Montreux School of Business

Obsessive Compulsive Disorder

Montreux School of Business

 

 

 

 

 

 

Dauren Iskakhov

First Draft

Obsessive Compulsive Disorder

Prof. Daniel Sciboz

 

 

 

 

 

 

 

Montreux 2013 

Obsessive Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational – but even so, you feel unable to resist them and break free. Many people associate repeated washing of hands, or flicking of switches, and even cleanliness with Obsessive Compulsive Disorder (OCD), however there are many more symptoms, and there are also explanations for those symptoms.. “Obsessive-compulsive disorder (OCD) consists of two behaviors that occur in the same person, obsessions and compulsions.” (Garrett, 387)

Obsessive Compulsive Disorder is a form of an anxiety disorder. The WHO classifies OCD as one of the top ten most “disabling illnesses.” (The Practitioner, 1) The most well-known side effect of OCD is the repeated washing of one’s hands. However, there is more to this compulsive hand washing then meets the eye. While it could technically be classified as a need to feel cleansed, it is actually more of a fear of germs or other impurities. The cleansing will proceed until the person is satisfied, which in some cases is never. This is the reason a person with OCD will wash their hands repeatedly. People with OCD also are known to have a fear of unlucky numbers or words, illness or injury (which relates back to the hand washing), uncertainty, thinking bad or harmful thoughts against someone, object symmetry, and many other issues, which to a non OCD person, seem almost miniscule.

How is it possible for people to get OCD? It is not something that can be transmitted from person to person, like a virus or the common cold, but rather it is a chemical imbalance in a person’s brain, and it is genetically transmitted. Scientists know that there are certain genes that cause this disorder, but as of now, they haven’t been able to pinpoint the specific gene. It is believed that OCD is caused as a result of a problem with the chemicals that deliver nerve cells to the brain. When the nerve cells are unable to reach the brain, or there are not enough delivered to the brain, the person can begin to dwell on certain things, leaving them with a feeling of doubt and worry. There are some rare cases, where young children get OCD when they are recovering from Strep Throat. While this is extremely rare, the symptoms appear out of nowhere, and are extremely severe.

Obsessive compulsive disorder was touched upon by Sigmund Freud in 1909. In “Notes upon a Case of Obsessional Neurosis”  Freud described a patient he had named “Rat Man”, who was a young man with a fairly well versed education. “Rat man suffered from blasphemous and sexual obsessions and vivid, recurring images of rats devouring him and his father.” (Summers, 54) Freud believed that the above listed symptoms were a result of failure to have been properly toilet trained, and also a form of the Oedipus complex.

While today, Freud’s theory behind OCD has been completely disproved, that was one of the first documented cases of the disease. According to Marc Summers’ book Everything In Its Place, doctors are better at treating cases of OCD, then they are with understanding it. In 1986, doctors prescribed Anafranil on people with diagnosed OCD. This was extremely important, not because the drug made the symptoms disappear (which it did not), but because some patients symptoms greatly diminished, and doctors learned that OCD is in fact treatable by medication. This discovery came at an ideal time, as it had recently been discovered that OCD was twice as common as ‘psychiatric disorders of schizophrenia’, bipolar disorder, and panic disorder. All of those disorders are present in approximately one percent (1%) of the United States population. According to Marc Summers, “Two to 3 percent of Americans have OCD.” (Summers, 55)

There have been recent studies that show that medication is a step in the right direction as far as making the disease more manageable. However, in some cases medication is not enough. In the study done in November of last year, the subject, eleven year old Abigail displayed classic symptoms of Obsessive Compulsive Disorder. She was afraid of germs, and as a result, she changed her clothes and washed her hands frequently. She was medicated for a little over a year, when her body seemed to develop a tolerance to the medication and the symptoms prevailed. In this case, Abigail would need to take a more serious approach to ridding herself of her obsessive compulsive symptoms. These approaches might include behavior therapy, or constant monitoring at a facility. (Nangle, O’Grady, Sallinen, 1442)

In another study conducted by the American Academic Child Adolescent Psychology Journal, the drug fluoxetine was tested on OCD sufferers. This was a fairly successful study, as the majority of subjects on medication had drastic improvements in their OCD symptoms. No subjects were forced to stop taking the drug due to adverse reactions, and even after sixteen weeks (four months), there continued to be positive results stemming from the drug. (Multiple Authors, Journal of Academic Child Adolescence Psychiatry 1438)

