Breaking Down OCD
 The OCD Institute is a facility in Belmont, Massachusetts where adults, 16 years or older, go to receive intensive treatment for their OCD. Patients can either live at the Institute for 24-hour treatment or come in for sessions throughout the week. Teen Voices interviewed Diane Davey, program director at the OCD Institute, who encourages teens to seek early diagnosis and treatment.
Teen Voices:
What are the causes of OCD? Is it genetic?
Diane Davey:
They are still working on the exact cause of OCD. It is generally called a biologically based illness, something that is not functioning correctly in the brain. It is not something that people develop solely because of their environment, although environment certainly plays a role. There are genetic factors involved also—you do see this running through families—but I don't think there is one specific cause for OCD.
TV:
How do you diagnose OCD?
Diane:
In order to qualify for a diagnosis of OCD, a person must have obsessions which are considered to be intrusive thoughts or images that are distressing to the person and which create anxiety. Also, a person experiences compulsions—usually repetitive thoughts or actions—which are meant to reduce anxiety that the person is experiencing. OCD is this cyclical pattern where people are having obsessions and then engaging in compulsions to reduce their anxieties, and they go around in this big circle.
TV:
What symptoms are related to OCD?
Diane:
There are many different symptom types. First, there are people that worry about dirt or germs and then do a lot of washing. The concerns that people with OCD have are sort of excessive. It's really not a normal reaction; it's a heightened, incessant*, unreasonable reaction. We have patients who worry that if they were to touch a faucet in a public bathroom that they would get AIDS, and they become almost paralyzed by that fear.
Another general symptom type is when a person worries she/he will be responsible for something bad happening, so she/he continually checks things. Again, it is an excessive amount of checking. One of the diagnostic criteria* is that it be distressing but also time-consuming.
Another common symptom type is the classic perfectionism, where things need to be ordered in a certain way, things can't be moved or rearranged, or it causes the person a great deal of stress. In their mind, they feel that if things aren't exactly right there will be some sort of terrible outcome, even though there would be no logical explanation.
Another common symptom type is people who have intrusive thoughts. They sometimes worry that they will act in a way that is totally out of character for them and that they would impulsively harm a person. People with these symptoms are never people who have a history of harming people and the thought is a very intrusive thought and a very disturbing thought. It is not that they actually do harm people.
TV:
Who has more cases of OCD
—women or men?
Diane:
In the general research women and men are just about equally susceptible. OCD is also in other cultures, so it's not just an American phenomenon. It cuts across different cultures, and different socio-economic backgrounds.
TV:
How often is OCD misdiagnosed? And what are the effects of a misdiagnosis?
Diane:
It's hard to quantify, but I would say it's misdiagnosed quite a bit. Compulsive shopping or spending or compulsive sexual behaviors, gambling, even some drugs, alcohol, or eating disorders can sometimes be confused with OCD. A misdiagnosis might delay proper treatment and like anything that goes untreated it tends to get worse over time. Typically, OCD treatment is quite effective, especially when the symptoms are recognized early on, before they are debilitating.
TV:
What are the different treatment options? How effective are they? What are some possible side effects?
Diane:
All the literature on OCD suggests that it is the combination of medication and behavioral therapy that is the most effective for treating OCD, better than either intervention on their own. There are relatively safe medications, which have relatively few side effects. Everyone's different, but in general they tend to be very safe medications. The behavioral therapy is where people are confronted with the things that they fear and then helped to not engage in the ritual they would use to reduce their anxiety. The purpose of the treatment is to get the patient to lose their anxiety habitually over time rather than to lose their anxiety because they ritualize.
TV:
How debilitating is OCD? What is the range in severity of the disorder?
Diane:
Like all psychiatric disorders, there's always a range of severity. There are people who have mild to moderate symptoms that are able to get by in their life and go to work or go to school, but you also see people who are unable to leave their homes or take care of themselves in really basic ways. The symptoms can be very embarrassing, so I think that people tend to keep it a secret. They don't think people will understand or they feel they would get laughed at. It's more important to encourage them to seek out information and treatment so the symptoms don't get worse over time.
*Incessant: occurring so frequently that one feels like it will never end.
*Diagnostic criteria: the symptoms a doctor uses to figure out what illness a person has.
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What should I do if I think I have OCD?
• Talk to someone you trust who can help you find a professional who can diagnose and treat you.
• Get information from your primary care physician about OCD and see if she/he will recommend a specialist if needed.
• Remember you are not "crazy." Your illness is treatable.
• Find out about treatment options. Two main treatments are cognitive behavioral therapy and the use of antidepressants. (See Words to Know)
• Visit the OCD Foundation (www.
ocfoundation.
org) for resources on treatments, support groups, how to find a provider, and a special section for teens with OCD.
Words to Know
Antidepressants: Drugs prescribed by a doctor that are used to prevent or treat symptoms of depression. Antidepressants work by increasing levels of serotonin or other chemical messengers in the brain.
Cognitive behavioral therapy: A form of therapy that helps a patient take control of her disorder by changing everyday thoughts and behaviors from negative ones to positive ones. A patient works with a psychiatrist, psychologist, social worker, or licensed counselor.
Serotonin: A brain chemical that affects mood, sleep, and appetite.
For More Information
The
Obsessive-Compulsive
Foundation, Inc.
203-401-2070
www.
ocfoundation.
org
Anxiety Disorders
Association of America
www.adaa.org
Talking Back to OCD: The Program That Helps Kids and Teens Say "No Way"— and Parents Say "Way to Go," by John S. March
Sources: Obsessive Compulsive Foundation,
www.webmd.com
www.nimh.nih.gov
en.wikipedia.org
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