Obsessive-Compulsive Disorder Demystified: An Essential Guide for Understanding and Living with OCD.
Cheryl Carmin, Ph.D.
De Capo Press, Perseus Books Group.
2300 Chestnut Street, Suite 200, Philadelphia, PA 19103
Obsessive-Compulsive disorder, an anxiety disorder characterized by unwanted, intrusive thoughts and rituals, affects approximately 6 to 9 million Americans. A complex illness that is largely misunderstood by the public, it often goes untreated or misdiagnosed. In addition, many mental health professionals have very little experience in diagnosing anxiety disorders. With Obsessive-Compulsive Disorder Demystified, OCD expert and clinical psychologist Cheryl Carmin explains the true nature of OCD, the factors that complicate its diagnosis, and the best ways to cope with it.
In clear, user-friendly language, the book offers crucial information such as getting a correct diagnosis, the most effective treatments, medication, guidelines for family and friends of OCD sufferers, issues for children and adolescents, related disorders, and a step-by-step self-help approach for those suffering from OCD.
Reviewer Dr. Alma H. Bond writes Obsessive-Compulsive Disorder Demystified is a fast-moving, interesting, and simply written book which clarifies the mystery of this little understood disease. It is a book that can change the lives forever of the millions of victims and their families who hitherto have suffered in silence. Written in a compelling manner, the book can be read easily by intelligent laymen, and should be required reading for physicians, clinicians, and therapists who deal with this perplexing disease.
The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-1V) defines Obsessions as "recurrent and persistent thoughts, impulses, or images that are experienced ...as intrusive and inappropriate and that cause marked anxiety or distress."
Compulsions are defined as "repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e. g. praying, counting, repeating words silently) the person feels driven to perform in response to an obsession, or according to rules that must be rigidly applied" (p. 6). Dr. Carmin informs us that although the term OCD is part of our culture's vocabulary, the vast majority of people have no idea of what the illness really is like. Although Hollywood plays OCD for laughs and presents victims as funny or bizarre, for the smitten individual and his or her family and friends, it is no laughing matter, but can be a terrifying affliction .The up-to-date book gives a great deal of information that this reviewer, for one, who has been a practicing psychoanalyst for 37 years, didn't know. For example, Carmin tells us, "OCD is a medical condition that causes your brain to function differently from that of someone who doesn't have the disorder "(p.xii). Many of Carmin's colleagues believe the disease is caused by an imbalance of chemicals in the brain, while others think that the chemical imbalance contributes to the disorder. Carmin tells us that the jury is not out yet on whether the behavior is biologically based or learned.
There are six to nine million sufferers, or two to three percent of the population who suffer from OCD, about one in forty adults and one in fifty school-aged children. About half of the adults diagnosed with anxiety disorders had demonstrated symptoms of a psychiatric illness before their fifteenth birthday. Obviously, a huge number of people need this book! The illness also takes a huge toll economically, amounting to approximately six percent of the estimated cost of all psychiatric disorders. It strikes boys and girls at about the same rate, and usually appears in the late teens or early twenties, possibly as a result of the surges of hormones and brain chemicals at that period. About twenty-five percent of OCD sufferers have a family member who is similarly distressed. Throughout the book, the author stresses that although OCD can ruin lives, it is a treatable disease. Many victims who have suffered for decades have been"cured" by proper treatment. Often such people do not know they have a treatable condition, and hence never seek help. Others think the condition means they are "crazy," and keep it secret. Although scientists frequently refer to OCD as a "complex" genetic disorder, research has yet to pinpoint a single gene that "causes" OCD, nor is there a definitive medical test that can diagnose the disorder.
Common OCD symptoms include contamination and cleaning compulsions, harm-based obsessions and checking compulsions, sexual and aggressive obsessions, perfectionism obsessions and compulsions, religious obsessions, hoarding, and other symptoms such as the constant search for reassurance and repeated questioning which do not fit into the other groupings.
According to the author, cognitive behavior therapy (CBT) and ERP, a form of CBT, is the therapy of choice for treating OCD. The basic idea behind CBT is to teach such people how to better understand and manage their obsessional beliefs and related anxieties so that they no longer need to engage in compulsive behavior or rituals. The therapy involves a specialized form of CBT called exposure and response prevention or ERP. The individual is exposed to whatever causes his or her anxiety and is taught to refrain from using rituals such as hand washing to counteract the anxiety. The technique sounds simple, but actually is very difficult to do and causes the troubled individual much stress and pain. It also requires a great deal of courage. The person must stay in the terrifying situation as long as it takes to find out that what is most feared does not happen The anxiety always lessens, as it is not possible to stay anxious forever. The process is called habituation. The aim of ERP is not to eliminate the painful thoughts but to learn to tolerate them without resorting to rituals. As the smitten individual becomes more skilled at refusing OCD, s/he becomes less frightened by the thoughts and images that formerly were experienced as a torment, and the obsessions diminish in frequency and intensity. They subside as a result of cognitive restructuring, as the ERP process involves not giving in to the rituals. Research has found that there is a fifty to eighty percent reduction in OCD symptoms after twelve to twenty sessions of ERP.
Some people require medication along with their therapy. Six common medications, along with their possible side effects, are described.
Chapter Ten, How to Help When a Loved One has OCD, should prove particularly useful to those close to an OCD sufferer. In it, the author describes ways of supporting the individual suffering from the disorder. Most important is the strategy, "Do not do what comes naturally." It is difficult to watch the pain the person is suffering without accommodating and helping him or her over a difficult moment by assisting with a ritual, for example help with aligning the coffee cups in the dishwasher, or giving reassurance, such as "Yes, I'm sure you turned off the water upstairs." Yet this "help" is detrimental to the person's getting well, and is to be avoided at all costs. Rather, patient should be told, "I'm not going to reassure you because reassurance will feed the OCD." In addition, irritating as it may be to live with a person so afflicted, the author advises families to watch their tempers, as the severity of a person's OCD symptoms is greatly influenced by the attitudes of those around him.
The book ends with a list of resources where OCD sufferers can get more help, a Glossary, and an appendix containing the Yale-Brown Obsessive-Compulsive Scale (YBOCSD).
If pressed to give negative criticism of this insightful book I would have to say that credit should have been given to Freud, who wrote that to cure a phobia, the sufferer needs to face the object of his fears. Freud would have well understood the basic premise of Obsessive-Compulsive Disorder Demystified, that the sufferer must give up the rituals that attempt to ward off anxiety and face his or her fears. (Sigmund Freud, The Standard Edition, London, 1955, The Hogarth Press, Lines of Advance in Psychoanalytic Therapy, 1919, pp. 165-166.) Despite this serious omission, Obsessive-Compulsive Disorder Demystified is highly recommended for medical personnel and psychotherapists whose knowledge of OCD frequently leaves much to be desired, afflicted laymen who may have suffered decades in silence for lack of information about the illness, and their long-suffering families and friends, who are frightened, bewildered by, and feel helpless before the strangeness of their loved one's symptoms.
Dr. Cheryl Carmin is a clinical psychologist and the director of both the Stress and Anxiety Disorder Clinic and Cognitive Behavior Therapy Program of the University of Illinois at Chicago, where she is also a professor. A nationally recognized expert in the research and treatment of anxiety disorders, Dr. Carmin is a Founding Fellow of the Academy of Cognitive Therapy
Dr. Alma H. Bond
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|Author:||Bond, Alma H.|
|Article Type:||Book review|
|Date:||Aug 1, 2009|
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