You just read that OCD was discovered to be a treatable illness; here’s a brief look at how. The Anafranil manipulated the body’s serotonin levels, and this in turn caused the symptoms of OCD to diminish. Therefore, scientists assumed that the cause of obsessive compulsive disorder had something to do with this chemical makeup. A neuron consists of a cell body, and a lot of tentacles. The longest tentacle is the axon. The synapse is the gap between two axons. Impulses are generated in the cell body, and then arrive at the tip of the axon. This forms an impulse, which then gets turned into chemical messengers called ‘neurotransmitters’. These neurotransmitters get released into the synapse. Then, the neurotransmitters cross the synapse and stimulate the receptors on the neuron that is receiving the impulses. This process repeats over and over, and at times, the impulses are traveling at speeds of over 200 miles per hour.

Serotonin has many important roles. Not only does it assist in allowing our nerve cells to communicate with each other, but it also regulates anxiety, sex drive, mood and appetite. More importantly, it assesses danger around the body, and fires its neurons accordingly. However, in people with OCD, the receptors that serotonin stimulates after it crosses the synapse are overly sensitive. This means that the brain has an exaggerated response to serotonin. Doctors believe this is partially responsible for the feelings of danger that OCD people experience. (Garrett, 388)

Here is another explanation. In laymen’s terms, “a particular neural pathway is overactive.” (Carter, 60) More specifically, the neural pathway is the one that goes from the frontal lobe to a part of the basil ganglia. The part of the basil ganglia is called the caudate nucleus. This is connected to something called the ‘putamen’, and combined, the two develop as one in the embryo. The putamen is mostly intertwined with the premotor cortex, and the caudate nucleus is mostly connected to the frontal lobes. The frontal lobes are where such processes as thinking, assessing, and planning take place. The caudate nucleus is the part of the brain that tells people to wash themselves when they are dirty, and reminds people to lock their house before they leave. When both the putamen and the caudate nucleus are working in unison, a person will automatically recognize if something is not right (a door being unlocked, or the oven being left on).

This recognition is due in part to one specific area of the frontal cortex. It is located directly above a person’s eyes in the orbital cortex. It is this area that acts as a security system, becoming more aware when things don’t seem right. In people with OCD, this part of the brain is constantly sending alerts that something isn’t right. (Garrett, 388)

The cingulate cortex is the part of the brain that is responsible for interpreting conscious emotions. In OCD people, the cingulate cortex exhibits great deals of emotional discomfort, which causes the orbital cortex to assume that something is awry.

The only way a non OCD person can simulate these same symptoms would be for them to over focus on a certain catastrophe, such as their house being on fire with their family stuck inside the burning building. However, if after thinking about such an awful thought as someone’s house burning down, or the death of their family, a researcher says to stop thinking about that and move on, a non OCD person will not have much of a difficult time. A person with OCD on the other hand, will continue to think about these events. When examining the brain of an OCD person, their orbital frontal cortex is still under the assumption that something is wrong.

Experts also believe that OCD comes from a problem with the way the mind handles messages about fear and doubt. They think this problem has to do with the chemicals that carry messages to nerve cells in the brain. If the flow of these chemicals gets blocked, or if there is not enough of them, messages about doubts and worry seem to get stuck; This leaves a person with a feeling that something's not right and makes lots of worrisome thoughts.

In people without OCD, the person is able to differentiate between their obsessions and their compulsions. However, a person with OCD is more likely to act both on their obsessions and their compulsions. This would explain the common cliché of a person washing their hands repeatedly until they feel cleansed. While a ‘normal’  person would know that while they wish to be clean, repeated washing is unnecessary, a person with OCD cannot distinguish the obsession from the compulsion, and as a result, ends up washing their hands over and over again.

Sufferers of OCD differ from “normal” people in that they cannot stop thinking about something, which is why they repeat certain actions. Non-OCD sufferers on the other hand are capable of seeing something, and being satisfied with it. They don’t feel the urge or compulsion to keep checking or worrying about anything.

