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Obsessive–compulsive disorder
From Wikipedia, the free encyclopedia
"OCD" redirects here. For other uses, see OCD (disambiguation).
Not to be confused with Obsessive–compulsive personality disorder.
Obsessive-compulsive disorder
Classification and external resources
ICD-10 F42.
ICD-9 300.3
DiseasesDB 33766
MeSH [2]
Obsessive–compulsive disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts (obsessions) and behaviors (compulsions). The symptoms of this anxiety disorder range from repetitive hand-washing and extensive hoarding to preoccupation with sexual, religious, or aggressive impulses. These symptoms can be alienating and time-consuming, and often cause severe emotional and economic loss. Although the acts of those who have OCD may appear paranoid and come across to others as psychotic, OCD sufferers often recognize their thoughts and subsequent actions as irrational, and they may become further distressed by this realization.
OCD is the fourth most common mental disorder and is diagnosed nearly as often as asthma and diabetes mellitus.[1] In the United States, one in 50 adults has OCD.[2] The phrase "obsessive-compulsive" has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is meticulous, perfectionistic, absorbed in a cause, or otherwise fixated on something or someone.[3] Although these signs are often present in OCD, a person who exhibits them does not necessarily have OCD, and may instead have obsessive–compulsive personality disorder (OCPD), an autism spectrum disorder or some other condition.
Contents [hide]
1 History
2 Symptoms
2.1 Obsessions
2.2 Compulsions
2.3 OCD without overt compulsions
3 Causes
3.1 Psychological
3.2 Biological
4 Diagnosis
4.1 Differential diagnosis
5 Treatment
5.1 Behavioral therapy
5.2 Medication
5.3 Alternative drug treatments
5.4 Electroconvulsive therapy (ECT)
5.5 Psychosurgery
6 Epidemiology
6.1 Comorbidity
7 Society and culture
8 See also
9 References
10 Further reading
11 External links
[edit]HistoryThis section requires expansion.
[edit]Symptoms[edit]Obsessions
Main article: Intrusive thoughts
The typical OCD sufferer performs tasks, or compulsions, to seek relief from obsession-related anxiety. Within and among individuals, the initial obsessions, or intrusive thoughts, can vary in their clarity and vividness. A relatively vague obsession could involve a general sense of disarray or tension, accompanied by a belief that life cannot proceed as normal while the imbalance remains. Among the more articulable obsessions one may have is a preoccupation with the idea of violently hurting others or oneself.[4][5] A survey of healthy college students found that virtually all of them had these types of thoughts from time to time,[6] Like these students, OCD sufferers generally do not enact or even enjoy these violent thoughts.[7] On the contrary, they are pathologically disturbed[8] by these ideas—and by the sense that they could inexplicably possess them. Other obsessions concern the possibility that someone or something other than oneself—such as God, the Devil, or disease—will harm either the sufferer or the people or things that the sufferer cares about. Some people dread entire concepts, fearing their materialization by causes that may seem implausible or indiscriminate to others. For example, a generalized fear of contamination might entail not only wariness of bodily secretions or excretions, but also apprehension toward household chemicals, radioactivity, newsprint, pets, or even soap.[9]
Sexual obsessions may involve intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", and can include "heterosexual or homosexual content" with persons of any age.[10] As with other intrusive, unpleasant thoughts or images, most people have some disquieting sexual thoughts at times, but people with OCD may attach extraordinary significance to the thoughts. For example, obsessive fears about sexual orientation can appear to the sufferer, and even to those around them, as a crisis of sexual identity.[11][12] The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the troubling thoughts, resulting in self-criticism or loathing.[10]
Some people with OCD may sense that the physical world is qualified by certain immaterial conditions. They might intuit invisible protrusions from their bodies, or could feel that inanimate objects are ensouled. These people tend not to profess religious or metaphysical convictions, such as a belief in animism, through which such notions are derived; even a child with OCD might find these notions ultimately silly.[13] However, regardless of how these ideas actually correspond with the external world, they can underpin the OCD sufferer's conception of the most practical or proper way for them to understand and face that world. For example, an individual who engages in compulsive hoarding might be inclined to treat inorganic matter as if it had the sentience or rights of living organisms, but such an individual might see no need or way to rationalize their hoarding on behalf of the items they collect.
