OCD: An Overview

Obsessive Compulsive Disorder (OCD) is often a source of humor and excuses by those who don’t have it, but it is a debilitating illness. This paper will define OCD, examine its symptoms, and probe treatments.

DEFINITION AND CAUSES: OCD is defined by its chronic symptoms, obsession and compulsion. Obsessions are thoughts, images, and urges that precipitate extreme anxiety (American Psychiatric Association [APA], 2013; National Institute of Mental Health [NIMH], 2016; Rachman and de Silva, 2009) Everyone has intrusive thoughts. Adam (2014) cites an experiment by Rachman and de Silva (1978) where people with OCD and unafflicted subjects were asked to list their weird thoughts over a two week period. When these were presented to a panel of experts, the experts could not distinguish the cards written by OCD sufferers from those written by the control group. What distinguishes the thoughts of OCD sufferers, this study suggests, is intensity, an inability to shut the thoughts down.

Compulsions are repetitive or ritualistic actions which an OCD sufferer performs repeatedly in response to some obsession or personal and rigid code of rules. (APA, 2013). Everyone checks or does things repetitively at some time during their day, but the person with OCD performs them so repetitively that she will spend an hour or more doing them each day or the thoughts and actions will disrupt their social, occupation, and other lives. (APA, 2013) The aim may be to relieve anxiety or to prevent some horrible catastrophe from happening. (APA, 2013, Rachman and de Silva, 2009)

Many theories attempt to identify the causes of OCD. This paper will briefly look at three: behaviorism, cognitive approaches, and biological theories.

Behaviorists hold that OCD is a learned behavior, an anxiety acquired through some trauma. They support this by the fact that OCD relieves anxiety. But they fail to explain why many patients cannot recall a triggering event. Nor can it explain the obsessions which appear to drive the ritualistic compulsions (Rachman and de Silva, 2009).

Cognitive modelers look to thought patterns. The Obsessive-Compulsive Working Group identifies six errors in thinking common to OCD patients who believe (1) the mind has the power or the responsibility to stop disasters and other negative outcomes; (2) bad thoughts can cause negative events or that thoughts are the moral equivalent of actually doing bad things; (3) it is possible to have total control over one’s thoughts; (4) Negativism; (5) Perfectionism; and (6) there is no uncertainty (Beyond OCD, 2017).

While the cognitive approach offers a thorough description of thought patterns, it does not explain what causes it. Biological researchers offer the explanation that an inadequate supply of serotonin causes symptoms. Critics argue that cognitive therapies are as effective as psychopharmaceutical treatment (Rachman and de Silva 2009). New research holds that an overactive signal pathway in the amygdala may be the culprit, offering new treatments (Ullrich, Weber, Post Poop, Grein, Gonzalez, Kreis, Üçeyler, Lesch, Schmidtt, Schuh, 2017).

WHAT OCD LOOKS LIKE: Adam (2014) cites the first case of OCD in the medical literature, “Madamoiselle F.” (Esquirol, 1845/1938). A French woman and accountant was obsessed with the thought that she was a thief. So she refused to wear aprons, removed the hems of her dresses, avoided handling money, rubbed her feet to remove any money that might have insinuated itself between her toes, shook her hand vigorously to do the same with her fingers, and checked and rechecked her books despite her reputation for honesty. Esquirol labeled her affliction as monomania, a partial insanity because she was aware of her madness as are most OCD sufferers.

The writer knows a few people with the disorder and many more who self diagnose. Self diagnosis and exaggeration of symptom was the subject of research for therapists and psychiatrists working at a clinic dedicated to OCD. Examining ten suspect cases, they found these clients tended to describe their symptoms using highly technical language harvested from the DSM which did not match the descriptions used by bona fide cases. Furthermore, the patients often manifested the nocebo effect where they developed unusual and undocumented side effects from the medications they were prescribed. Other mental disorders were frequently identified for this group. When they were questioned about their self diagnosis, many became angry and defensive. One man “pulled a knife from his waist, placed it on the table, and asked why the doctor did not believe that he had OCD” (Fontenelle, Lins-Martin, Natalia, Meica, Lima, de Menezes 2014). Clearly the popularization of the illness in best-selling books and television shows such as Monk has had its effect in creating a personality or other illness based obsession with having OCD.

