals over & over. The thoughts & rituals of OCD cause distress & get in the way of daily life.

The repeated, upsetting thoughts of OCD are called obsessions. To try to control them, people with OCD repeat rituals or behaviors, which are called compulsions. People with OCD can't control these thoughts & rituals.

Examples of obsessions are fear of germs, of being hurt or of hurting others & troubling religious or sexual thoughts. Examples of compulsions are repeatedly counting things, cleaning things, washing the body or parts of it, or putting things in a certain order, when these actions aren't needed & checking things over & over.

People with OCD have these thoughts & do these rituals for at least an hour on most days, often longer. The reason OCD gets in the way of their lives is that they can't stop the thoughts or rituals, so they sometimes miss school, work, or meetings with friends, i.e.

What are the symptoms of OCD?

People with OCD:

  • have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly neat.
  • do the same rituals over & over such as washing hands, locking & unlocking doors, counting, keeping unneeded items, or repeating the same steps again & again.
  • have unwanted thoughts & behaviors they can't control.
  • don't get pleasure from the behaviors or rituals, but get brief relief from the anxiety the thoughts cause.
  • spend at least an hour a day on the thoughts & rituals, which cause distress & get in the way of daily life.

When does OCD start?

For many people, OCD starts during childhood or the teen years. Most people are diagnosed at about age 19. Symptoms of OCD may come & go & be better or worse at different times.

Is there help?

There is help for people with OCD. The first step is to go to a physician or health clinic to talk about symptoms. People who think they have OCD may want to bring this booklet to the physician, to help them talk about the symptoms in it. The physician will do an exam to make sure that another physical problem isn't causing the symptoms. The physician may make a referral to a mental health specialist.

Physicians may prescribe medication to help relieve OCD. It's important to know that some of these medicines may take a few weeks to start working. Only a physician (a family physician or psychiatrist) can prescribe medications. (In 2 states, psychologists with specific training & certification may prescribe medications for anxiety disorders.)

The kinds of medicines used to treat OCD are listed below. Some of these medicines are used to treat other problems, such as depression, but also are helpful for OCD.

  • antidepressants,
  • antianxiety medicines, and
  • beta-blockers.

Physicians also may ask people with OCD to go to therapy with a licensed social worker, psychologist, or psychiatrist. This treatment can help people with OCD feel less anxious & fearful.

There's no cure for OCD yet, but treatments can give relief to people who have it & help them live a more normal life. If you know someone with signs of OCD, talk to him or her about seeing a physician. Offer to go along for support. To find out more about OCD, call 1-866-615-NIMH (1-866-615-6464) to have free information mailed to you.

Who pays for treatment?

Most insurance plans cover treatment for anxiety disorders. People who are going to have treatment should check with their own insurance companies to find out about coverage. For people who don't have insurance, local city or county governments may offer treatment at a clinic or health center, where the cost is based on income.

Medicaid plans also may pay for OCD treatment.

Why do people get OCD?

OCD sometimes runs in families, but no one knows for sure why some people have it, while others don't. When chemicals in the brain aren't at a certain level it may result in OCD. Medications can often help the brain chemicals stay at the correct levels.

To improve treatment, scientists are studying how well different medicines & therapies work. In one kind of research, people with OCD choose to take part in a clinical trial to help physicians find out what treatments work best for most people, or what works best for different symptoms.

Usually, the treatment is free. Scientists are learning more about how the brain works, so that they can discover new treatments.

Personal story

"I couldn't touch any doors or countertops in public areas. I knew it didn't make any sense, but I was terrified of getting germs that could kill me. I almost couldn't go out in public, I was so afraid. If I thought I had touched anything, I would have to wash myself for hours. Sometimes I washed so much that my skin would get red & raw & bleed.