[edit]Compulsions
Main article: Compulsive behavior
While some with OCD perform compulsive rituals because they inexplicably feel they must, others act compulsively so as to mitigate the anxiety that stems from their obsessive thoughts. The sufferer might regard these actions as the conditions set forth by an ominous obsession, or might frame them as a more direct route to eliminating the obsessions from the mind. In either case, the sufferer's reasoning is idiosyncratic or distorted to a maladaptive level. Compulsions include counting specific things (such as footsteps) or in specific ways (for instance, by intervals of two) and doing other repetitive actions, often with atypical sensitivity to numbers or patterns. People might repeatedly wash their hands[14] or clear their throats; repeatedly check that their parked cars have been locked before leaving them; turn lights on and off, or touch objects, a certain number of times before exiting a room; or walk in a certain routine way.
For some people with OCD, these tasks, along with the attendant anxiety and fear, can take hours of each day, making it hard for the person to fulfill their work, family, or social roles. In some cases, these behaviors can also cause adverse physical symptoms: people who obsessively wash their hands with antibacterial soap and hot water (to remove germs) can make their skin red and raw with dermatitis.[15] To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways. OCD sufferers are aware that their thoughts and behavior are not rational,[16] but they feel bound to comply with them in order to fend off feelings of panic or dread.
[edit]OCD without overt compulsions
Main article: Purely Obsessional OCD
OCD sometimes manifests without overt compulsions.[17] Informally nicknamed "Pure-O",[18] OCD without overt compulsions could, by one estimate, characterize as many as 50 percent to 60 percent of OCD cases.[19] Rather than engaging in observable compulsions, the person with this subtype might perform more covert, mental rituals, or might feel driven to avoid the situations in which particular thoughts seem likely to intrude.[18] As a result of this avoidance, people can struggle to fulfill both public and private roles, even if they place great value on these roles and even if they had fulfilled the roles successfully in the past.[18] Moreover, a sufferer's avoidance can confuse others who do not know its origin or intended purpose, as it did in the case of a man whose wife began to wonder why he would not hold their infant child.[18]
[edit]Causes[edit]Psychological
Scholars generally agree that both psychological and biological factors play a role in causing the disorder, although they differ in their degree of emphasis upon either type of factor.
From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual, or other obsessive thoughts were possessed by the Devil.[20] Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through exorcism.[21] In the early 1910s, Sigmund Freud attributed obsessive–compulsive behavior to unconscious conflicts which manifested as symptoms.[21] Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious".[22]
The cognitive–behavioral model suggests that compulsive behaviour is carried out to remove anxiety-provoking intrusive thoughts. Unfortunately this only brings about temporary relief as the thought re-emerges. Each time the behaviour occurs it is negatively reinforced by the relief from anxiety, thereby explaining why the dysfunctional activity increases and generalises (extends to other, related stimuli) over a period of time. For example, after touching a door-knob a person might have the thought that they may develop a disease as a result of contamination. They then experience anxiety, which is relieved when they wash their hands. This might be followed by the thought "but did I wash them properly?" causing an increase in anxiety once more, the hand-washing once again rewarded by the removal of anxiety (albeit briefly) and the cycle being repeated when thoughts of contamination re-occur. The distressing thoughts might then spread to fear of contamination from e.g. a chair (someone might have touched the chair after touching the door handle).
[edit]Biological
Main article: Biology of obsessive–compulsive disorderThis section may contain original research or unverified claims. Please improve the article by adding references. See the talk page for details. (January 2009)
OCD has been linked to abnormalities with the neurotransmitter serotonin, although it could be either a cause or an effect of these abnormalities. Serotonin is thought to have a role in regulating anxiety. In order to send chemical messages from one neuron to another, serotonin must bind to the receptor sites located on the neighboring nerve cell. It is hypothesized that the serotonin receptors of OCD sufferers may be relatively understimulated. This suggestion is consistent with the observation that many OCD patients benefit from the use of selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant medications that allow for more serotonin to be readily available to other nerve cells.[23]
Recent research has revealed a possible genetic mutation that could help to cause OCD. Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD. Moreover, in his study of identical twins, Rasmussen (1994) produced data that supported the idea that there is a "heritable factor for neurotic anxiety".[24] In addition, he noted that environmental factors also play a role in how these anxiety symptoms are expressed. However, various studies on this topic are still being conducted and the presence of a genetic link is not yet definitely established.
