Obsessive-compulsive disorder causes people to feel trapped by distressing and senseless thoughts or to feel as if they have to repeat actions, such as washing their hands or checking locks.
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As Good as It Gets
In the 1997 movie As Good As It Gets, actor Jack Nicholson portrays a character who does many things that seem odd. He feels as if he has to eat lunch at the same table each day, and he always brings his own plastic uten-sils. He follows a complicated procedure to lock his front door. Many of the things he does, from the way he walks around cracks to the way he talks and thinks, are making his life more difficult to live. This character has obsessive-compulsive (ob-SES-iv-kom-PUL-siv) disorder, a mental disorder that affects approximately 4 to 7 million people in the United States.
What Is Obsessive-Compulsive Disorder (OCD)?
Many people have little rituals * that they follow. They might walk the same way to school every day or always touch a particular tree before going into their house. Other people have superstitions * , so they might refuse to walk under a ladder. These rituals and superstitions are generally harmless.
People with obsessive-compulsive disorder go much further. Some have obsessions * , which are repeated thoughts, urges, or images that intrude into a person's mind and seem senseless and distressing. Others have compulsions * , which are repeated behaviors or mental acts that a person feels driven to perform. Such behaviors are aimed at preventing or reducing distress, not providing pleasure. For example, people might have repeated, unnecessary doubts about whether they have performed an important task, such as locking the door. Or they might think that if they do not walk the same route to school every day, something awful will happen to them or to someone they love.
Obsessive thoughts can push aside more important things that the person needs to do and make the person feel compelled to take action. For example, people may follow the same route to school even if it takes them miles out of their way or makes them late for class. Or they may let their doubts about touching the tree cause them to go out and touch it again, only to doubt again whether they took the action. Such people may follow their compulsions because they hope to ease the anxiety * they feel about their obsessions.
The key difference between a harmless ritual or superstition and obsessive-compulsive disorder is that the thoughts and behaviors disrupt the lives of people with the disorder. They cannot resist their obsessions and compulsions, even though they know it makes little sense to think and do the things they do.
Doctors are not sure what causes obsessive-compulsive disorder. However, they suspect that the cause involves neurotransmitters * in the brain that are not sending signals correctly.
What Are the Symptoms of Obsessive-Compulsive
The first signs of obsessive-compulsive disorder often appear during the late teenage years. The most common symptom is anxiety over germs. This may lead to washing the hands repeatedly, often with harsh cleansers, or to the fear of catching a disease from shaking hands or eating in restaurants.
Other symptoms include checking rituals, such as returning often to check a door lock, even though each time the person finds it locked. Some people with obsessive-compulsive disorder have violent thoughts. They may fear that they or someone they love will die in a horrible accident or that they will harm someone. One example is drivers who fear that they have run down someone, so they return to the spot to check or give up driving.
Common vs. Uncommon
Here are some of the terms doctors use to describe obsessive-compulsive disorder and its treatment.
- anxiety (ang-ZY-e-tee) can be experienced as a troubled feeling, a sense of dread, fear of the future, or distress over a possible threatto a person's physical or mental well-being. It is normal to feel anxiety at times, particularly when a person is reacting to a threat of some kind. However, too much anxiety can interfere with the way the person functions in daily life.
- anxiety disorder is a mental disorder characterized by extreme, unpleasant, and unwanted feelings of apprehension orfear, sometimes accompanied by physical symptoms.
- behavior therapy is a type of counseling that helps people work to change undesirable behaviors.
- compulsions (kom-PUL-shunz) are repeated behaviors or mental acts that a person feels driven to perform. The goal of such behaviors is preventing or reducing distress, not providing pleasure. In many cases, the person feels driven to behave this way to reduce the distress caused by an obsession.
- neurotransmitters are chemicals in the nervous system that transmit nerve signals to and from the brain.
- obsessions (ob-SESH-unz) are repeated thoughts, urges, or images that intrude into a person's mind and seem senseless and distressing. They are not simply excessive worries about real-life problems. Such thoughts come to the mind despite the person's attempts to ignore or suppress them.
- rituals are actions that are repeated in a set way.
- superstitions are irrational beliefs resulting from false ideas, fear of the unknown, or trust in magic or chance.
How Is Obsessive-Compulsive Disorder Diagnosed
Obsessive-compulsive disorder is considered a type of anxiety disorder * . Diagnosis involves looking for symptoms and ruling out other physical and mental conditions, including other anxiety disorders. Many patients respond well to prescription drugs that change how neurotransmitters work in their brain.
Behavior therapy * to help patients overcome their anxieties also may be useful. One of the most effective types of behavior therapy is known as exposure and response prevention. During treatment sessions, patients are exposed to situations that give rise to their obsessions and compulsions. Patients then learn how to reduce, and eventually stop, their usual responses.
Although there is no way to prevent the disorder, it is important to seek help. Many people with obsessive-compulsive disorder hide their symptoms and withdraw from social contacts. They wait years to seek help, even though treatment is available and quite often successful.
The Boy Who Couldn't
Fourteen-year-old Charles would take showers for three hours or more each day, and then take anothertwo hours to get dressed. His true story is one of many in the book The Boy Who Couldn't Stop Washing, by Dr. Judith L. Rapoport.
The book provides many views of obsessive-compulsive disorder as well as information about its causes, diagnosis, and treatment. One of the best things about The Boy Who Couldn't Stop Washing is that it encourages patients with obsessive-compulsive disorder and theirfamilies to speak out about their situation.
Rapoport, Judith L. The Boy Who Couldn't Stop Washing. New York: Plume, reissued 1990. One of the first books to bring obsessive-compulsive disorder to public attention.
U.S. National Institute of Mental Health, 6001 Executive Boulevard, Room
8184, MSC 9663, Bethesda, MD 20892-9663. A government institute that
provides information about obsessive-compulsive disorder and other
anxiety disorders. Its fact sheets
Step on a Crack
are posted at its website.
American Psychiatric Association, 1400 K Street N.W, Washington, DC
20005. An organization of physicians that provides information about
obsessive-compulsive disorder and other anxiety disorders. Its fact
Let's Talk Facts About Obsessive-Compulsive Disorder
is posted at its website.
Obsessive-Compulsive Foundation, P.O. Box 70, Milford, CT 06460-0070. A
support organization for people with obsessive-compulsive disorder and
their family and friends.