"At first I was too embarrassed to get help, but a friend told me to call the doctor. I'm so glad I did. I took the medicine my doctor gave me. I also talked with a counselor, in therapy. I learned to cope with my fear of germs & to stop washing so much."

obsessive compulsive disorder

obsessive compulsive disorder

How Strep Triggers Obsessive Compulsive Disorder – New Clues

A likely mechanism by which a bacterial infection triggers obsessive compulsive disorder (OCD) in some children has been demonstrated by scientists at the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) and collaborators at California State University (CSU) and the University of Oklahoma (UO). Their research suggests that an antibody against strep throat bacteria sometimes mistakenly acts on a brain enzyme, disrupting communications between neurons and causing a form of obsessive compulsive and related tic disorder in children — pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS).

When added to cultured neurons, three fourths of blood samples from acute, symptomatic PANDAS cases boosted the brain enzyme to significantly higher levels than samples from recovering, non-symptomatic patients. Similarly, nearly three-fourths of the blood samples from symptomatic cases contained antibodies for strep, compared to only 23 percent of samples from recovering, non-symptomatic patients. PANDAS patients' cerebrospinal fluid (CSF), which bathes the brain and directly reflects its activity, contained highly elevated levels of the suspect strep-triggered enzyme, while CSF of non-PANDAS subjects contained little or none. NIMH's Drs. Susan Swedo and Lisa Snider, Christine Kirvan (CSU) and Madeleine Cunningham (UO) report on their discovery in the July 26, 2006 online edition of the Journal of Neuroimmunology.

Although Swedo and her team had long hypothesized such a strep-triggered process in which antibodies gone awry disrupt brain activity, the specific players involved were unclear. To identify them, the researchers followed up clues from their studies of Sydenham chorea, which is marked by involuntary movements and speech impediments, and is thought to be the neurological counterpart of rheumatic fever, which is known to result from a strep-triggered autoimmune process in which the body attacks itself.

All patients with the movement disorder had high levels of the strep antibody that induced activity of the enzyme, thought to play a role in making and releasing neurotransmitters, most notably glutamate, which is implicated in OCD. In addition to the above findings, the researchers showed that PANDAS blood samples cleansed of the antibody failed to activate the enzyme.

Swedo and colleagues propose that in PANDAS somewhat lower levels of enzyme activity than seen in chorea may contribute to OCD symptoms. Although how the antibodies cross the blood-brain barrier remains a mystery, the researchers say the new findings provide insights into how antibodies against strep may disrupt neuronal communications and cell function.

Kirvan CA, Swedo SE, Snider LA, Cunningham MW. Antibody-mediated neuronal cell signaling in behavior and movement disorders. J Neuroimmunol. 2006 Jul 26; [Epub ahead of print]

source: NIMH

obsessive compulsive disorder

What are some common obsessions?

The following are some common obsessions:

  • Fear of dirt or germs
  • Disgust with bodily waste or fluids
  • Concern with order, symmetry (balance) & exactness
  • Worry that a task has been done poorly, even when the person knows this is not true
  • Fear of thinking evil or sinful thoughts
  • Thinking about certain sounds, images, words or numbers all the time
  • Need for constant reassurance
  • Fear of harming a family member or friend

source: familydoctor.org

What are some common compulsions?

The following are some common compulsions:

  • Cleaning & grooming, such as washing hands, showering or brushing teeth over & over again
  • Checking drawers, door locks & appliances to be sure they're shut, locked or turned off
  • Repeating, such as going in & out of a door, sitting down & getting up from a chair, or touching certain objects several times
  • Ordering & arranging items in certain ways
  • Counting over & over to a certain number
  • Saving newspapers, mail or containers when they're no longer needed
  • Seeking constant reassurance & approval

source: familydoctor.org

Going To College With OCD
by Lori J. Kasmen, Psy.D.

The Anxiety and Agoraphobia Treatment Center
Bala Cynwyd, PA 19004

You've made the decision to move away from home to go to college! Congrats!! As a teen with OCD, you will be faced with unique challenges and wonderful opportunities. College is the start of many new relationships,new friends, professors, roommates and, perhaps, a new therapist. If you're already in treatment, your current therapist can help you to make the transition to a new therapist. If you are not currently in treatment with a therapist trained in cognitive behavioral therapy (CBT) for OCD now is a great time to get the treatment. Experts agree it is most effective for OCD! You may want to consider the school's proximity to the CBT-trained providers when making your college selection. The OC Foundation is a great resource to help you locate a CBT-trained therapist. If there are not CBT trained therapists near your school, most schools have college counseling centers that provide free therapy. Counselors that are not trained in CBT for OCD, may be willing to learn. Many CBT-trained therapists are willing to consult with therapists wanting to learn to do CBT for OCD.

