In that respect, it differs from Obsessive Compulsive Disorder (OCD) because the behaviors are constructive. Individuals with OCD allow obsessions and rituals to deter them from living life normally and functioning effectively. A person with OCD has obsessive and compulsive behaviors that are extreme enough to interfere with everyday life.
A reasonable depiction of OCD was portrayed in the movie “As Good as it Gets”. The lead role, played by Jack Nicholson, demonstrated how a person with OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. If OCD is severe and left untreated, it can destroy a person's capacity to function.
Obsessions are unwanted ideas or impulses that recur in the mind of the person with OCD. Fears about harm to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated--I must wash them"; "I may have left the gas on"; or "I am going to injure my child." These thoughts are intrusive, unpleasant, and produce tremendous anxiety.
In response to obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking. Other compulsive behaviors include counting, repeating, hoarding, and rearranging objects in an effort to keep them in precise alignment with each other. Mentally repeating phrases, list making, or checking are also common. These behaviors are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals gives the person with OCD temporary relief from anxiety.
Most people with OCD struggle to banish unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their symptoms under control during work or school hours. But over the months or years, resistance may weaken. OCD may become so severe that time-consuming rituals take over the sufferers' life, making it impossible to continue activities outside the home.
Suferrerrs of OCD may benefit from drugs, behavioral treatment, or both. The drug treatment for OCD could include certain antidepressants such as clomipramine (AnafranilR), flouxetine (ProzacR), paroxetine (PaxilR), or sertraline (ZoloftR). Large studies have shown that more than 75% of patients are helped by these medications at least a little. Improvement usually takes at least three weeks of treatment or longer. After symptoms have subsided, most people will need to continue with medication indefinitely to prevent relapse.
A behavior therapy approach is often for OCD. One approach is to have the patient confront a feared object or idea, directly or by imagination. The patient is encouraged to refrain from ritualizing. The therapist provides support and structure for the approach. The patient also generally recruits loved ones for assistance. For example, a compulsive hand washer may be encouraged to touch an object believed to be contaminated, then urged to avoid washing for several hours until the anxiety has greatly decreased. Treatment then proceeds on a stepwise basis, guided by the patient's ability to tolerate the anxiety and control the rituals. As treatment progresses, most patients gradually experience less anxiety and are able to resist the compulsive urges. A distinct advantage of this approach is that the positive effects of behavior therapy endure once treatment has ended.
Michelle Herbert Thomas, PharmD, CDE
Clinical Director, Richmond Apothecaries, Inc.
Rev. 1/2010 MHT