Another section of the brain, the striatum, was implicated in 2007 by scientists at Duke University Medical Center in the US. They genetically engineered a striatal abnormality in mice. This area of the brain is linked to planning and the initiation of appropriate actions. The mice spent thrice the amount of time grooming themselves as ordinary mice, to the point that their fur fell off.[25]
Using tools such as positron emission tomography (PET scans), researchers have shown that those with OCD tend to have brain activity[vague] that differs from those who do not have this disorder.[26] In the book, Brain Lock[27], Jeffrey M. Schwartz suggests that OCD is caused by the part of the brain[vague] that is responsible for translating complex intentions (e.g., "I will pick up this cup") into fundamental actions (e.g., "move arm forward, rotate hand 15 degrees, etc.") failing correctly to communicate the chemical message that an action has been completed. This is perceived as a feeling of doubt and incompleteness, which then leads the individual to attempt consciously to deconstruct their own prior behavior—a process which induces anxiety in most people, even those without OCD[citation needed].
It has been theorized that a miscommunication between the orbitofrontal cortex, the caudate nucleus, and the thalamus may be a factor in the explanation of OCD. The orbitofrontal cortex (OFC) is the first part of the brain to notice whether or not something is wrong.[vague] When the OFC notices that something is wrong, it sends an initial "worry signal" to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to interpret the worrying event. The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function normally, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in compulsive behaviors in an attempt to relieve this apprehension.[23] This overactivity of the OFC is shown to be attenuated in patients who have successfully responded to SSRI medication. The increased stimulation of the serotonin receptors 5-HT2A and 5-HT2C in the OFC is believed to cause this inhibition. [28]
Some research has discovered an association between a type of size abnormality in different brain structures and the predisposition to develop OCD. Through the use of magnetic resonance imaging (MRI), researchers at Cambridge's Brain Mapping Unit were able to discover distinctive patterns in the brain structure of individuals with OCD and their close family members. [29] This is the first instance in which it has been demonstrated that those with a familial risk of developing OCD have anatomical differences when compared with ordinary individuals. The discovery of these structural differences in the area of the brain associated with stopping motor response may ultimately aid researchers who seek to determine which genes contribute to the development of OCD.
Some cases are thought to be caused at least in part by childhood streptococcal infections[30] and are termed PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections).
[edit]DiagnosisFormal diagnosis may be performed by a psychologist, a psychiatrist or psychoanalyst. To be diagnosed with OCD, a person must have obsessions, compulsions, or both, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The Quick Reference to the 2000 edition of the DSM[31] suggests that several features characterize clinically significant obsessions and compulsions. Such obsessions, the DSM says, are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and that cause marked anxiety or distress. These thoughts, impulses, or images are of a degree or type that lies outside the normal range of worries about conventional problems. A person may attempt to ignore or suppress such obsessions, or to neutralize them with some other thought or action, and will tend to recognize the obsessions as idiosyncratic or irrational.
Compulsions are defined as repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or they are excessive. In addition to these criteria, at some point during the course of the disorder, the individual must realize that their obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning.[31]
[edit]Differential diagnosis
OCD is often confused with the separate condition obsessive–compulsive personality disorder. The two are not the same condition, however. OCD is egodystonic, meaning that the disorder is incompatible with the sufferer's self-concept. [20][32] Because disorders that are ego dystonic go against an individual's self-concept, they tend to cause much distress. OCPD, on the other hand, is ego syntonic—marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with their self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with anxiety; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions.[33]
Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.
Some OCD sufferers exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually delusional, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not. There are severe cases when the sufferer has an unshakeable belief within the context of OCD which is difficult to differentiate from psychosis.[34]
OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is characterized as an anxiety disorder, but like many forms of chronic stress it can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life—particularly its substantial consumption of time—can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available.