The writer’s friends have genuine OCD diagnoses. One kept poking at the bridge of his nose until one day his finger slipped and he jabbed himself in the eye, detaching his retina. Another cannot go to bed without checking every door, window, lock, and appliance. This chore can take her more than an hour. She worries that her adoptive daughter mimics the behavior. Dematillomania, a disorder on the OCD spectrum, afflicts another friend of his. She picks at her face at the slightest sign of acne until she cannot go out. Others are concerned with germs and their appearance. (Sax 2017)

Obsession with contracting HIV bothers many OCD sufferers. Rapoport began noticing this trend in germophobia arising before the publication of her best-selling book in (1989). One of her patients lost his job after having a brawl over whether a co-worker should get an AIDS test. Adam (2014) says that he acts as if it is still 1988 at the height of the AIDS scare. He contrasts himself with Andy Warhol who would not eat food prepared by other gay men or wear clothes that had been washed and folded by gay men. Warhol, Adam argues, did not display OCD because he was acting on the best common knowledge of his time. Adam, on the other hand, obsessively calls HIV hotlines to check if he has been infected with HIV and should get an AIDS test – he is always told that he has nothing to worry about – but he is never convinced that he is not in danger. Louise was convinced that she was HIV positive, so she showered for hours, washed her hands and feet several times a day, and wouldn’t prepare or touch food for fear that she might contaminate it. Her ultimate catastrophe was infecting and killing her friends and family (Stuart 2017).

Shannon Shy’s illness took a different course. He rose to the rank of Lieutenant Colonel in the Marines despite his illness. Whenever he saw a car by the side of the road, he worried that there might be a dead body. Even though he tried to ignore the compulsion to stop, he often found himself turning around to check to be sure that everything was all right. He also obsessed over the covers of underground gas tank at filling stations: he would not step on them and otherwise avoided them. If he happened to drive over one, he would run to tell the attendant what he had done because he feared he might have caused an explosion or a fire. When he served as Officer of the Watch, he meticulously recorded every petty event that happened on his shift lest he leave out something that might be important. Other officers went out of their way to serve with him. He finally sought help when he heard the sound of a piece of lumber falling to the ground and imagined it was gunfire. There was no doubt that the lumber had caused the sound – he saw it fall. But he turned back and drove around until he found a pair of police officers who politely took his report (Shy 2009).

A Swedish study found that children with OCD experience more sleep disturbances than children with psychosis or school children of comparable age. This correlation awaits further research (Ivarsson and Larsson 2009). Another study, also out of Sweden, showed that people living with OCD have a higher suicide rate than those suffering from other psychiatric illnesses as well as the general population (Fernandez de la Cruz, Rydell, Runeson, D’Onofrio , Brander, Ruck, Lichtenstein, Larsson, Mataix-Cols 2016). OCD is not only a debilitating illness but a dangerous one.

TREATMENT: Psychiatrists prescribe SSRIs such Fluorhexidrine to control obsessions, compulsions, and accompanying anxiety. Anafranil – a tricyclic antidepressant has been used successfully since the late 1980s when Rapoport used it with her patients. The finding that overactivity of the receptor tyrosine kinase TrkB is at the root of OCD suggests that cancer drugs controlling the Ras/ERK-MAP kinase cascade may be of help (Ullrich, Weber, Post Poop, Grein, Gonzalez, Kreis, Üçeyler, Lesch, Schmidtt, Schuh, 2017).

Psychosurgeries – including brain surgery, Gamma knife, and Deep Brain Stimulation — have proved helpful in some severe cases.

SUMMARY: Obsessive-Compulsive Disorder is a debilitating illness with its origins in the amygdala. Sufferers can experience symptoms that cripple their ability to function. The intensity of the obsessions may lead some to attempt to escape their pain via the avenue of suicide. New research offers the hope of new treatments using already available cancer drugs. It is not something to be joked about.

Citations

Adam, David. (2014). The Man Who Couldn’t Stop: OCD and the True Story of a Life Lost in Thought. New York: Sarah Crichton Books, Farrar, Straus and Giroux.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Beyond OCD. (2017). What causes OCD? Retrieved April 30, 2017 from http://beyondocd.org/information-for-individuals/what-causes-ocd/.

Esquirol, J. (1845/1938). Mental Maladies: A Treatise on Insanity. Philadelphia: Lea and Blanchard. Cited in Adam (2014).

Fernandez de la Cruz L , Rydell M , Runeson B , D’Onofrio BM , Brander G , Ru?ck C , Lichtenstein P , Larsson H , Mataix-Cols D (2016). Suicide in obsessive-compulsive disorder: A population-based study of 36,788 Swedish patients. Molecular Psychiatry, 2016 Jul 19. doi:10.1038/mp.2016.115

Ivarsson, Tord and Larsson, Bo. 2009. Sleep problems as reported by parents in Swedish children and adolescents with obsessive-compulsive disorder (OCD), child psychiatric outpatients and school children. Nordic Journal of Psychiatry. 63:6. DOI: 10.3109/08039480903075200

National Institute of Mental Health (2016). Obsessive Compulsive Disorder. Retrieved April 30, 2017, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml.

