Coping with obsessive-compulsive disorder.

Millions deal with a disorder that makes their daily life Frustrating and frightening. The good news is that Treatment is available. Here's what you need to know.

Disorder

Sarah,(*) 24, wakes up every morning and immediately taps seven times on the edge of her bed; she's compelled to perform this ritual like clockwork, out of fear that if she doesn't, something terrible will happen to her or her family. Seven is Sarah's safe number; she eats her meals only at 7:00 a.m. or 7:00 p.m., repeats words compulsively under her breath seven times in a row, and on the rare occasions she gets up enough courage to leave her apartment, Sarah paces herself frantically to be sure she takes exactly 77 steps to reach the corner store. Sarah also lives in fear that she has contracted AIDS and can spread it to others, even though she's never been sexually active.

Sarah is suffering from obsessive-compulsive disorder (OCD), a frightening and frustrating biological affliction that afflicts an estimated 2 percent of the United States population with varying degrees of severity. You may have become aware of OCD through the recent Oscar-winning film As Good as It Gets, in which Jack Nicholson plays a New York writer struggling to deal with the disorder and its isolating effects. In the film, as well as in life, OCD patients grapple with unrealistic levels of anxiety. The condition is characterized by involuntary patterns of behavior. An OCD sufferer feels absolutely compelled to perform a certain action or series of actions over and over, perhaps constantly--which could mean doing so thousands of times a day--in order to gain comfort over their anxiety.

The compulsions that are symptomatic of OCD may include:

* Counting, in which a person may become fixated on a particular number, as Sarah is with the number seven, and will continually perform actions that certain number of times;

* Checking, in which a person feels a gnawing worry that something has been forgotten or "missed" (such as leaving a stove burner on at home, which would burn the house down, or running over someone with a car unintentionally);

* Washing or showering obsessively to combat germs and contamination, or cleaning house frenetically;

* Repeating a word or phrase again and again;

* Making sudden movements such as Sarah's 77 steps, or perhaps touching surfaces continually, groping the air, swinging the arms and legs, etc.;

* Imagining recurring images of tragedies, such as train wrecks or plane crashes, a sufferer may become convinced he or she has actually seen;

* Arranging papers or items on a table until they are at the "perfect" angle; or worrying excessively about disease, as Sarah does about AIDS, and being consumed with the guilt of potentially infecting others.

Sarah's problem first became apparent when she was 21, a typical age for the onset of OCD symptoms. "I needed reassurance constantly from my mother," Sarah relates. "I asked her over and over if it was really possible that I had AIDS. She told me no, but I couldn't relax. I started calling AIDS hot lines for information constantly, but then I could never believe what the experts told me either." Indeed, once an OCD sufferer has gotten verbal reassurance, it's a short-lived respite; soon any logical confirmation that the OCD compulsions needn't be repeated is doubted by the sufferer, and it's back to performing rituals. Chronic uncertainty is a tough complication to OCD.

Why does a person develop OCD?

Scientific research points to an abnormal function in particular sections of the brain. The brain chemical serotonin, which facilitates mood and behavior, acts as a "messenger" throughout sections of the brain itself; an imbalance of serotonin may very likely provide root cause to OCD. Additionally, scientists are looking into strong genetic links that would point to OCD as an inherited disorder. Environmental and social stresses, as well as childhood trauma, are also contributing factors.

How can a person with OCD treat their problem?

First, no one can be expected to tackle fixing it alone. People with OCD lack the objectivity and information to deal with this multifaceted disorder effectively. It is completely wrong to think of OCD as a habit to be broken. You can't "quit" OCD as you would smoking, nail-biting, or overeating; quality professional help is necessary to quell the disorder's impulses, and treatment consists of medication, behavior therapy, or a combination of both.

Dr. John H. Griest, currently working with the Madison Institute of Medicine in Middleton, Wisconsin, is an internationally renowned expert on obsessive-compulsive disorder. Dr. Griest is currently pioneering computer-assisted behavior therapy for OCD patients. He is also sympathetic to the plight of those initially dealing with the realization that they have OCD, to the possibility they'll feel fear and shame.

"It's probably a relief to realize that you're not alone," Dr. Griest offers supportively. "OCD is remarkably common, but hidden because sufferers are embarrassed about having thoughts they view as silly or goofy or dumb. They're worried other people will detect their rituals."

Indeed, OCD patients have no reason to feel hopeless about their condition. "This is a good disorder to have, among the maladies that humankind can suffer, because OCD is highly compatible with functional life. But it needs treatment," Dr. Griest urges.

So how do you know if OCD is interfering with your functional life?

Basically, if you are not overly inconvenienced by double-checking if you locked the door when you honestly doubt whether you need to, OCD is not a problem. If you spend a great deal of time either carrying out repetitive tasks or worrying about them, take notice, though; OCD is a progressive disorder in that its symptoms tend to worsen and intensify as time passes. Sooner or later you may reach a point where living in a box can no longer be tolerated.

Sarah could no longer read a book or visit with friends without her rituals plaguing her. "After a while I was having constant panic attacks, my heart raced, and I'd lie on the living room sofa just waiting to go into cardiac arrest or something," she says. "That was rock bottom for me. I called our family doctor."

This is a good start; your general physician can examine you to rule out any medical difficulties and perhaps refer you to a specialist if OCD does seem to be the issue.

Once an OCD sufferer is under the supervision of an informed and appropriate doctor, the specifics of controlling the disorder can be decided. There's no single treatment plan for every patient. Some people may find that medication on its own will be sufficient to gain relief from their symptoms. Drug therapy is best thought of as insulin would be for a diabetic--if the patient is diligent in taking his or her medicine each day, OCD may be completely held at bay; of course, by the same token, if one were to stop taking their medicine, the symptoms of OCD would return.

Five medications are used to treat OCD, through increasing the transmission of serotonin through the brain. Review individual medication options with your physician to determine if one may be right for you.

In terms of behavior therapy, a doctor may introduce one or several possible techniques to help a patient. "Flooding" means intensely exposing a patient to stimulus that brings on anxiety and compulsive actions. Flooding in theory may then speed up the patient's improvement in dealing with his or her compulsive actions. It's a heavy-duty technique, but if a patient is prepared to deal with its effects, it can work. In-depth analysis between doctor and patient in regard to identifying specific "triggers" that bring on OCD--the people, places, and situations that cause compulsive actions--is another therapy technique that may produce good results.

Of great encouragement is the fact that up to 90 percent of all OCD sufferers who seek treatment find they can absolutely control the disorder. Their quality of life improvements "last years," says Dr. Griest, if they remain diligent about maintaining the treatment techniques that work best for them.

Sarah is now undergoing behavior therapy and is feeling much better. "I'm finding ways to manage OCD, of staying centered and calm, and learning to identify my triggers," she reports. "I'm concentrating on the future, and feeling as though anything is possible again."

If OCD is an issue in your life, know that you too can experience a more joyous way of life--just reach out for the help you need and deserve.

For more information on obsessive-compulsive disorder, contact:

The Obsessive-Compulsive
Information Center
Madison Institute of Medicine
P.O. Box 628365
Middleton, WI 53562-8365

Telephone: [phone]
Fax: [phone] or visit the
National Institute of Mental
Health's website at
http://www.nimh.nih.gov/anxiety

(*) Not her real name.

Lisa Mulcahy is a writer living in Fitchburg, Massachusetts.