As mentioned earlier, behavior therapy is sometimes beneficial for OCD sufferers. It is usually an intensive program that lasts for at least a week, but usually longer. It requires OCD sufferers to face their fears and learn first-hand that there is nothing to worry about. This cognitive behavior therapy (CBT) is most effective if the person receiving the treatment has an open mind. This therapy is extremely difficult for OCD sufferers, and it has a high dropout rate; sometimes as high as fifty percent. (Lippincott/Williams & Wilkins, 2003)

Trichotillomania is a theme that is closely associated with obsessive compulsive disorder. Simply put, it is when a person feels compelled to keep pulling out their hair. It is believed that OCD is thought to be the cause of about half of all trichotillomania cases. A lot of OCD sufferers are hypochondriacs, which means that they fear that something is wrong with the way that they appear. This would explain their compulsion to alter their appearance by pulling out their hair. (Carter, 60)

There was a study performed by the World Health Organization Collaborating Centre for Mental Health and Substance Abuse a few years ago. The patient, Michael, was a self-proclaimed worrier. He constantly worried about whether or not he had turned off any and all electronic appliances in his house, as well as if he had locked the doors and windows. He felt that by not locking up or turning off appliances, bad things could happen to himself and his neighbors. When he was 18 years old, he used to call his house and ask whoever was home if they could check to make sure that all of the appliances had been turned off. In order for Michael to be satisfied that the stove was off, he would have to keep his hand over each burner for 10 seconds to prove to himself that it was cool to the touch.

When Michael lost his job, he became depressed. His therapist put him on an experimental drug called clomipramine. The clomipramine was both for his obsessive behaviors as well as his depression. Due to negative side effects, Michael was forced to discontinue the clomipramine. He did however keep seeing his psychiatrist for approximately six months. He stopped the sessions because while his mood had improved, his obsessive behaviors had not. (World Health Organization Collaborating Centre for Mental Health and Substance Abuse, 1995, 1997, 1999)

Another case study involved a patient named Stephanie. Stephanie was a housewife and a new mother. She was afraid that her newborn son would be kidnapped, and therefore rarely took him out of the house. When she did take him out of the house in her car, she nervously watched him at every stop sign and traffic light to ensure that no one would attempt to snatch him while her car was stopped. In her house, she would lean objects up against doors with hopes that she would hear them if an intruder tried to enter.

Since the birth of her child, Stephanie had become extremely conscious of germs. As a result, she kept her house extremely clean at all times to avoid contaminating her son. She was also a compulsive hand washer. Stephanie is rare in that she is aware that her actions are obsessive. It is because of this that she sought the help of a psychiatrist.

Her psychiatrist calls Stephanie “OCD galore”, because she exhibits so many different symptoms. Her psychiatrist is helping Stephanie to overcome her compulsive actions by confronting them. Part of her therapy requires her son to touch the dirty wheels of his stroller with his clean hands. Between the therapy and her extremely supportive husband, Stephanie is able to lead a relatively normal life. (BBCi Science and Nature: Human Body)

When one person in a family has OCD, the entire family suffers tremendously. To combat this, the Journal of Academic Child Adolescence Psychiatry published a study dealing with cognitive-behavioral family-based therapy, or (CBFT) for short. To briefly summarize, CBFT can be just as effective as individual treatment, and as the study shows, the were positive throughout the entire study. The study itself lasted for six whole months and studied seventy-seven children. This can be the little bit of optimism that families of OCD sufferers need. It shows the individual how to overcome their OCD, and it shows the family how to help that person overcome their OCD. (Barrett, Healy-Farrell, March, 46)

While OCD is somewhat uncommon, there are quite a few celebrities who suffer from it. For example, radio disc jockey Howard Stern says that his OCD was once so severe, that before each radio show that he broadcasted, he would bang his head on the studio wall a certain amount of times.(Summers, 27) Other famous celebrities suffering from the disorder include Kathie Lee Gifford, Donald Trump, Cameron Diaz and Howie Mandel. Cameron Diaz told Time Magazine that she opens up door handles with her elbows in order to avoid germ infested knobs. Actor, talk show host, comedian, and frequent guest of the Tonight Show with Jay Leno, Howie Mandel suffers from severe OCD. His fear of germs is so severe that he built a full sized house directly behind his existing house, and fully furnished it. Whenever someone in his house is sick, he goes to live there until they’re better. This way there aren’t any ‘sick germs’ in his presence.

