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In Transition

Anxiety and the Anxious: Where Does Obsession Compulsion Disorder (OCD) Fit In?


Dr. Peter Melgaard Thompson

Progressing from the first articles, we have covered Depression: Signs of Depression, Treatment of Mood Disorder (Part 1 & Part 2); Manic Depression; and Anxiety Disorders in general. We are now transitioning into specific anxiety disorders.

I would like to start with a discussion of Obsession Compulsion Disorder (OCD). Up to 2.5% of the population and one half times as many women as men will meet the criteria for OCD in their life time. In keeping with the range of severity as with any illness, some may have a mild life inconvenience and others, total disruption. The illness is characterized by the presence of either obsessions or compulsions. Some investigators believe that the compulsion is a defense mechanism to reduce the anxiety of bothersome thoughts. The good news is that compulsions do reduce the anxiety associated with obsessions. The bad news is that the ritual behavior significantly interferes with one's life.

What is an obsession? It is an unwanted, intrusive and repetitive thought. The thought is different for different people but there are themes. The most common obsession is an excessive worry of being contaminated. Here an individual will worry that the world is dangerous due the presence of germs; this individual worries excessively that the germs will cause harm. Such persons may also worry about environmental toxins and go to extremes to avoid them, such as moving out of their home and into some imaged clean environment.

Other common obsessions are worry about being attacked ( when there is no real threat), belief that everything must be symmetrical, excessive hoarding, excessive religious thoughts, and unwanted urges (these range from having unwanted sex to doing things that they really don't want to do and may include hurting those they don't want to harm).

Well, what would you do if you were repeatedly flooded with thoughts that do not make any sense and are extremely bothersome? You may have stumbled onto some behavior that seems to reduce the anxiety associated with these thoughts but if you do this over and over again it becomes a compulsion. The most common compulsion is checking. Not just normal occasional checking but checking with such frequency that hours a day are spent checking such things as doors, windows or just about anything. The next most common compulsion is excessive cleaning and washing, followed by repeating and counting.

I would like to make it clear if I have not, that OCD can be a serious debilitating illness. The thoughts and behaviors seem strange and bizarre from both the observer and patient's point of view. OCD interferes, limits and causes great pain for the patient and family. OCD is often accompanied by other mental disorders such as major depression, another anxiety disorder and alcohol abuse which make the disorder that much worse.

How is OCD treated? As with other mental illnesses, some of the treatments depend on the severity of the illness and some treatments depend on patient preference. There are several medications and psychotherapies that are helpful. The medications include clomipramine (anafranil), sertraline (zoloft), fluvoxamine (luvox), fluoxetine (prozac), and paroxetine (paxil). Generally it can take 6-10 weeks for improvement and most people will continue to have some symptoms. In addition, behavioral psychotherapy is effective as a treatment. For OCD the optimum treatment at this time is a combination of behavioral psychotherapy and medication.

Next time I will discuss generalized anxiety, social phobia and simple phobias.

© 1997 Peter Melgaard Thompson

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