Obsessive Compulsive Disorder
The doubting disease
What is OCD?
Definition of OCD:
Obsessive Compulsive Disorder is a brain and behavior disorder.
In OCD, there are issues with communication, from the front of
the brain to the deeper sections. The issues involve a chemical
that acts as a messenger, known as serotonin. In a brain with
OCD, certain sections are overactive, causing the patient to
experience very bad anxiety. It affects their everyday lives
tremendously, in both children and adults.
The Obsessive Compulsive Brain
As you can see from the picture above, the OCD patient’s brain is much more
active than the normal person’s brain. When triggered, certain parts of the
brain are overactive, causing the brain to “skip” like a scratched CD.
The human brain
Here is a diagram of the human brain. In OCD, the front part of the brain
(here, frontal lobe) and some structures deeper into the brain are
affected.
Symptoms of OCD
In OCD, the person experiences obsessions and compulsions.
OBSESSIONS
COMPULSIONS
•
Aggressive obsessions
•
Repeating rituals
•
Contamination obsessions
•
Washing/cleaning compulsions
•
Saving/hoarding obsessions
•
Checking compulsions
•
Religious obsessions (scrupulosity)
•
Collecting/hoarding compulsions
•
Exactness or symmetry obsessions
•
Ordering or arranging compulsions
•
Somatic obsessions (hypochondriasis)
•
Counting compulsions
An additional branch: Emotional
Contamination
Emotional contamination is another form of OCD. This is the same
idea as the other contamination obsessions, but in emotional
contamination, the person with OCD is afraid of “catching” the
negative personality traits of another person, like one would catch a
contagious illness.
More information on OCD symptoms
• The need to ritualize is unique to OCD, whereas worrying is
not.
• OCD can range from being mild to very severe.
• OCD is chronic. There is no cure yet. However, with treatment,
many people can go on to lead normal lives, even with the
OCD.
• OCD isn’t fatal in the literal sense; however, in a few cases, it
can be so severe that the patient may want to commit suicide.
Causes of OCD
•
•
•
OCD can be caused partially by genetics. It often runs in families, so if a parent has OCD,
their child is genetically at risk for getting OCD as well.
The diathesis-stress model describes the development of OCD. A person has a biological
vulnerability for OCD and then experiences a stressful life event, such as leaving home
for college, or having a baby, and then develops symptoms of OCD.
PANDAS is another cause of OCD, in which a child can develop OCD symptoms overnight
while infected with streptococcus (strep throat).*
Three parts of the brain are overactive in OCD, and that causes the person to doubt and
feel a need to find 100% certainty about things, which they then attempt to do through
ritualizing. So, brain tissue (nervous tissue) is affected by OCD. Serotonin is a chemical
that theses brain structures use, and so OCD can sometimes be treated with serotonin
medications.
*For more information on PANDAS, see the next slide.
P.A.N.D.A.S
PANDAS, short for “Pediatric Autoimmune Neuropsychiatric Disorder
Associated with Streptococcus” is when a child suddenly gets OCD symptoms
during or immediately following a strep throat infection. (It can occur
whether the child already had mild OCD or has never had it at all.) PANDAS
can occur in children from age 3 to around the time of puberty. PANDAS is
caused by the way the child’s body reacts to the streptococcus bacteria (not
by the bacteria itself). In PANDAS, the body makes a specific protein and
antibodies, and then the strep spreads to the brain. The antibodies then
attach to the base of the brain and cause OCD. To treat PANDAS, the patient
receives blood transfusions every month and then goes through behavior
therapy.
Which Human Body Systems Does
OCD Affect?
OCD primarily (and always) affects the nervous system, but the
different obsessions and compulsion s affect other specific body
systems.
For example:
• PANDAS, as a cause, is associated with the body’s immune system parts,
such as the lymphatic system.
• When a person has trichotillomania (which is often associated with OCD),
they pull out their hair or pick at their skin excessively. That affects the
integumentary system (skin, hair, and nails).
Transmission and Prevention of OCD
• OCD cannot be transferred; it is a disorder of the brain, not a virus or
bacteria that one can catch. Living with a person with OCD won’t give you
OCD.
• There is no specific way to prevent OCD, as it is often genetic. However, if
a child is genetically at risk to get OCD ( for example, if a close relative has
it, like a parent), the family can take certain precautions to make it less
probable that the child will get OCD. The child should be taught to be able
to tolerate being uncertain about things, and should be encouraged to not
fear germs. (One way to do this is to have the child eat a cookie or other
food item even after it has fallen on the floor, showing them that germs
are not that big a deal.) Perfection should not be a main focus either, and
overall, the child shouldn’t be taught that the world is a dangerous place
for them. By preventing certain behaviors, such as the fear of germs, the
child’s vulnerability to OCD can be lessened, regardless of any genetics.
Epidemiology: OCD Timeline
•
•
•
1600s – Intrusive thoughts and repeating behaviors were considered to be
indicating the presence of melancholia, a really bad form of depression where the
person no longer takes any joy in anything in life. Church leaders also often
thought that these behaviors meant that the person didn’t pray to God enough.
19th century – At this point, these symptoms were viewed as real mental health
problems. As the century progressed, more and more ideas about obsessions and
compulsions arose and were studied.
Beginning of 20th century – Many psychiatrists were finally pairing obsessions
with compulsions, and this was the biggest point of advancement yet. Two
particular people played a major role in bringing our understanding of OCD to the
way it is today: Sigmund Freud and Pierre Janet. Freud compared obsessions and
compulsions to “cause and effect”; the obsessions were the cause of the
compulsions. Janet had the idea that the cause of the obsessions had to do with
high mental levels and nervous energy. This led to the prospect of impulses.
