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Psychiatric Descriptions

Obsessive-Compulsive Disorder

Making lists and stringently following rules are all personality characteristics of people who are obsessed with organization and compulsive in finishing tasks. These traits are common in American culture and are often associated with occupational and economic success. Obsessive-compulsive individuals usually have usually displayed these traits since young adulthood and consider them as a component of their personality. People who display these traits are usually not distressed by them and acknowledge them as an aspect of their personalities that helps them cope with life. Having obsessive-compulsive personality traits is not considered a mental illness.

Obsessive-compulsive disorder (OCD) is an illness and a different entity than an obsessive-compulsive personality. The obsessions in OCD are unwanted, intrusive, and by no means help the sufferer cope with life. These thoughts arouse anxiety and are experienced by the patient as inappropriate, foolish ideas.

Interestingly, the obsessions in OCD tend to be similar across different cultures. The most common obsession worldwide is that of contamination. Howard Hughes, the famous American aviator, had this obsession. He would demand that all materials brought to him be wrapped in volumes of paper. The next most common obsession is that of harm. An individual will have the overbearing fear that he has done or is about to do some act to harm someone or something. An example of this obsession would be of an individual driving over an irregularity in the road and having extreme distress that he had just run over someone. The individual recognizes that this concern is senseless; that is, the sufferer knows he drove over a speed bump, yet he cannot rid himself of these thoughts. The only way he is able to relieve the thought is through the performance of a ritual.

The compulsions of OCD are the acts done to decrease the anxiety of the obsession. These acts tend to be repetitive. Common compulsions include acts of cleaning or checking. For example, the above individual who thinks that he has driven over someone may stop the car and check under it to make sure that no one has been injured. The person without OCD would then continue to drive on, with the assurance that he had not injured anyone. In contrast, a patient with OCD may have to stop his car repeatedly to check that he had not injured someone. These types of rituals may last for hours. The compulsions alleviate the anxiety of the obsession and, like the patients' perceptions of their obsessions, are known to be senseless. In OCD, the urge to carry out the compulsions is overwhelming and is difficult to resist.

OCD has been recognized since the late fifteenth century and has been considered a rare phenomenon. That is, until recently. Worldwide studies have shown that two percent of the population has OCD. A possible reason for the discrepancy is that individuals with OCD are apt to hide their compulsions from others out of shame and humiliation, as well as out of fear of being stigmatized as mentally ill. OCD patients are usually embarrassed about their symptoms, feeling frustrated that they cannot avoid and control them, and seldom reveal them unless asked. Another factor disguising the true prevalence of OCD is that, until recently, there were no effective treatments.

Fortunately, many more patients with OCD are seeking treatment, and much more information is known about the disorder today. Studies show that OCD usually presents in late adolescence and early adulthood and affects men and women equally. Once OCD emerges, are a variety of different courses for the illness to take. The symptoms may dissipate over time, wax and wane, or become progressively worse. In addition, the intensity of the obsessions and compulsions vary among patients

Over the past twenty years, there has been an explosion in the understanding of brain function in patients who have these obsessions and compulsions. Recent advances in brain physiology, immunology and brain imaging have revealed that the neurotransmitter serotonin and brain circuits housed in the basal ganglia - a cluster of neurons deep within the brain involved in the regulation of motor movements - are involved in the pathogenesis of OCD.

The neuroscience research implicating involvement of the basal ganglia is particularly interesting because this finding fits what is observed clinically about the condition. There is an increased incidence of OCD in patients who also suffer from Huntington's disease, Parkinson's disease, Sydenham's chorea, and Tourette's syndrome - which are all disorders of movement. The diseases have different causes; however, the common factor among these disorders is that they all involve the basal ganglia.

The basal ganglia, in addition to regulating motor control, has been recently found via neuroscience research to be involved with planning movements and digesting and storing new rules via its connections with higher areas of the brain. This expanded understanding of the function of basal ganglia has led to the current theory for OCD that states there is a dysfunction in the ability of the basal ganglia and its connections to regulate rules and movement; that is, there is a disturbance between the areas of the brain that control reason and the basal ganglia which can store rules and help control behavior. This explains the higher incidence of OCD seen in these disorders involving the basal ganglia and has led to a new understanding of why certain treatments for OCD are successful.