Once you've made your decision about schools and lined up a therapist lined up, you may want to schedule some sessions with that person during the summer before your freshman year. This alleviates the stress of having to adjust to a new therapist while you are adjusting to college life. Your old therapist and your new therapist can help you with another important task: BE PREPARED. Think about OCD triggers that may arise at school and plan on how you will deal with them. Then plan how you will deal with all of the things that you don't have a plan for. Think about how and with whom you will share information about your OCD. Remember that three of every 100 kids has OCD-this means that there will most likely be other kids at your school with OCD. This is a great opportunity to meet other kids with it! You may even want to speak with your college counseling center about starting an OCD GOAL group on campus.

A teen diagnosed with OCD, under a set of rules and regulations called IDEA, may be entitled to additional support or accommodations at college. This can help to keep things manageable. Depending on your situation, this can include financial, academic and/or counseling supports. You can check with your high school counselor, special education department, current therapist or college's student support office. It may have a different name at other schools but would be the resource for students with learning disabilities.

source: Organized Chaos

How I Got Where I Am Despite OCD
by Rob, Doctoral Candidate

I am in my fourth years as a doctoral candidate in psychology. I would like to give you a brief history of how I arrived at this place in my life. As an undergraduate, I studied finance and found it interesting. Besides I was a fraternity man who had a good time partying, played sports and socialized with girls. I graduated with high honors but was unclear about what I was going to do next. What made this worse was there were no more parties sports and very limited socializing.

My OCD took a turn for the worst. I hit rock bottom. I began to drink and smoke, just to subdue the anxiety and the obsessions generated from OCD. At this point, I had a degree, but what lie in my future was a complete mystery. AlthoughI was offered jobs, I was not functioning well enough to take any of them.

My only hope was to stop my bad habits. I embarked upon the greatest journey ever, my journey to recovery. There was no more feeling sorry for myself or running away from my problems. I started exposure and ritual prevention therapy (ERP) again and found a topnotch pharmacologist.

I also found a part-time job to occupy my time. I was hired at CVS stocking shelves and working the cash register. My OCD was so bad that I was constantly obsessing. The constant obsessing kept me from being bored with the mundane tasks I was doing.

I would like to fast-forward eight months to the point that I made a successful recovery. After the ERP and some adjustment with medication, I was ready for the real world filled with everyday trials and tribulations. I opened up my own caf�. It did reasonably well. However, something was missing in my life. I felt a need to be more productive everyday. I wanted a career where I could make a difference. The idea of becoming a psychologist excited me.

Although, I had only taken one introductory psychology class, I was determined to pursue my goal. Most people believed that it wasn't a practical dream. They were a little right. I still needed to take the GRE's, the Psychology GRE's, a number of prerequisite classes and fill out a lengthy application in a three-month period.

After battling OCD, I was up for the challenge. I completed everything and submitted my application. About two months later, I had an interview and was accepted into the Psy.D. program. I found taking graduate classes like moving from minor league baseball to the pros. The professors were throwing assignments at the students like 90 m.p.h. fastballs. After a period of adjustment, everything seemed to fall into place. Don't get me wrong. It was difficult, but after overcoming OCD, I had the confidence that I could do it.

One of the hardest tasks was working with my classmates on psychology assignments without them knowing that I had OCD and bipolar disorder. I didn't want sympathy from the professors or my classmates. Even today, I keep this personal information to myself.

