Dealing with obsessive-compulsive disorder

Published 5:25 pm Saturday, January 11, 2014

This article will highlight a common, yet little understood mental disorder. That is obsessive-compulsive disorder. The prevalence of this illness exceeds bipolar disorder or schizophrenia. It can take up to seven years before some patients receive the diagnosis. OCD is part of the anxiety disorders; the symptoms cause extreme distress to the patient. Obsessions are recurrent, unwanted, intrusive thoughts that are disturbing to the person experiencing them. Examples are contamination, violent thoughts toward loved ones, taboo sexual thoughts and the like. Patients will perform compulsive acts or repetitive acts to suppress the thoughts. It is the compulsive acts that tend to consume a lot of the patient’s time.    Another key feature is the illness impairs the patient’s ability to function.

So if you are checking the front door 15 times each night, does it mean you suffer from the illness?  Not necessarily, if you’re checking the door because you were the victim of a home invasion, you’re just being cautious. However, if a patient has recurrent violent thoughts and he or she is intrusive and you check the door to get relief from him or her, one could make the argument for OCD.    Most importantly it causes extreme debilitating anxiety, and you spend at least one hour a day dealing with obsessions/compulsions.

Majority of patients are ashamed of the obsessions and too embarrassed to speak to anyone about them. Thus, a lot of the compulsive acts are done in secrecy. Patients can spend at times $250.00 a month on soap to wash their hands. The illness consumes a majority of their life. Unfortunately, 60 percent of patients will experience trouble in their home, at work and in their relationships.

The most common obsession patients experience is the fear something will happen to the patient or their loved one. The most recognizable is the contamination obsession with washing compulsion. This represents about 25 percent of OCD patients. About 75 percent of compulsions are repeating to one and checking. Patients with OCD can also suffer with anxiety and depression.    This can cloud the diagnostic picture when evaluating these patients.

Patients can receive relief with pharmacological treatment, psychotherapy and, at times, with surgery. The first line of treatment for the majority of patients is medication. Usually, patients will require higher doses than would be required for depression. Patients should at least be treated for 10 weeks before treatment change is warranted for them. Most medications will have a 60 percent response rate. Sometimes patients will need medications from different indications for them to function.

Psychotherapy can also be effective for patients.  Usually, cognitive behavioral therapy is a form psychotherapy that is effective for patients.  However, it can be difficult for patients who are intellectually disabled, cognitively impaired, and have poor insight into the illness. Patients who do not recognize the senselessness of their symptoms have not done well with cognitive behavioral therapy. Also patients who are severely depressed will have a poor response to psychotherapy.

In addition patients need a supportive environment at home. This can also be a predictor of success with the patient. This is why it is imperative the family is educated about the illness. If a patient has a family that is overly involved, hostile and constantly criticize the patient, the rate of response is significantly reduced. Familial hostility was most consistent negative predictor of premature termination of treatment. A lot of times, I will bring the family in to discuss with them the way they are coping with the patent’s symptoms. Sometimes guilt, anger and depression are experienced by the family.

If you or someone you know struggles with this illness, or you suspect it, treatment is available and effective. Call 252-946-3666 if you have any questions about treatment.

Dr. Paul Garcia is chief of psychiatry for Vidant Beaufort Hospital.