Your Health: Obsessive-Compulsive Disorder Controllable With Proper Treatment
Rallie McAllister, M.D., M.P.H.

A recently identified genetic factor may help explain why obsessive-compulsive disorder (OCD) runs in families. Although scientists have long known that close relatives of people with OCD are as much as nine times more likely to develop the condition than those without a family history of the disorder, the reason remained a mystery. Two new studies, published in the July 2006 issue of the Archives of General Psychiatry, may help provide the answer. The results of the studies point to a link between OCD and a gene called SLC1A1. In individuals with OCD, inherited variations of the SLC1A1 gene may alter the flow of glutamate, a neurotransmitter that facilitates communication among brain cells.

"Obsessive-compulsive disorder has two parts," explained clinical psychologist Mark Crawford, Ph.D., author of "The Obsessive-Compulsive Trap: Real Help for a Real Struggle."

"There are obsessions, which are intrusive thoughts, images and worries that come out of the blue and cause tremendous anxiety; and there are compulsions, which are behaviors, rituals or patterns that are performed to alleviate the anxiety."

Common obsessions of OCD-sufferers include fear of contamination after touching doorknobs, money or items in public restrooms. Some individuals develop hoarding obsessions, which render them virtually incapable of throwing anything away, while others experience doubting obsessions that cause them to constantly question their own behaviors. The nature of the obsession often determines the subsequent compulsive behavior. People who fear contamination may feel compelled to wash their hands dozens -- or even hundreds -- of times a day. Individuals with hoarding obsessions often fill their homes with so much junk that they run out of space to store it all. Those with doubting obsessions may spend hours checking and rechecking to make sure they unplugged the coffee pot, locked the door or turned off the lights. Some OCD-sufferers engage in behaviors that seem to be completely unrelated to a particular obsessive fear or doubt. These "random" compulsive behaviors include repeating specific words or phrases, counting, and touching, tapping or rubbing various objects.

"People with OCD may realize that the obsessive thoughts are irrational or illogical, but the anxiety they experience is very real," explained Crawford. "These individuals feel powerless to avoid engaging in specific behaviors that are intended to temporarily eliminate the anxiety, or to prevent something bad from happening."

Although scientists are still unraveling the mysteries of OCD, low levels of a brain chemical known as serotonin appear to play a key role in its development. Research suggests that two major areas of the brain are also involved: structures known as the basal ganglia and the orbital frontal region.

"The basal ganglia and the frontal orbital region of the brain normally work together to process and filter information received from the environment, and to help control thinking and behavior," said Crawford. "In people with OCD, the brain doesn't filter out irrelevant information as well as it should."

As a result, OCD-sufferers are constantly bombarded with disturbing thoughts and images, and are driven to engage in compulsive behaviors. Because these behaviors are frequently repeated numerous times throughout the day, people with OCD often feel consumed by the demands of their disorder. The good news is that with proper diagnosis and treatment, most people with OCD can find relief. Numerous studies show that when OCD-sufferers are treated with serotonin-boosting drugs, including certain antidepressants, symptoms frequently improve. Non-pharmacological treatments for OCD typically include cognitive therapy and behavior therapy. Cognitive therapy involves learning to replace illogical, obsessive thoughts and beliefs with those that are more rational, while behavior therapy consists of exchanging destructive, compulsive behaviors for more productive responses. One of the most effective treatments for OCD is a therapy known as exposure and response prevention. Working in cooperation with a therapist, the patient is gradually exposed to anxiety-producing thoughts, while resisting the urge to engage in the compulsive behaviors that typically follow.

"When the patient refrains from performing the compulsive behaviors, the anxiety produced by the obsessive thoughts eventually peaks and goes away," said Crawford. "The more times a patient does this successfully, the greater the chances of controlling the symptoms of this disorder."

While the appropriate therapy provides significant relief to the majority of patients with OCD, education about the nature of the disorder is a critical part of every treatment program.

"It's important for patients and their families to understand that OCD is a disorder of brain functioning, and not a problem caused by a psychological weakness," he said.

======== Rallie McAllister, M.D., M.P.H., is a family physician in Kingsport, Tenn., and author of "Healthy Lunchbox: The Working Mom's Guide to Keeping You and Your Kids Trim." Her Web site is http://www.rallieonhealth.com. To find out more about Rallie McAllister, M.D., and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. Copyright 2006 Creators Syndicate Inc.