How is graduate school for a person with OCD? I would say that it is a challenge. People with OCD are very special and resilient individuals who are capable of accomplishing any goals that they set their minds to. OCD interfered with my school work in that I worried about whether I had unintentionally plagiarized someone's work. These obsessions and the compulsions stuck in my head a long time. In my third year, I finally handed in an imperfect paper that I told myself was plagiarized. And, as I anxiously waited to get it back, I had ruminations of terrible things happening. However, on the day I got the paper back, this imperfect paper had a big, fat "A" on the top of it.

My advice for people with OCD who want to go to graduate school is to just go ahead and do it.

source: Organized Chaos

May 7, 6:04 PM EDT

Therapy Helps Boy Control Tourette's

CARY, N.C. (AP) -- Thanks to new behavioral therapy at a Duke University Medical Center clinic, 9-year-old Rick Shocket is doing what seemed impossible for him a year ago: gain control over Tourette's syndrome, a brain disorder that causes repetitive movements and sounds.

The illness made it difficult for him to cross a room. A myriad of tics he's battled include sniffs, coughs, yips, fidgets and twitches. Rick felt compelled to do a deep knee bend with nearly every step, leaving him exhausted by the end of the day.

"Every time I went anywhere it was like, squat, squat, squat," he said. "I could never get anywhere."

Since starting behavioral therapy at Duke last year, he can recognize the warning signs that precede the tics then resist the urge to perform them. The therapy also has enabled him to stop many of the prescription medications he took.

The therapy goes against years of thought on Tourette's syndrome, which has held that the tics are involuntary and that it's best for those with the illness to simply ignore them.

The habit-reversal training offered at Duke teaches the exact opposite, instructing patients to stay hyper-aware of tics so they can anticipate and suppress them.

Doctors believe Tourette's affects one in 100 people, a change from past thinking that considered it a rare disorder occurring in no more than five of every 10,000 people. The new view stems from physicians being more likely to recognize even mild cases.

They also no longer view it as a mental illness but as an inherited neurological condition, which occurs in boys up to four times more often than in girls. Symptoms usually appear when they're between the ages of 7 and 10.

"There's a big severity spectrum," said Dr. Jarrett Barnhill, a specialist in tic disorders and director of the Developmental Neuropharmacology Clinic at UNC Hospitals in Chapel Hill. "There are kids who meet the diagnostic criteria for tics, but if you weren't looking for them, you might not think anything of it."

As a young child, the doctor told Rick's mother that his tics were common and that he'd grow out of his idiosyncrasies that included hard sniffing and hitching up his trousers and kicking out one leg.

When he was 7, she began paying closer attention to his idiosyncrasies after watching a documentary on the disorder. Around that time, Rick asked for help.

"Mom, I need help. I'm having a problem with some noises," Clare Shocket remembers him saying.

The went to see Barnhill, who specializes in tic disorders. Tourette's was confirmed, and Rick was also diagnosed with anxiety, attention-deficit problems and obsessive-compulsive disorder. Medications led to side effects including drowsiness and weight gain.

That led his parents to seek an alternative in cognitive behavioral therapy.

Dr. John March, chief of adolescent and child psychiatry at Duke Hospital and a national leader in the use of cognitive behavioral therapy with children, had Rick identify the tics he most wanted to control. Rick named the squat, squeaks, coughs, and tics that caused him to jerk his neck and look away from people mid-conversation.

Rick was told to concentrate on the feelings or sensations that occur right before a tic, which can be much like a building tension or feeling of intense discomfort.

He then developed a competing action or response to counter the tic. Slow breathing was done to block squeaking and coughing. He locked his knees to counter an approaching squat.

"There's this feeling like, 'You've got to do this, you've got to do this,' " Rick said in describing how he uses the approach. "But then you say, 'OK, I need to do this. But not right now. Maybe later.' "

"He hasn't squatted since September," said Clare Shocket, who says she would have tried behavioral therapy before drugs if she had known it was an option. "I've tried to figure out why more people don't rush out and do this."

Still, behavioral therapy is not a cure for Tourette's, which is considered a lifelong disorder.

But it has given Rick and his family hope.

"It appears to be something that's not the end of the world," Abe Shocket said. "The tics come and go. Every month that goes by, it seems more likely that he'll be able to have a normal life."

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