Statistics
(More Epidemiology)
• 1 in every 200 kids/teens have OCD
• 1 in every 100 adults has OCD
• 80% of OCD patients develop OCD before the age of 18
Additional Information:
• Most people who have OCD are highly intelligent – and this makes sense,
because OCD requires complex thought patterns.
• The wealthy often cannot get the best treatment, believe it or not.
Because they have so much money, they are able to pay people to help
them ritualize. That does not help them get better, but most of the people
will do anything for a large sum of money, or because the person is so
famous.
Famous Obsessive Compulsives
• David Beckham – symmetry and exactness obsessions
• Howie Mandel – contamination
• Jessica Alba, too, has OCD.
• And last but not least…
Michael Jackson had both BDD (body dysmorphic
disorder) and OCD. He had contamination obsessions.
Treatment of OCD
OCD does not have a cure, per say, but there are many
treatments that can greatly improve people’s lives. The
best treatments are as follows:
• Help from a well-trained behavior therapist
• Exposure and Response Prevention, or ERP
• Medications
ERP
ERP, or Exposure and Response Prevention, is a type of
behavior therapy that is frequently used to help treat
OCD. In Exposure and Response Prevention, the patient
is supposed to do the exact opposite of what their OCD
tells them to do, and end up facing their fear, but
without ritualizing. ERP triggers the person’s obsessions
on purpose. Habituation is what happens when they
get scared at first, and more anxious, but then the
feeling subsides as they get used to it, much like how
you feel after jumping into a cold swimming pool.
Brain Surgery and Deep Brain
Stimulation
Brain surgery and Deep brain stimulation are two other forms of possible treatment
for OCD. In brain surgery for OCD, specific small sections of the brain are removed to
try to get rid of or subdue the OCD symptoms. In deep brain stimulation, a probe is
put into the brain, and a power box (which communicates with the probe) must be
located somewhere in or on the patient’s body. It sends electrical signals throughout
the brain to stop the OCD. However, even after undergoing one of these two surgeries,
the OCD patient must go back and do more behavior therapy. If they have brain
surgery, but then do not put in any more effort at all, they will not get better despite
the alterations to their brain. (Brain surgery does not completely rid the person of
symptoms.) These surgeries are very rare and very new; they only started in the 1980s
and only about 26 OCD patients have actually had these procedures done, with varied
results. (Surgeries work better for some patients than others.) Overall, as a treatment
option, surgery is still in its trial stage.
Additional Information
• There is no vaccine for OCD, because, again, it is not a virus or bacteria, it
is a brain disorder.
• Lots of kids have OCD, but after going through treatment, they can often
lead normal lives, just like those of us who don’t have OCD.
• Sometimes, without meaning to, families help their children with OCD to
ritualize. This is known as “Family Accommodation Behavior”, and it does
NOT help the person to get better. In fact, it is reinforcing the behavior,
which only causes the OCD to worsen. So, when a family member has
OCD, the family should learn more about OCD, to avoid further issues.
References: Images
Actual Brain:
http://2.bp.blogspot.com/_0KMnzNqRq8Y/S8JFJP75x_I/AAAAAAAAClk/4hKWDQvCfOs/s1600/brain.jpg
High Energy Use in the Brain:
http://www.parentsofocd.org/2011/04/09/energy-use-in-the-ocd-brain-very-interesting/
Human Brain Diagram:
http://apividori84.edublogs.org/files/2008/10/brain.gif
Strep Throat Diagram:
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19694.htm
Strep Throat Test: Little Girl
http://www.gerberlife.com/gl/view/newsletter/nov07/images/other2.jpg
Jessica Alba:
http://topnews.in/light/files/Jessica-Alba_6.jpg
David Beckham:
http://sportsvideo24.com/wp-content/uploads/2010/06/David-Beckham-3.jpg
Howie Mandel:
http://media1.podbean.com/pb/39041bdbd54f89baff781129ae962359/4dd06ab3/blogs/13755/uploads/howie-mandel-350.jpg
Michael Jackson:
http://www.rawkblog.net/wp-content/uploads/2009/06/thriller-michael-jackson.jpg
Behavior therapist:
http://64.244.7.164/Content/stk93908cor.jpg
CBT logo:
http://www.sfsmith-mft.com/images/cbtlogo.jpg
Pills:
http://www.synaesthete.net/ocd/gr/psychopharmacology.gif
Water:
http://www.freefoto.com/images/33/04/33_04_3---Water-Texture_web.jpg?&k=Water+Texture
Kids in Swimming Pool:
http://www.cen.eu/cen/News/Spotlight%20on%20standards/Archive/PublishingImages/Swimmingpool.jpg
Worried Teenage Girl:
http://www.irishhealth.com/content/image/13232/Worriedteengirl.jpg
2nd real brain:
http://www.morphonix.com/software/education/science/brain/game/specimens/images/wet_brain.gif
Deep brain stimulation:
http://www.mc.vanderbilt.edu/root/sitebuilder/mcweb/images/neurological_surgery/dbs-poster-segment-2web.jpg
References: Information
Websites
http://www.brighthub.com/mental-health/ocd/articles/84789.aspx
http://www.ocfoundation.org
Books
When Once Is Not Enough –Help for Obsessive Compulsives– written by Gail Steketee,
Ph.D. and Kerrin White, M.D.
Reference Papers
Y-BOCS Symptom Checklist (Arch Gen Psychiatry adaptation-copyright 1989 AMA)
Professionals:
(Speaking with)
Carol Hevia, Psy.D.
Behavior therapist, McLean Hospital, Belmont MA