- The Washington Times - Monday, February 26, 2007

Imagine hoarding so many newspapers and magazines that an extra shed would be needed to store them. Or washing the hands so many times that the skin cracks and bleeds. Or taking a two-hour shower to be clean enough. Or hitting a bump in the road while driving and stopping to check if the car hit a person.

These are not unrealistic scenarios for people suffering from obsessive-compulsive disorder, says Jerilyn Ross, president and chief executive officer of the Anxiety Disorders Association of America in Silver Spring. She is director of the Ross Center for Anxiety and Related Disorders in Northwest.

“Someone with OCD thinks, ‘If I wash my hands one more time, they will be clean,’ ” Ms. Ross says. “They walk away and think, ‘Did I get it clean enough?’ They say, ‘How do I know I got it clean enough?’ There is an urge or itch to do it again and again.”

Obsessive-compulsive disorder includes recurrent unwanted thoughts and repetitive ritualistic behaviors. One in 50 adults have obsessive-compulsive disorder, and twice that many have had it at some point in their lives, according to the Obsessive Compulsive Foundation in New Haven, Conn.

“For some people, it’s a nuisance, and it’s annoying to them and people around them, but they are still able to function, but they do so with a lot of anxiety, embarrassment and frustration,” says Ms. Ross, a licensed independent clinical social worker. “Other people might spend the entire day cutting things out and saving things.”

Symptoms of obsessive-compulsive disorder include continual washing and cleaning, checking of themselves or others to avoid harm, repeating a sequence or phrase and hoarding useless items, Ms. Ross says. One of her patients moved into a house and couldn’t unpack any of the boxes.

People who think they may have the disorder can take a test at the Web site (www.rosscenter.com/anxiety_disorders/obsessive_compulsive_disorder/quiz).

Recent research shows that the disorder may be genetic, says Dr. Joseph Bienvenu, assistant professor of psychiatry at Johns Hopkins University School of Medicine in Baltimore.

If a person comes from a family with obsessive-compulsive disorder, the person is more likely to have the disease, he says. Further, studies of twins suggest that the disorder runs in families because of genes, not environment. If one identical twin has the condition, the other twin often does as well. Identical twins match more than fraternal twins in having obsessive-compulsive disorder.

“We are trying to find the genes for obsessive compulsive disorder,” Dr. Bienvenu says. “Since there is evidence that genes are important, we are doing studies in regions of the human genome to find the genes.”

Although the disease seems to be genetic, a stressful situation could trigger the symptoms, he says. Obsessive-compulsive disorder can be associated with secondary conditions, such as depression and other anxiety disorders.

Obsessive-compulsive personality traits also run in families of people with obsessive-compulsive disorder, such as being a perfectionist, working too hard, being overly conscientious, being rigid and extremely detail-oriented, he says. Having one condition does not mean that a person will have the other, but it is possible.

Typical treatment for obsessive-compulsive disorder includes meeting twice a week for three weeks for double sessions, Ms. Ross says. At the beginning of therapy, intensive treatment is most effective. Patients take a test to determine their strongest obsessions and compulsions. A hierarchy is created to treat the most difficult symptoms. Depending on how hard patients are willing to work and how willing they are to give up the obsessions will affect the quality of recovery.

“Sometimes the worse the disorder, the better the patient does in treatment,” Ms. Ross says. “It’s just created so much havoc in their lives that they do everything possible to treat it.”

In most instances, the person is exposed to their fear and given techniques to guide their response, usually during a visit to the home, she says. The therapy is called response-prevention therapy, where patients are encouraged to confront the anxious feelings, but not give in to doing the compulsive behavior associated with it.

“We teach people to take small steps, even though the feeling of discomfort still exists,” Ms. Ross says. “Take one pile, or one magazine, or even one page of a magazine and throw it out. We teach people what to do when the anxiety is coming up and how to ride through it like a wave.”

If underlying stressors are causing illness, they need to be identified for a complete treatment, says Dr. Karen Johnson, associate chair of the department of psychiatry at Washington Hospital Center in Northwest.

Also, if behavioral therapy doesn’t fully help the patient, medication should be considered. Selective serotonin reuptake inhibitor drugs, such as Prozac, are usually used to treat obsessive-compulsive disorder. Patients shouldn’t be embarrassed to take medication for the illness, she says.

“No one wants to admit that there is something wrong. No one wants to admit they are having constant preoccupation,” Dr. Johnson says. “The longer it goes untreated, the harder it is to get it under control and [it] impairs the person’s ability to function.”

Recent neuroimaging studies have shown that there is a dysregulation of circuitry from the cortex to the thalamus region of the brain, says Dr. Noori Mirmirani, director of behavioral services at Inova Alexandria Hospital and Inova Mount Vernon Hospital in Alexandria.

When medication is used to treat obsessive-compulsive disorder, the high level of activity seems to diminish to normal level in neuroimaging tests, he says.

Friends or family members of people who could be suffering from obsessive-compulsive disorder should refer them for treatment, Dr. Mirmirani says. Telling the person over and over again that “everything is going to be OK” isn’t going to fix a circuitry problem in the brain.

“If you are about to hurt yourself or you can’t sleep, you need to seek treatment so you can function normally,” Dr. Mirmirani says. “If you check the lock on your door one or two times before you go to bed, you don’t need treatment. If you check it for two hours, you need treatment.”

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