$Unique_ID{BRK02041}
$Pretitle{}
$Title{Recognizing and Treating Obsessive-Compulsive Disorder}
$Subject{Obsessive-Compulsive Disorder OCD cleaners obsessive behavior fear
compulsive behavior obsessive compulsive behavior behavior therapy
psychotherapy clomipramine psychology psychiatry}
$Volume{}
$Log{}

Copyright (c) 1993  Tribune Media Services, Inc.


Recognizing and Treating Obsessive-Compulsive Disorder


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QUESTION:  A disturbing long distance call with my sister-in-law has revealed
some actions by my brother that just go far beyond the range of the normal.
He is constantly washing his hands, scrubbing them for many minutes on end.
He takes 5 or 6 showers a day, sometimes more, and refuses to touch hand rails
or bannisters, for fear of other peoples' germs.  It seems he has been getting
worse over the past months, but refuses to acknowledge that anything is wrong
or seek treatment.  What do you think is wrong with him, and is there any
help?

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ANSWER:  Within a reasonable doubt you describe actions that are typical of
someone with obsessive-compulsive disorder (OCD).  Although once considered
rare, it is now thought that as many as 5 million Americans have some form of
this problem.  OCD often takes the form or repetitive acts or thoughts,
provoked by some anxiety or fear.  Even when the patient realizes that the
acts are senseless, the fear that something terrible will happen is so great
as to compel them to continue to repeat the same activity over and over again.
A most common fear is one of contagion or contamination by germs, and these
people indulge in the type of washing activity you describe.  Such patients
are known as "cleaners", and form the greatest number of patients that are
tormented by OCD, about 85 percent of those diagnosed.
     Obsessions and compulsions are not always a apart of a disease process,
for many people do feel the need to perform certain tasks in a regular and
meticulous fashion.  Sometimes this need is a positive force in a person's
life, providing the motivating force necessary to get things done properly.
It is only when the actions begin to interfere with normal living, and become
time consuming (over 1 hour per day) that they are considered to be abnormal.
     OCD comes in many forms and different degrees of severity.  For most
life may go on with the compulsive behavior hidden, confined to the privacy
of their own home.  The need for the activity may come and go, with periods of
remission, only to find the compulsion returning after a quiet period of
months.  In about 10 percent of the cases, they become chronic and truly
disabling.  OCD behavior may be seen in children, as young as 2 years of age,
though more frequently it begins during the adolescent years.  It affects
adults of all ages, women and men equally, and can be seen in people from all
backgrounds and societies.
     Although the specific cause of the disease still remains a mystery, there
are a number of treatments that are quite effective in controlling the
symptoms and restoring a normal pattern to living.  A technique called
"behavior therapy" is reported to be even more useful than traditional
psychotherapy.  While the fear may be discussed and explored, the patient is
prevented from performing the action.  In brother's case the therapist would
encourage him to touch a hand rail, but request that the hand washing not be
performed.  After several attempts, when the patient discovers that no great
harm has occurred, the need to wash becomes diminished.  Medication
(clomipramine) may also be used to reduce the amount and frequency of the
episodes of compulsive behavior.  In some cases the patients improvement
allows the physician to gradually reduce the dose of medication, until it is
no longer needed.  Combining both behavior therapy with medication may offer
the best promise for a successful outcome.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.