OBSESSIVE COMPULSIVE DISORDER

Obsessive-compulsive disorder is characterized by anxious thoughts or rituals you feel you can't control. If you have OCD, as it's called, you may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. You may be obsessed with germs or dirt, so you wash your hands over and over. You may be filled with doubt and feel the need to check things repeatedly. You might be preoccupied by thoughts of violence and fear that you will harm people close to you. You may spend long periods of time touching things or counting; you may be preoccupied by order or symmetry; you may have persistent thoughts of performing sexual acts that are repugnant to you; or you may be troubled by thoughts that are against your religious beliefs. The disturbing thoughts or images are called obsessions, and the rituals that are performed to try to prevent or dispel them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the discomfort caused by the obsession. A lot of healthy people can identify with having some of the symptoms of OCD, such as checking the stove several times before leaving the house. But the disorder is diagnosed only when such activities consume at least an hour a day, are very distressing, and interfere with daily life. Most adults with this condition recognize that what they're doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their behavior is out of the ordinary.

OCD strikes men and women in approximately equal numbers and afflicts roughly 1 in 50 people. It can appear in childhood, adolescence, or adulthood, but on the average it first shows up in the teens or early adulthood. A third of adults with OCD experienced their first symptoms as children. The course of the disease is variable--symptoms may come and go, they may ease over time, or they can grow progressively worse. Evidence suggests that OCD might run in families. Depression or other anxiety disorders may accompany OCD. And some people with OCD have eating disorders. In addition, they may avoid situations in which they might have to confront their obsessions. Or they may try unsuccessfully to use alcohol or drugs to calm themselves. If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home, but more often it doesn't develop to those extremes. Research by NIMH-funded scientists and other investigators has led to the development of medications and behavioral treatments that can benefit people with OCD. A combination of the two treatments is often helpful for most patients. Some individuals respond best to one therapy, some to another. Two medications that have been found effective in treating OCD are clomipramine and fluoxetine. A number of others are showing promise, however, and may soon be available. Behavioral therapy, specifically a type called exposure and response prevention, has also proven useful for treating OCD. It involves exposing the person to whatever triggers the problem and then helping him or her forego the usual ritual--for instance, having the patient touch something dirty and then not wash his hands. This therapy is often successful in patients who complete a behavioral therapy program, though results have been less favorable in some people who have both OCD and depression.

Doctors and scientists don't know exactly what causes OCD, although they think it might be related to levels of a chemical in the brain called serotonin (pronounced: sir-uh-toe-nin). Teens with OCD may not have enough serotonin, and this could cause the messages in the brain to be miscommunicated. Scientists haven't discovered a gene that causes OCD, but they do know that it tends to run in families, so if you have a parent with OCD, you have a higher risk of developing it. Doctors do know that OCD isn't a teen's fault - and he can't stop his thoughts or actions even if he wants to. A lot of teens are so embarrassed by the obsessions and compulsions they experience that they keep it from their parents and friends. "OCD is a private disorder, and it can take years before a parent knows a teen has it," says David Sheslow, PhD, a psychologist who works with teens with OCD in Wilmington, Delaware. "Because the disorder comes with a sense of shame and embarrassment, the teen will keep the rituals very private," Dr. Sheslow says. If you have a friend with OCD, you may not even notice that your friend has it - he may be very good at hiding his behaviors. OCD often begins during the teen and early adult years, although it's found in kids, too. Guys may be more likely to develop OCD earlier, between the ages of 6 to 15, whereas girls are more likely to develop OCD in the later teen years and early adulthood. In addition, teens with OCD have a higher risk of also having depression, attention deficit/hyperactivity disorder (AD/HD), learning disorders such as dyslexia, and habit disorders such as nail biting or skin picking. What Are the Signs and Symptoms? It's not easy being a teen, but it's especially hard to be a teen with OCD. Dealing with obsessions and performing compulsions require time and energy that ordinarily would be spent on school or with friends or boyfriends or girlfriends. Because many teens with OCD feel ashamed and embarrassed, they may have low self-esteem.