Rachman, Stanley and de Silva, Padmal. (1978). Abnormal and Normal Obsessions. Behaviour Research and Therapy, 16, pp. 233-48.

Rachman, Stanley and de Silva, Padmal (2009). Facts : Obsessive-Compulsive Disorder : The Facts (4th edition). Oxford, England: Oxford University Press.

Rapoport, Judith L M.D. 1989. The Boy Who Couldn’t Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder. Boston: E.P. Dutton.

Shy, Shannon. 2009. “It’ll be Okay.”: How I Kept Obsessive-Compulsive Disorder (OCD) from Ruining My Life. Bloomington, Indiana: Authorhouse.

Stuart, Ralph. (2017). The OCD Stories: Stories that educate and inspire those with OCD. Kindle edition downloaded March 28, 2017 from https://www.amazon.com/OCD-Stories-educate-inspire-those-ebook/dp/B06XVF7DNM.

Ullrich M, Weber M, Post A M, Popp S, Grein J, Zechner M, Guerrero González H, Kreis A, Schmitt A G, Üçeyler N, Lesch K-P, Schuh K. 2017. OCD-like behavior is caused by dysfunction of thalamo-amygdala circuits and upregulated TrkB/ERK-MAPK signaling as a result of SPRED2 deficiency. Molecular Psychiatry. DOI: 10.1038/mp.2016.232 cited in University of Würzburg. 2017. Cause of obsessive-compulsive disorder discovered. ScienceDaily. Retrieved May 8, 2017 from www.sciencedaily.com/releases/2017/03

My Family History of Mental Illness

I remember my grandmother in her baggy dresses that covered every inch of her body like the shrouds that covered the furniture when the summer folk had left for the season. My cousin Heidi was surprised when I told her that my grandmother — her aunt — had spent many hours of each day lying in bed.

“But she was always so jolly, so friendly.”

“Yes,” I said. “She could be like that. Like so many of us she knew how to fake happiness.” I do not mean that as a slander. I admire how she could pull herself together despite her suffering and be there.

I know my grandmother loved me. When I was young, she used to get in big fights with my mother for the way she mistreated me. The rows were long and loud — I would go to the very back of the yard so that I could not hear them.

My mother had her own problems: there was a deep-seated meanness in her. She disparaged my grandmother when we were alone together, complaining about what she thought as Stella’s laziness. When I was depressed, she was panicked at the thought that would do the same, so she hectored me about getting a job — any job — no matter how inappropriate or soul-killing it was. Once, when she was in the hospital with roof-busting high blood pressure, I told the doctor about our family secret. A psychiatrist prescribed Prozac. For three months, she was a nice person.

Dealing with anxiety over the holidays

I wrote another article for “The Mighty” that I wanted to share

http://themighty.com/2015/12/7-tips-for-surviving-the-holidays-when-you-live-with-anxiety/

At my house, we celebrate both Christmas and Hanukkah. The kids love it; twice the parties, more gifts and more fun. But for me, this means twice the stress and more anxiety. And while most of the severe symptoms of my mental illness are under control, it can be harder to manage my anxiety as the holidays approach.

But I’ve learned little adjustments can make a huge difference. Here are some things that help reduce my anxiety over the holidays:

1. Take two cars to a holiday party.

It’s easier to relax when I know I have an exit plan. If my husband and I take separate cars to an event, I know I can leave at any time.

2. Find a “safe space.”

When we’re at a holiday party or family gathering, I make sure I find a quieter room or place outside to get away from all the noise. Or I spend time with the animals if there are any pets. It just needs to be a space where I can recharge.

3. Give yourself permission to walk away from upsetting conversations.

There’s always that one person who wants to argue about politics or compare achievements. I used to dread holidays mainly because of these uncomfortable interactions. Now, I know I don’t have to listen. I can walk away or not participate.

4. Keep it low-key.

In my house, we don’t feel pressure to entertain guests or worry about buying the “perfect gift.” There’s so much going on already, we don’t want to add to the stress by holding unrealistic expectations. We try to keep it low-pressure and enjoy what we have.

5. Know it’s OK to say, “No.”

Around the holidays there are lots of opportunities to help others, but if making that batch of cookies or running that errand is going to cause me too much stress, I have started saying no. The holidays are a time to give, but it’s important to know your limits.

6. Accept help.

On the other hand, if people do offer me help, I’ve learned it’s OK to accept it. I try to remind myself they wouldn’t ask if they weren’t willing.