Hitting more close to home, my girlfriend’s mother has severe OCD. This is why I’m writing this paper on OCD; I wanted to become more knowledgeable about the disease. Her mother had set up ‘clean’ and ‘dirty’ parameters in their old house. When a person entered the house, they entered the ‘dirty area’. In order to cross over to the ‘clean’ area, they had to take a shower. And even showering had a certain procedure. They had to enter the tub on one end, and exit on the other, using utensils to turn the faucets on and off. If something was left on the dirty side, the only way to get it would be to cross over, and be forced to shower again.

Her mother would buy food, but unless she washed it off, it wasn’t edible. Her mother was the only one who would be allowed to prepare food, do the laundry, and do the cleaning. It was really an unfortunate situation, and since they’ve moved to a house which someone had lived in before, her condition has improved. Apparently, because they were the original owners of their previous house, her mother wanted to keep things as clean as possible, since that’s how things were when they had moved in. She had gone to a therapist, but stopped. She also stopped taking her medication, and as a result, her condition is worsening. She cannot work, and rarely leaves the house. 
To conclude my paper, I’ll recap everything that I’ve discussed. OCD or Obsessive Compulsive Disorder is a disease that causes people to have obsessive tendencies, and unless the disease is recognized and treated, it can be detrimental. It was discovered in the mid nineteen eighties that OCD is a treatable disease. Since that discovery, great advances in modern medicine have helped to create drugs to help a person to overcome their obsessive and compulsive tendencies. 
 
As some of the studies mentioned above have shown, medication can be an effective tool in combating obsessive and compulsive symptoms. Another effective tool is the cognitive-behavioral family based programs. This program shows family members living with OCD sufferers how to stay sane as well as help the person in need. While there is no ‘miracle pill’ or ‘cure’ for OCD, medication is the closest one can come to being symptom free.

Each person has different ways of expressing and dealing with their OCD. Some people are compulsive hand washers, others are afraid of leaving appliances on, and some people are so afraid of germs that they will leave a contaminated area until they feel it is clean. While OCD is a crippling disease, it is treatable, and a person suffering from it can still lead a normal and healthy life. 

 

 

 

 

 

 

 

 

 

 

Works Cited

 

Garrett, Bob (2003). Brain and Behavior. California: Wadsworth/Thomson Learning 
 
Carter, Rita (2000). Mapping the Mind. California: University of California Press 
 
Summers, Marc and Hollander, Eric (2000). Everything in Its Place: My Trials and Triumphs With Obsessive Compulsive Disorder. New York: Penguin Putnam Inc. 
 
The OCD Foundation, retrieved April 4th, 2004 from http://www.theocfoundation.org 
 
World Health Organization Collaborating Centre for Mental Health and Substance Abuse, retrieved April 5th, 2004 from http://www.nelmh.org/page_view.asp?c=4&fc=007003003&did=546 
 
BBC Interactive (BBCi) Science and Nature:Human Body and Mind, retrieved April 5th, 2004 fromhttp://www.bbc.co.uk/science/humanbody/mind/articles/disorders/gallery/gallery_case4.shtml?disorder=4&submit.x=5&submit.y=10 
 
Nangle, Douglas W., O’Grady, April C., Sallinen, Bethany J., Successful Medication Withdrawal Using Cognitive-Behavioral Therapy for a Preadolescent with OCD. Journal of Academic Child Adolescence Psychiatry, 43:11, 1441-1444. November 2004. 
 
Multiple Authors, Fluoxetine in Children and Adolescents with OCD: A Placebo Controlled Trial. Journal of Academic Child Adolescence Psychiatry, 41:12, 1431-1438. December 2002. 
 
Lippincott/Williams & Wilkins, American Academy of Child and Adolescent Psychiatry., Retrieved April 2005. 
 
Barrett, Paula, Healy-Farrell, Lara, March, John. Cognitive-Behavioral Family treatment of Childhood Obsessive-Compulsive Disorder: A controlled Trial. Journal of Academic Child Adolescence Psychiatry, 43:1, 46-62. January 2004 
 
The Practitioner, 181-183, March 2002.

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