OVER AND OVER AND OVER AGAIN


OVER AND OVER AND OVER AGAIN
INTRODUCTION
We all have traditions and a certain way we
like to do things. And those traditions become a part of our lives. If we skip
or do not do them we feel as if something is missing. However., when the
traditions become so ingrained that we must do them over and over again or we
feel that something bad is going to happen we may have crossed the line into
OCD. Obsessive Compulsive Disorder is an anxiety-based disorder. Millions
suffer form it in silence and many do not know there is treatment available.

Medical science has advanced so much in the last few years that there is now
treatment or OCD that works better than ever before. A combination of
medication and behavior therapy can allow someone previously trapped in a
private hell with COD the freedom of a normal and full life(Lee, 1996).
HOW IT WORKS
One of the problems with OCD is that it
manifests itself in so many ways, those who suffer with it can go years before
being properly diagnosed and treated.
There
is no welcome mat at the door of Connie Foster’s home in Ellsworth, ME. Not
that she wouldn’t love to have you over for dinner. It’s just that she fears
you’ll contaminate her house. For many years now, not a soul has been allowed
past this portal except Connie’s husband and three sons – and she’s shaky about
them until they’ve washed. No friends, no family, no FedEx or Domino’s Pizza
deliveries – not even a beloved brother who came to visit from Singapore.

Please understand: Connie is not a hermit. She can go out – to restaurants and
shops, on planes, trains, and buses – but nobody else can come in. Her mother-
in-law once tried to defy this canon, marching into the living room with a
force of will and reason. Connie cleaned for the next 24 hours(Lee, 1996).


Current research indicates there are
approximately three to five million Americans suffering from Obsessive
Compulsive Disorder. (OCD). That figure
is only an estimate and may be low because OCD can go widely unreported and
does. Those who have it dont always know to seek help and some are afraidto
tell anyone what is happening to them therefore they do not receive diagnosis
or treatment(Lee, 1996).
The
Obsessive- Compulsive Foundation, a nonprofit group in Milford, CT, estimates
that the average patient waits 17 years before getting any appropriate help,
and nine out of 10 people with OCD are not in treatment. “It tends to be a
secretive disease,” says Scott Rauch, M.D., a psychiatrist at Harvard
Medical School and Massachusetts General Hospital in Boston. “People know
that it is obsessive and compulsive and kind of crazy, but the drive is just
too strong to stop(Lee, 1996).”
People who have OCD have recurring
thoughts or obsessions that can be relentless. The thoughts can be about
anything from religious questions to thinking others are talking about
them.
The difference between desires and
compulsions is that the person who performs the act gets pleasure form a desire
to perform the act. The person who does it out of OCD gets no pleasure form it
and must do it or they will be driven to distraction until it is done.
The French refer to OCD as the doubting
disease(Lee, 1996). The reason is that those who are afflicted know logically
that they have obsessions or compulsions however they still cannot stop the
need to perform compulsive acts or obsess over thoughts. These can range form
simply having to touch ones nose before eating to believing they just hit and
killed someone with their car and having to go back again and again in a frenzy
to get out of the car and search for the body(Lee, 1996). They tell themselves
there is no body, they cannot find a body, and they did not feel a hit yet they
have an uncontrollable urge to look for the body(Lee, 1996).
You’re
sure that you didn’t hit a pedestrian with your car, but you return to the
intersection again and again for hours(Lee, 1996). People with OCD often have
perfect clarity about their intrusive thoughts and bizarre actions – they
acknowledge the inconsistency of being able to breathe the recirculated air in
a 747 yet finding it necessary to bar guests from their own home(Lee, 1996).

They do things the rest of us do – they might use a paper towel to grasp the
doorknob in a public restroom, or have a lucky number, or worry that they didn’
t lock all the windows and turn off the stove(Lee, 1996). It’s just that their
dread has a hair-trigger onset, and the response that feels so compelling takes
over their lives(Lee, 1996).


The people who have the disorder often
describe it as one part of the brain having its own thought process. The one
part is having OCD while the rest of the brain is screaming shut up, shut up!
Until recent years OCD was discussed and
believed to be related to the Freudian terms and conditions. “Freud believed that all behavior
represented blocked or repressed drives, usually of a sexual nature, “
explains David Comings, M.D., head of medical genetics at City of Hope National
Medical Center in Duarte, CA. “In one explanation for OCD, a man who kept
going back to lock the doors or check the gas really wanted to do away with a
burdensome wife and children(Lee, 1996).”
Today the experts believe that there is a
genetic link to OCD , or at least a predisposition to the disorder(Lee, 1996).
Unitl
recently we were unable to conduct advanced brain studies on live sufferers of
OCD but because of the advanced technology available to the medical community
we now know that OCD brains show a different level of neural activity in
certain parts of the brain(Lee, 1996).
“People
sit in the scanner and do specific tests having to do with motor movement or
memory or paying attention – tasks that activate the brain circuits we’re
interested in. A good analogy is a cardiac stress test: If I have a perfectly
functioning heart and an older man has heart trouble, our EKGs may look the
same when we’re both lying down, but that changes with exercise(Lee,
1996).”
Many experts
now believe that the actual origin of
OCD is a chemical process of the brain. They think the chemical called
serotonin is involved. This is the same chemical that we now know is in short
supply in people who suffer from depression(Lee, 1996).
Experts believe also that dopamine is
involved which is the chemical in the
brain that handles pleasure with eating , sex attention and other positive
things(Lee, 1996).
“There
are certain centers in the gray matter that are perpetually firing,”
explains Lewis Baxter, M.D., professor of psychiatry and pharmacology at the
University of Alabama in Birmingham and at UCLA. “There’s a circuit that’s
literally a loop in the brain between its neurons, and it’s like a broken
record(Lee, 1996).” In pictures produced by the PET scan, this circuit in
the brain of a normal person looks like Podunk, IA, on a school night, while in
the brain of an obsessive-compulsive it looks like Las Vegas(Lee, 1996). In her
groundbreaking book The Boy Who Couldn’t Stop Washing (Plume), Judith Rapoport,
M.D., chief of the child psychiatry branch at NIMH, defined OCD as a hiccup of
the mind(Lee, 1996).