7. Remember to actually enjoy yourself.

As much as there are parts about holiday gatherings I don’t enjoy, there are things I like. Certain foods, smells, people and seeing the children’s excitement. I try to enjoy those special moments — it keeps the holidays in perspective.

Review: An Angel at My Table

Janet Frame endured eight years as a mental patient before she went on to become the poet laureate of New Zealand. She was misdiagnosed. While she was incarcerated she underwent electro-convulsive therapy without anesthesia and was lined up for a lobotomy until her doctor learned that she had won a prestigious literary prize and took her off the list. This movie is the story of three periods in her life. Her time in a mental hospital is the second.

I would guess that social anxiety and, perhaps, depression were the demons that afflicted Frame. She would hide in corners. She failed at her work as a teacher. When two of her sisters died, she crashed into a frozen despair.

If Angel at My Table is accurate, Frame was most certainly not schizophrenic. An early scene in the second part of the film shows her riding to the hospital in a car with two women who are severely impaired by their illnesses. She stands out as unafflicted by whatever is troubling her fellow passengers. Things were done to her while she was in the hospital just because they were the latest treatment. Her mother desperately signed the papers for the lobotomy: if Frame had been trapped in a mindless system, we would have lost a great author. Fortunately, a doctor noticed in time and helped her win her release.

Read More

When are remarks “remarkable”?

Not long ago I was listening to the Heidi and Frank show on the radio. They were doing a show on OCD. I don’t listen often and hoped maybe it would be okay. After all, it was mental health awareness month, at the time.

No. It was a comedy bit. I realize that is their job. but they were making fun of callers and people they know. Calling them “Freaks and “Weird”.

I rarely respond to those types of things but I contacted the radio station and NAMI. I didn’t expect to hear back from the station. NAMI told me they don’t deal much with that diagnosis and to contact an OCD foundation. I passed on the info and let it go.

Now I see this article:

Mike Huckabee and Schizophrenia; NAMI Calls for Apology Over Supreme Court Remarks on Iowa Radio Talk Show

 http://www.nami.org/Press-Media/Press-Releases/2015/Mike-Huckabee-and-Schizophrenia;-NAMI-Calls-for-Ap

I understand Mike Huckabee is a Presidential candidate. Is that what makes him a good example of stigma? He called a man with no mental illness (Supreme Court Justice Roberts) “schizophrenic”. I don’t think that compares with calling someone with a disorder “Freak”.

I do think he should be called on it, like others in the media. The choice  just seems arbitrary.

Getting ahead of myself

I haven’t been able to work for over 10 years. Mostly because stress makes my symptoms worse. I have been thinking of attempting to work. I have sent out some resume’s and gone on interviews.

Those didn’t go so well, but I am still looking. I found an agency that places people with disabilities in jobs. The employer gets a tax break. I haven’t been very impressed with the company so far, but I haven’t seen any of the job leads.

But, I have been rolling the idea around in my head. Who will pick up the kids and do the things I do when I am around? Am I making a mistake? What if I can’t handle it? What can/can’t I do?
Read More

Focus

I wake up and throw myself into rants about how I am irritated with a multitude of issues in my life that are all intersecting to make my day frustrating and uncertain.

After ranting for two hours to various people, I start studying. I am fixated trying to complete problem after problem with undying devotion. When I get stuck I force myself to turn my attention to what is more important- the assignments due tomorrow.

What should have been a half hour at best of work, turns into what feels like over an hour. I write an abstract for my lab report and spend an immense amount of time editing it until it is “perfect.”
Read More

Outside Perspective

Sometimes I don’t notice changes in myself. They come on gradually. I don’t think of them until someone mentions it.

People have been telling me for awhile that I seem less anxious. I have been able to give presentations, start conversations, some things that might not seem like much but have been hard for me in the past. I even took part in a podcast once.

I was telling my therapist that I have had trouble with some physical things like fingerprinting (for work) or mammograms where they have to position you. I get tense and the more I am told to relax the worse it gets. Today. I had a mammogram. i warned the woman that I have had trouble in the past, but 1, 2 3 she was able to easily take the pictures.

I also told my therapist I have these brief periods when I feel at peace, happy out of the blue. She thinks I am finally starting to come out of a depression. That my meds are working on anxiety and depression. I really hope so.

How Far Would You Go?

We are quick to judge someone who abuses drugs. But shouldn’t we evaluate what led them to use such methods in the first place?

The first time I smoked weed was because I felt depressed and wanted to feel anything else. I didn’t know I was in a depressive episode at that time.

