Obsessive Compulsive Disorder
Brain abnormality theory
Some researchers describe obsessive-compulsive disorder as a biologically rooted syndrome associated with abnormalities in the basal ganglia region of the brain. The abnormality makes those with OCD doubt what their eyes, knowledge, and good judgment tell them. For this reason, OCD is often referred to as the "doubting disease." Because of this doubt, they check and recheck or repeat the same acts over and over. When compared with control subjects, PET scans have shown that patients with OCD burn energy more rapidly in the frontal lobe and cingulate pathway, which connects the frontal lobe to the basal ganglia. This increased metabolism is also correlated with the severity of OCD. It may be because of this increased metabolism that something goes wrong with the way the body registers and responds to information.
Chemical imbalance theory
Obsessive-compulsive disorder has also been linked with low levels of a substance in the brain. This substance is a neurotransmitter known as serotonin. Brain nerve cells use neurotransmitters such as serotonin to send messages to each other. Serotonin is stored in the nerve cells and when a nerve cell wants to communicate with the next nerve cell, it releases the serotonin into the next cell 's message receivers. Because drugs that increase the amount of serotonin in the brain have been shown to reduce OCD symptoms, it is thought that people with OCD may have too little serotonin for their nerve cells to communicate effectively. Two other neurotransmitters may contribute to OCD. These neurotransmitters are dopamine, which is linked to thought and movement disorders, and norepinephrine, which is related to stress.
Heredity research supports the biological model. Studies are often done with sets of twins where one member of the set has the disorder. These studies found that the other twin is more likely to be affected if he or she is an identical twin. Because identical twins have identical genetics, it is felt that this difference is due to an inheritable cause of the disorder.
In addition, first-degree relatives of individuals with OCD have higher rates of OCD than the general population. Family members of people with OCD also have more than normal occurrences of major depression, bipolar illness , panic attacks , severe phobias, and neurological problems.
Very few people have recovered from obsessive-compulsive disorder without treatment. Nearly 90% of those who begin the combination of behavior and drug therapy decrease their symptoms and for about 30 - 40% of people, the symptoms disappear completely. If a person with OCD only has drug therapy, his or her symptoms will most likely return if the medication is discontinued. Outlook is even better if the person had a relatively well-adjusted personality before the disorder developed and the person has typical or mild symptoms. Early onset and personality disorders may also indicate a poor prognosis.
The Basics of Treatment
The two basic types of treatment for obsessive-compulsive disorder are psychotherapy and drug therapy.
Psychotherapy typically involves talking to a trained professional about your symptoms, problems, and self-perception. The most common type of psychotherapy is behavior therapy which focuses on maladaptive behavior patterns of clients. The client's and the therapist's goal is to decrease obsessions and compulsions and increase positive behaviors. Psychotherapy is appropriate for people who do not wish to take any medications. Another benefit to psychotherapy is that the positive effects remain after the therapy has been discontinued.
Drug therapy is also commonly used. Drugs used for treating OCD increase levels of a naturally occurring chemical in the brain called serotonin. Some of the same drugs that are used to treat depression are used to treat OCD but typically required higher dosages than with depression. Drug therapy is a good choice for people who do not have the time or motivation to follow through with a psychotherapy plan. Disadvantages to drug therapy is that often drugs have unpleasant side effects and symptoms often return after the medication has been discontinued.
The most effective treatment plan for OCD is a combination of behavioral and drug therapy. About 70 - 75% of people who use either type of therapy without the other show at least moderate improvement. When behavior therapy and drug therapy are used together, about 90% of the people show improvement. The medication gives the person a quick boost by reducing the obsessions and compulsions. This change often gives the person extra motivation and time to succeed with behavior therapy.
Medications have been shown to reduce the symptoms of OCD. Antidepressant medications that increase the use of serotonin in the brain appear to have the most significant effects. Serotonin is a chemical our bodies produce that is necessary for our nerve cells to communicate with each other. Because so many people who have OCD are also suffering from depression, the antidepressant drugs help treat both disorders. Several medications have shown to be be the most effective when treating OCD:Anafranil(clomipramine), and several of the SSRIs such as Luvox (fluvoxamine), Paxil (paroxetine), and Prozac (fluoxetine).
Anafranil was the first to be approved by the FDA for treatment of OCD in 1989. About 2/3 of the patients treated have responded to this medication. Most of the patients are not completely cured but their condition has improved. The other drugs have had similar success.
Anafranil is classified as a tricyclic antidepressant, or TCA, and Luvox and Prozac are both classified as SSRI's, or selective serotonin reuptake inhibitors. SSRI's generally have less side effects than TCA's.
Medications should be taken regularly for at least ten to twelve weeks, and in some cases up to six months, before a psychiatrist determines if they are helping. Higher doses of antidepressant drugs are generally required when treating OCD compared to the treatment of depression but NEVER adjust your dosage without consulting with your psychiatrist first. Unfortunately, OCD symptoms usually return after a patient stops taking the medication.
Although medications alone can help patients, the most effective treatment for OCD is the combination of drug therapy and behavior therapy.