HISTORY
OCD may have only started receiving
attention lately but its symptoms have been documented for many years. In 1890 a doctor made one of the earliest
records of its strange manifestations when he recorded a 13-year old girl who
would lift each foot and tap it nine times on the edge of the bed. He went on
to document her need to count to 100
each time she brushed her teeth and that she had to knock three times in a
nearby window each time she reached a door(Lee, 1996).


The
children treated by Rapoport and her colleagues are some of the most
heartbreaking victims. One nine-year-old boy at NIMH was convinced that
martians were putting thoughts in his head. About 20 percent of the pediatric
cases have a close relative with OCD, and although it may show up in a
different way, this does support the genetic-link theory. A child who needs to
touch every tree and lamppost on the way to school may have a parent who
scrupulously avoids the word death when reading the newspaper, afraid of contaminating
the future with eyes that have beheld such a terrible word. A child with OCD
might do such things as tear toilet paper into tiny pieces or spend hours
aligning his toys rather than playing with them. The symptoms wax and wane over
time, fluctuating in severity and expression(Lee, 1996). Childhood washers or
counters may grow up to be adult checkers or repeaters. But there’s a
difference between OCD and normal childhood rituals – say, reading Good Night,
Moon 14 times – just as there’s a difference between what Susan Swedo of NIMH
calls cocktail party OCD and the real thing. “All of us worry about germs
and check on things,” she says(Lee, 1996). “But if you were miles
away from your house, you’d probably say, ‘Oh, I’m sure I did turn off the gas
and lock the door.'” And most of us wouldn’t return home 50 times to make
certain of it(Lee, 1996).


TREATMENT
In recent years medical advances have come
a long way in the treatment of OCD. Now with a combination of medications and
behavior therapy many ocd patients are leading full productive lives either
free of all symptoms or in a position to not have them interfere so drastically
with their lives.
There are several drugs which have been
found to be useful with OCD. Proac, Luvox and Anafranil are three of the most
popular choices among the medical profession in the treatment of OCD. In addition to medication many try
behavioral therapy. They are exposed to increasing levels of triggers and
taught to recognize and ignore those triggers.


There are those who respond really well to
drug intervention, those who respond well to behavior modification and those
who do not respond to either.
Perhaps
the most intriguing bit of news emerged in 1994, when doctors at Yale collected
spinal fluid from people with OCD and found an elevated level of oxytocin, a
hormone involved in the uterine contractions of women in labor and the release
of milk in nursing mothers. “We had to ask, What on earth does OCD have in
common with maternal behavior?” says James Leckman, M.D., a psychiatrist
at the Yale Child Study Center and its OCD Clinic. “The answer is that the
initiation of maternal behavior is a time when women are totally obsessed and
preoccupied with the new baby. With OCD it’s almost as if there’s an inappropriate
clicking-on of that same switch, when women are caught up in the first phase of
mothering. It turns out that some women have postpartum depressions where the
intrusive thought is that they’ll do something to injure the baby, which is
close to a form of OCD.” The research is continuing, but slowly:
Unfortunately, measuring the amount of oxytocin in the blood is not a good
indication of what’s going on in the brain, and there aren’t a lot of people
volunteering to have their brain examined for research.


the
drug Paxil was recently approved by the FDA in the treatment of OCD. Clinical
studies showed that the patients who took it had far fewer obsessions and compulsions than those who took a
placebo(New, 1999).
Recently in San Francisco OCD gained national notoriety when an woman
filed suit because she was fired. She has OCD and has to primp so much in the
morning she is frequently late for work. She won the right to sue and prove
that she is in fact disabled. When the suit is over, if she won. It will open
the door for millions of sufferers to be protected under the federal disability
act(Davis, 2001).
CONCLUSION
For millions of OCD patients across the nation there is now
hope. With new drugs hitting the market every day that will alleviate symptoms
and the need to obsess those who suffer form the disorder are finding tremendous
relief. A combination of behavior therapy and drug treatment seems to work for
many. As we head into the new millennium we will continue to study the cause of
OCD . Until we find and fix the cause however, it is exciting that we now have
tools to curb or obliterate its symptoms.
REFERENCES
Author not available, New
Drugs/Drug News: Psychotherapeutic Drugs. Vol. 23, Physician Assistant,
09-01-1999, pp 83.


KAREN A. DAVIS, Associated Press Writer, Obsessive Primper
Wins Appeal. , AP Online, 03-23-2001.


Lee, Jonathan, Smith,. Karen, Joseph, Martin. The World of
OCD, The Journal of Disorders. (1994):
June