I no longer use it, I actually rather despise the substance.

But it is not the only drug.

I want to feel guilty about abusing my psychiatrist’s trust but I am not the type to feel much remorse.

The powder can work better than the whole. Your nose may ache and the initial rush is so heavy you feel like your heart will explode out of your chest. But I found if you balance the drug with another… then you can excel.

In a way, it is typical cliche college student. They say a ridiculous amount of college students abuse stimulants but I’m not sure of how accurate that is. I have yet to meet any who do but then again- I don’t have many friends and I’m sure it is not something most will announce to the world.

It is not something I do that often, at least not anymore. It is something I do when I’m desperate. I felt so stressed out that I couldn’t function- I couldn’t focus, I couldn’t get started- and the seconds were ticking away.

The pressure to never fail. Not a single class. You want to go to grad school, don’t you? You want to be a success, you want this career because for some reason you have equated it to happiness.

You’d do an awful lot to get this, wouldn’t you?

There are some who would go further than I am. Sabotage their peers even. I am not so devious.

Shouldn’t I feel bad that I have to use these methods at times? I should but I don’t. Like I said earlier, I’m not the type to feel guilt. Would I feel more accomplished if I did it the “right” way? Eh. Maybe. But I’d probably see no real difference. Either way I got the work done- that’s what matters, right?

I’m driven to these methods by expectations. Expectations that were put on me by family and by myself. Ever since I was little it was like my whole life revolved around my future career. Was it my fault? I don’t know. My siblings are all older than me by quite a bit. When I was old enough to start having a good concept of the future, my siblings were all determining what they wanted to do in this world. It made me ask myself the same question. And for as long as I can remember I have had a career goal. I revolve my life around it. But I don’t want to. I want to be happy and have fun.

So I come to be between a rock and a hard place. I can either spread out the time spent studying by not going out drinking or I can get it done in one night by working excessively (and perhaps with a little help) and go drinking.

I’ve done this to myself. I feel trapped in a world where career is everything. But to get to career, I have to get through college. And let me be honest- I hate college. Or at least, I hate the pressure. The deadlines, the high marks, everything. I wish I could learn in an enjoyable way. But let’s face it, I hate my major. I love my minor. Both are useless unless I can get into grad school. I’ve given up on med school, which is what I have completely devoted my college classes towards and it is too late to go back. I am shifting my goal but it doesn’t exactly align with what I’ve done.

What a mess.

Stability… does that word even truly apply to me, ever? You would think so. But I don’t think so. I am always a little up or down. Always have some unhealthy addiction. Am always a little self destructive.

Tonight I used unethical means to get some school work done.

But will you judge me before you even consider what made me want to?

Don’t call me lazy. But if you want… you can call me desperate.

-Quinn

Yet Another Post- Finding the “Me” in “Meds”

After missing my meds the other night, and then taking them last night, it was like a transformation occurred.

I went to class today and was able to focus the entire time. I was energetic enough to seek out potential professors seeking research assistants. I got stuff done and tonight I plan on going to a club. Most of all- I felt happy to be alive. Maybe a little too happy and productive, but whatever I’ll roll with it.

But my friend texted me something. She said, “With meds. Without meds. Completely different. It’s both terrifying and amazing at the same time how much of an affect they can have on you.”

And I have to agree with her. The times I’ve gone off meds I’ve turned into a nervous wreck, unable to function, vomiting from anxiety, and apparently dangerously suicidal as last night proved.

But what I told her is that, yes, it is frightening. But what frightens me more is that I don’t know who that person is. I’ve only been on meds 3 years (which isn’t a long time compared to some people) but it is weird to me not knowing who I am without them.

I know for me, when I’ve quit my meds spontaneously, part of my reasoning was that I wanted to see who I was without them. And every time I did I was scared beyond belief. I wish there was a way to know that person but it is simply too dangerous. Part of me wants to see just how bad I can get. I want to know. I want to see the difference medication has made.

I do see it, sometimes. If I think back to high school before I turned 18 and got meds, I was a nightmare. I was suicidal, I was erratic, I was pessimist beyond belief… In all honesty, I was really just a horrible person. I won’t deny it, I didn’t like that person. That’s why I wanted to kill her.

Meds changed my life, even if the antidepressants did later further my problems. They started off helping before I descended again. But it was different than before, when there was no meds. On them I was still somewhat sedated. I can’t help but wonder anyway.

A lot of people think the meds strip you of personality. Make you numb. Make you a zombie.

And the right ones in the right dosages don’t.

I know who I am on the meds.

But I can’t help but wonder anyway…

Who am I underneath this safety blanket?

-Quinn