[edit]TreatmentMain article: Treatment of obsessive–compulsive disorder
According to a team of Duke University-led psychiatrists, behavioral therapy (BT), cognitive therapy (CT), and medications should be regarded as first-line treatments for OCD.[35] Psychodynamic psychotherapy may help in managing some aspects of the disorder. The American Psychiatric Association notes a lack of controlled demonstrations that psychoanalysis or dynamic psychotherapy are effective "in dealing with the core symptoms of OCD."[36]
[edit]Behavioral therapy
The specific technique used in BT/CBT is called exposure and ritual prevention (also known as "exposure and response prevention") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking.
Exposure ritual/response prevention (ERP) has been demonstrated to be the most effective treatment for OCD. Using ERP alone, one can become completely symptom free. However, the individual must be highly motivated and consistent. It has generally been accepted that psychotherapy, in combination with psychotropic medication, is more effective than either option alone. However, more recent studies have shown no difference in outcomes for those treated with the combination of medicine and CBT versus CBT alone.[37]
Recently it has been reported simultaneous administration of D-cycloserine (an antibiotic) substantially improves effectiveness of Exposure and Response prevention.[38][39]
[edit]Medication
Medications as treatment include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, sertraline, fluoxetine, escitalopram, and fluvoxamine as well as the tricyclic antidepressants, in particular clomipramine. SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Instead, serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety and obsessive thoughts. In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious.
Benzodiazepines are also used in treatment. It's not uncommon to administer this class of drugs during the "latency period" for SSRIs or as synergistic adjunct long-term. Although widely prescribed, benzodiazepines have not been demonstrated as an effective treatment for OCD and may be habit-forming in those with a history of substance abuse.[40]
Serotonergic antidepressants typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. In addition to this, the treatment usually requires high doses. Fluoxetine, for example, is usually prescribed in doses of 20 mg per day for clinical depression, whereas with OCD the dose will often range from 20 mg to 80 mg or higher, if necessary. In most cases antidepressant therapy alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Much current research is devoted to the therapeutic potential of the agents that affect the release of the neurotransmitter glutamate or the binding to its receptors. These include riluzole, memantine, gabapentin,N-Acetylcysteine and lamotrigine.
Low doses of the newer atypical antipsychotics olanzapine, quetiapine, ziprasidone and risperidone have also been found to be useful as adjuncts in the treatment of OCD. The use of antipsychotics in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their dopamine receptor antagonism), at high doses these same antipsychotics have proven to cause dramatic obsessive–compulsive symptoms even in those patients who do not normally have OCD[citation needed]. This can be due to the antagonism of 5-HT2A receptors becoming very prominent at these doses and outweighing the benefits of dopamine antagonism. However antidepressant mirtazapine which is a 5-HT2A antagonist has shown to be of benefit to OCD patients[41]. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief enzyme that is responsible for metabolising antipsychotics—CYP2D6—so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results.
[edit]Alternative drug treatments
The naturally occurring sugar inositol has been suggested as a treatment for OCD[42], as it appears to modulate the actions of serotonin and reverse desensitisation of neurotransmitter receptors. St John's Wort has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities[citations needed], although a double-blind study using a flexible-dose schedule (600-1800 mg/day) found no difference between St John's Wort and a placebo[43].
Nutrition deficiencies may also contribute to OCD and other mental disorders. Vitamin and mineral supplements may aid in such disorders and provide nutrients necessary for proper mental functioning[44].
Opioids may significantly reduce OCD symptoms, though their use is not sanctioned for treatment due to physical dependence and long term drug tolerance[citations needed]. Tramadol is an atypical opioid that appears to provide the anti-OCD effects of an opiate and inhibit the re-uptake of serotonin (in addition to norepinephrine)[45].
Tryptamine alkaloid psilocybin has been attempted as treatment[46]. There are reports that other hallucinogens such as LSD and peyote have produced similar effects[citations needed]. It has been hypothesised that this effect may be due to stimulation of 5-HT2A receptors and, less significantly, 5-HT2C receptors; this causes an inhibitory effect on the orbitofrontal cortex, an area of the brain in which hyperactivity has been strongly associated with OCD[47].
