Biology 202
2002 Third Paper
On Serendip

OCD is an anxiety disorder that is described as someone with obsessive thoughts and/or compulsive behavior. People with OCD are caught up in repetitive behavior and thoughts that they cannot stop. Obsession is defined as unwanted, recurrent, and disturbing thoughts that a person cannot stop. These thoughts are unable to be suppressed and can result in severe anxiety. Compulsions are the result of the obsession. These are repetitive, ritualized behaviors that are done to alleviate the anxiety caused by the obsession. (2) The most common obsessions are fear of contamination, fear of causing harm to another, fear of making a mistake, fear of behaving in a socially unacceptable manner, need for symmetry or exactness, and excessive doubt. The most common compulsions are cleaning/washing, checking, arranging/organizing, collecting/hoarding, and counting/repeating. (3) Some people with OCD have rituals that help relieve the anxiety; however, that relief is only temporary. (4) Most patients (at least 80%) with OCD have both obsessions and compulsions. Less than 20% of the patients have one or the other. (2)

Most people with OCD sometimes know that their obsessions are senseless. This usually occurs when they are not obsessing. They know that their obsessions and compulsions are based on unwarranted fears. However, there are other times when they feel that their fears are completely valid. Even though people with OCD know that their fears are unwarranted, many try to rid themselves of these unwanted, obsessive thoughts and to stop performing their compulsive behaviors. Some can control themselves more while at work or at school. However, over the months or years, people's abilities to resist their feelings weaken and in the some cases, these rituals that the people with OCD perform can become so time-consuming which impedes their ability to have a full and normal life. Although OCD can consume one's life, people try to keep their disorder from their friends rather than to seek help. Most of the time people are successful in keeping it a secret from their friends and co-workers, but the downside is that they do not get the necessary help until years later after which they have learned to work their lives around their obsessions and compulsions. (4)

OCD can begin at any age from preschool age to adult, usually by age 40. Unfortunately, OCD is often unrecognized and a person with OCD can see three or four doctors can spend a decade seeking treatment before being properly diagnosed. It has been found that takes about 17 years from time that symptoms first appear to receiving proper treatment. The reason why so many are incorrectly diagnosed and treated incorrectly is that people with OCD are usually secretive about their symptoms or do not realize that they might not fully understand the potential reason behind their symptoms. Another reason is that many healthcare providers are not familiar with OCD and do not have the proper training to diagnose and treat OCD. The downside of the delayed diagnosis and treatment is that aside from finding the proper medication, people can avoid any suffering associated with OCD. (5)

The need to diagnose OCD early leads to the question of whether or not OCD is an inherited disorder. As of now, there has been no identification of a specific gene. However, research has found that it is possible that genes do, in fact, have a role in the development of OCD. When OCD develops at childhood, it has been found that OCD runs in the family. If a parent has OCD, then there is a slightly higher possibility that the child will also develop OCD. However, the risk is still low. Due to the nature of OCD, the child may inherit the disorder but not the symptoms. For example, if the parent with OCD washes compulsively, the child may check compulsively. (5)

Although it is not known whether OCD is inherited, there are several possibilities that researchers think are the cause. It is that that OCD could be due to abnormalities of the frontal lobe, basal ganglia, and cingulum. The function that the basal ganglia are involved with is routine behaviors, like grooming. The frontal lobe is involved with organizing behaviors and in planning. Finally, the cingulum is involved with communication in the brain's behavioral and emotional messages. Cingulum is comprised of fibrous bands. There has been evidence to support the hypothesis that cingulum is involved with OCD. This evidence is that when the cingulum is surgically severed, the result is that people with OCD are cured of the disorder. (6) What researchers believe is that OCD is caused by problems in communication between the frontal lobe and basal ganglia. (5) When PET scans of people with OCD were compared to PET scans of people without OCD, it was found that those with OCD burned energy more quickly in the frontal lobe and cingulate pathway. The cingulate pathway is made of cingulum, so the cingulate pathway is what connects the frontal lobe to the basal ganglia. The energy that is burned the more severe OCD is. So it is possible that this increased use of energy is the cause of OCD. (7)

The other possible cause of OCD is the abnormally low levels of serotonin found in people with OCD. Serotonin is a neurotransmitter that sends messages from one nerve to another throughout the brain. The way the neurotransmitter works is that it is released by a nerve ending, known as a synapse, it then crosses a gap and is then picked up by another nerve ending. The serotonin is usually cleaned out of the synapses by enzymes located in the brain. (6) It has been found that drugs that increase the levels of serotonin in the brain reduce the OCD symptoms. Therefore, it is reasonable to deduce that the reduced amount of serotonin inhibits a person's nerve cells to communicate effectively. (7)

There are two possible treatments for OCD: psychotherapy and medication. Cognitive behavioral psychotherapy (CBT) is one of the possible treatments of OCD. This type of treatment helps patients internalize a strategy to resist OCD for the rest of their life. The way behavioral therapy works is that it helps people learn to change their thinking and feelings by first changing their behavior. For OCD, behavior therapy involves exposure and response prevention (E/RP). The idea behind exposure is that anxiety will go down after being in long enough contact with what the person fears. A person's anxiety should decrease after repeated exposure until the fear is gone. The next part of the treatment is the response or ritual prevention (RP) used in combination with exposure. In RP, the person's rituals are blocked, so for example, someone who is always concerned about germs is not allowed to washing their hands all of the time. The purpose of this part of treatment is to help decrease compulsive behavior. Cognitive therapy (CT) is added to E/RP to help reduce the catastrophic thinking and exaggerated sense of responsibility. CT will helps end faulty assumptions made by obsessions. CBT is free of side effect, but all patients undergoing this type of treatment have some type of anxiety. (8)

Medication is the other type of treatment. It has been found that serotonin reuptake inhibitors (SRIs) are very effective in treating OCD. What this medication does is increase the concentration of serotonin in the brain. Five commonly prescribed SRIs in the United States are clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline. Fluoxetine, fluvoxamine, paroxetine, and sertraline are different from clomipramine because they primarily affect only serotonin, so they are called selective serotonin reuptake inhibitors (SSRIs). Since clomipramine affects other nuerotransmittors, there are more side effects than SSRIs. Because of this, SSRIs are usually tried first. When on this type of treatment, improvement was seen after 8-10 weeks on SRIs. The downside is that less than 20% of those treated end with no OCD symptoms. For this reason, it is thought that SRI used in combination with CBT might be the best course of action. (9)

Obsessive compulsive disorder is a disorder that can be more debilitating than one would think. With this disorder, a person can become obsessed with something like germs which leads to compulsive hand washing, as a mild example. This can lead to a person washing his or her hands multiple times a day. This can disturb their work and relationships. It has been found that the cause of OCD is either due to brain abnormalities or a chemical imbalance. There are various types of treatments out there to treat OCD. The important thing is that OCD is diagnosed and treated early so that people can get the help that they need so that they do not have to suffer long.

References

1) http://health.yahoo.com/health/dc/000929/0.html

2) http://www.1-obsessive-compulsive-disorder.com/what-is-ocd.html

3) http://www.1-obsessive-compulsive-disorder.com/obsessions.html

4) http://www.nimh.nih.gov/publicat/ocd.cfm#ocd1

5) http://www.ocfoundation.org/ocf1010a.htm

6) http://www.mentalhealthchannel.net/ocd/

7) http://www2.health-center.com/mentalhealth/obsessivecompu/cause_of_ocd/default.htm

8) http://www.psychguides.com/oche.html

9) http://www.ocfoundation.org/ocf1030a.htm

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