Regular nicotine treatment may ameliorate symptoms of OCD, although the pharmacodynamical mechanism by which this is achieved is not yet known, and more detailed studies are needed to fully confirm this hypothesis[48].
[edit]Electroconvulsive therapy (ECT)
This has been found effective in severe and refractory cases. [49]
[edit]Psychosurgery
For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive–compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. In this procedure, a surgical lesion is made in an area of the brain (the cingulate cortex). In one study, 30% of participants benefited significantly from this procedure.[8] Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue. In the US, the Food and Drug Administration approved deep-brain stimulation for the treatment of OCD under a humanitarian device exemption requiring that the procedure be performed only in a hospital with specialist qualifications to do so. [50]
In the US, psychosurgery for OCD is a treatment of last resort and will not be performed until the patient has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive cognitive–behavioral therapy with exposure and ritual/response prevention.[51] Likewise, in the UK, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive–behavioral therapist has been carried out.
[edit]EpidemiologyOCD does not have a higher affinity for a specific gender. It can begin as early as the age of two, but most often begins in the late teens for males and the early twenties for females. Studies have placed the prevalence between one and three percent,[vague] although the prevalence of clinically recognized OCD is much lower, suggesting that many individuals with the disorder may not be diagnosed.[52] The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD.
In a 1980 study of adults from several U.S. cities, the lifetime prevalence rate of OCD for both sexes was recorded at 2.5 percent. Education also appears to be a factor. The lifetime prevalence of OCD is lower for those who have graduated high school than for those who have not (1.9 percent versus 3.4 percent). However, in the case of college education, lifetime prevalence is higher for those who graduate with a degree (3.1 percent) than it is for those who have only some college background (2.4 percent). As far as age is concerned, the onset of OCD usually ranges from the late teenage years until the mid-20s in both sexes, but the age of onset tends to be slightly younger in males than in females.[53]
A study suggests that OCD symptoms in Japanese patients are similar to those found in Western countries, suggesting that this disorder transcends culture and geography. The study, published in 2008, appears to contradict previous theories, said the study’s lead author, Hisato Matsunaga. Having "hypothesized that symptom structure might be substantially influenced by the sociocultural differences", Hisato said that he was surprised by the results.
It has been proposed that sufferers are generally of above-average intelligence, as the very nature of the disorder necessitates complicated thinking patterns[54].
[edit]Comorbidity
People with OCD may be diagnosed with other conditions, such as generalized anxiety disorder, anorexia nervosa, social anxiety disorder, bulimia nervosa, Tourette syndrome, Asperger syndrome, compulsive skin picking, body dysmorphic disorder, trichotillomania, and (as already mentioned) obsessive–compulsive personality disorder. There is some research demonstrating a link between drug addiction and OCD as well. Many who suffer from OCD also suffer from panic attacks. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among OCD patients may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among sufferers of OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an "out of control" type of feeling.[55]
[edit]Society and cultureBritish poet, essayist, and lexicographer Samuel Johnson is an example of a historical figure with a retrospective diagnosis of OCD. He had elaborate rituals for crossing the thresholds of doorways, repeatedly walked up and down staircases counting the steps, and had compulsions regarding repetitive prayer which were most likely a form of religious scrupulosity.[56][57][58]
American aviator and filmmaker Howard Hughes is known to have suffered from OCD and it is believed that his mother may have also been a sufferer. Friends of Hughes have mentioned his obsession with minor flaws in clothing and he is reported to have had a great fear of germs, common among OCD patients.[59] He did also suffer from Social Anxiety Disorder (SAD) and Post-traumatic Stress Disorder (PTSD) due to an aviation accident in which he was severely injured. This resulted in him becoming reclusive later in life.
English footballer David Beckham has been outspoken regarding his struggle with OCD. He has told media that he has to count all of his clothes, and that magazines have to lie in a straight line. If there are three soda cans in his refrigerator, he will throw one out to make an even pair, and if there are any more at home they have to be placed in a cupboard. In hotels, any books that are on a shelf must be moved into a drawer. He has also explained that his reason for getting more tattoos is that he feels addicted to the pain of the needle. He has expressed a desire to get help for his problems.[60]
American game show host Marc Summers has written a book about how OCD has affected his life. The book is titled Everything in Its Place: My Trials and Triumphs with Obsessive Compulsive Disorder.[61]
Actor, comedian and game show host Howie Mandel partially attributes his success in comedy to his ability to express himself through OCD, his unique humour manifested from his brains complex processes. Howie says his success today is attributed to the internalization of OCD or "pure O" rather than the external nature of the illness that gave him his success in comedy. He says he needs to express himself continually as this mitigates the obsession. Howie has been proactive in lobbying government to have OCD recognized by insurance companies to offer programs to cover the cost of therapy. Information taken from CBC show "The Hour" August 4 2009.
[edit]See alsoOCD Action
Basal ganglia
Dermatillomania
Monk (TV series)
Mysophobia
Yale–Brown Obsessive Compulsive Scale
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[edit]Further readingMy Worktime Routine, ISBN 1-59-113901-5, by David Vince.
Abramowitz, Jonathan, S. (2009). Getting over OCD: A 10 step workbook for taking back your life. New York: Guilford Press. ISBN 0-06-098711-1.
Beyette, Beverly; Schwartz, Jeffrey H. (1997). Brain lock: free yourself from obsessive–compulsive behavior: a four-step self-treatment method to change your brain chemistry. New York: ReganBooks. ISBN 0-06-098711-1.
Salzman, Leon (1985). Treatment of the obsessive personality. Northvale, N.J: J. Aronson. ISBN 0-87668-881-4.
Neziroglu, Fugen; Yaryura-Tobias, Jose A. (1991). Over and Over Again: Understanding Obsessive Compulsive Disorder. New York: Jossey Bass. ISBN 0787908762.
Jonathan Grayson (2003). Freedom From Obsessive–Compulsive Disorder: A Personalized Recovery Program For Living With Uncertainty. New York: Jeremy P. Tarcher. ISBN 1-58542-246-0.
Rachman, Stanley; Rachman, S. J. (2003). The treatment of obsessions. Oxford [Oxfordshire]: Oxford University Press. ISBN 0-19-851537-5.
Sharon Begley; Schwartz, Jeffrey H. (2003). The Mind and the Brain : Neuroplasticity and the Power of Mental Force. New York: Regan Books. ISBN 0-06-098847-9.
Lee, PhD. Baer (2002). The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts. New York: Plume Books. ISBN 0-452-28307-8.
Penzel, Fred (2000). Obsessive–compulsive disorders: a complete guide to getting well and staying well. Oxford [Oxfordshire]: Oxford University Press. ISBN 0-19-514092-3.
Seligman, Martin E. P. (1995). "Obsessions". What you can change—and what you can't: the complete guide to successful self-improvement: learning to accept who you are. New York: Fawcett Columbine. ISBN 0-449-90971-9.
IAN OSBORN (1999). Tormenting Thoughts and Secret Rituals : The Hidden Epidemic of Obsessive–Compulsive Disorder. New York: Dell. ISBN 0-440-50847-9.
Cooper, David A. (2005). The Art of Meditation. Jaico Publishing House. ISBN 81-7992-164-6.
Wilson, Rob; David Veale (2005). Overcoming Obsessive–Compulsive Disorder. Constable & Robinson Ltd. ISBN 1-84119-936-2.
John B. (2008). The Boy Who Finally Stopped Washing: OCD From Both Sides of the Couch. Cooper Union Press. ISBN 9780979133961.
Davis, Lennard J. (2008). Obsession: A History. University of Chicago Press. ISBN 9780226137827.
[edit]External linksObsessive Compulsive Foundation
[show]
v • d • e
WHO ICD-10 mental and behavioral disorders (F · 290–319)
[show]
v • d • e
Anxiety disorder: Obsessive–compulsive disorder
Categories: Anxiety disorders | Ritual | Anxiety | Obsessive–compulsive disorder
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