Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
While there is no known specific cause for OCD, family history and chemical imbalances in the brain are thought to contribute to the development of the illness. Generally, while people who have relatives with OCD are at a higher risk of developing the disorder, most people with the illness have no such family history. A specific chromosome/gene variation has been found to possibly double the likelihood of a person developing OCD. It is thought that an imbalance of the chemical serotonin in the brain may also contribute to the development of OCD. Some life stressors, like being the victim of sexual abuse as a child, can increase the chance of developing OCD as an adult.
How is OCD diagnosed?
Some practitioners will administer a self-test of screening questions to
individuals whom they suspect may be suffering from OCD. In addition to looking for symptoms of obsessions and compulsions by conducting a mental-status examination, mental-health professionals will explore the possibility that the individual's symptoms are caused by another emotional illness instead of or in addition to OCD. For example, people with an addiction often have obsessions or compulsions,
but those symptom characteristics generally only involve the object of the
addiction. The practitioner will also likely ensure that a physical examination and any other appropriate tests have been done recently to explore whether there is any medical problem that could be contributing to the signs or symptoms of OCD.
What are the treatments for OCD?
Most individuals with OCD experience some symptoms of the disorder
indefinitely, with times of improvement alternating with times of difficulty.
However, the prognosis is most favorable for OCD sufferers who have milder
symptoms that last for less time and who have no other problems before
developing this illness.
Treatments include cognitive behavioral psychotherapy, behavioral therapies,
and medications. Behavioral therapies for OCD include ritual prevention and
exposure therapy. Prevention of rituals involves a mental-health
professional helping the OCD sufferer to endure longer and longer periods of
resisting the urge to engage in compulsive behaviors. Exposure therapy is the
process by which the individual with OCD is put in touch with situations that
tend to increase the OCD sufferer's urge to engage in compulsions, then helping
him or her resist that urge. Cognitive/behavioral therapists help patients
change the negative styles of thinking and behaving that are often associated
with the anxiety involved with obsessive compulsive disorder.
Selective serotonin reuptake inhibitors (SSRIs) are the medications that are
most commonly used to treat OCD. These medications increase the amount of the
neurochemical serotonin in the brain. (Remember that brain serotonin levels are
thought to be low in OCD.) As their name implies, the SSRIs work by selectively
inhibiting (blocking) serotonin reuptake in the brain. This block occurs at the
synapse, the place where brain cells (neurons) are connected to each other.
Serotonin is one of the chemicals in the brain that carries messages across
these connections (synapses) from one neuron to another.
The SSRIs work by
keeping serotonin present in high concentrations in the synapses. These drugs do
this by preventing the reuptake of serotonin back into the nerve cell that is
transmitting an impulse. The reuptake of serotonin is responsible for turning
off the production of new serotonin. Therefore, the serotonin message keeps on
coming through. It is thought that this, in turn, helps arouse (activate) cells
that have been deactivated by OCD, thereby relieving the symptoms of the
condition.
SSRIs have fewer side effects than clomipramine, an older medication
that is actually thought to be somewhat more effective in treating OCD. SSRIs do
not cause orthostatic hypotension (a sudden drop in blood pressure when sitting
up or standing) and heart-rhythm disturbances, like clomipramine can. Therefore,
SSRIs are often the first-line treatment for this illness. Examples of SSRIs
include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram
(Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro). When the improvement that people with OCD experience is not optimal when an SSRI is the only medication prescribed, the addition of a neuroleptic medication like risperidone (Risperdal), olanzapine (Zyprexa), or aripiprazole (Abilify) can sometimes be helpful.
SSRIs are generally
well tolerated, and side effects are usually mild. The most common side effects
are nausea, diarrhea, agitation, insomnia, and headache. However, these side
effects generally go away within the first month of SSRI use. Some patients
experience sexual side effects, such as decreased sexual desire (decreased
libido), delayed orgasm, or an inability to have an orgasm. Some patients
experience tremors with SSRIs. The so-called serotonergic (meaning caused by
serotonin) syndrome is a serious neurologic condition associated with the use of
SSRIs. It is characterized by high fevers, seizures, and heart-rhythm
disturbances. This condition is very rare and has been reported only in very ill
psychiatric patients taking multiple psychiatric medications.
Newer, often called atypical, neuroleptic medications like the ones named above tend to cause fewer side effects than many of the older medications in this class. The most common side effects of atypical neuroleptics include sleepiness, dizziness, dry mouth, and weight gain. Sometimes, people can be more sensitive to the effects of the sun while taking these medications and therefore should take care to wear adequate sunblock whenever exposed to the sun. Less commonly, side effects of atypical neuroleptic medications can result in painless, although abnormal, muscle movements like tremors, stiffness, and very rarely permanent muscle twitches called tardive dyskinesia.
Studies on the
effectiveness of treatment of OCD in adults have variable results. Some indicate
that medications, response prevention, and CBT are equally, although only mildly
to moderately, effective in treating this problem. Cognitive
behavioral group therapy (CBGT) has also been found to be an effective treatment
for OCD.
Research on treating OCD in children and adolescents suggests that while
medications are clearly effective in treating this disorder, the improvement
that is experienced as a result is quite mild. However, clomipramine tends to be
more effective than the SSRIs, and the individual SSRIs tend to be equally
effective. As in adults, people under 18 years of age
tend to improve more significantly when treated with a combination of medication
and CBT. There is increasing evidence that deep brain stimulation may be effective in treating severe OCD that has not responded to other treatments. There is also increasing research about whether or not hallucinogens have a role in treating OCD.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizzyness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Anorexia is an eating disorder characterized by markedly reduced appetite or total aversion to food. Anorexia is a serious psychological disorder and is a condition that goes well beyond out-of-control dieting. With anorexia, the drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. There are psychological and behavioral symptoms as well as physical symptoms of anorexia including: depression, social withdrawal, fatigue, food obsession, heart and gastrointestinal complications, kidney function, flaky skin, brittle nails, and tooth loss (this list is not exhaustive).
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Huntington's disease is the result of degeneration of neurons in areas of the brain. Huntington's disease is an inherited disorder. Early symptoms include mood swings, apathy, depression, and anger uncharacteristic of the individual. Judgement, memory, and other cognitive functions may become impaired. Presymptomatic testing is available for individuals who have a family history of Huntington's disease. Treatment includes medication and therapy for symptoms.
Antisocial personality disorder (ASPD) has many symptoms, signs, and causes. Therapy is one treatment option for antisocial personality disorder. It is closely related to other personality disorders (PD), such as borderline personality disorder and narcissistic personality disorder.
ADHD afflicts approximately 3 percent to 5 percent of school-age children and an estimated 60 percent of those maintain the disorder into adulthood. Symptoms of adult ADHD include chronic lateness, anxiety, low self esteem, employment problems, difficulty controlling anger, impulsiveness, poor organization skills, procrastination, chronic boredom among others.
Bulimia is an eating disorder characterized by episodes of secretive excessive eating (bingeing) followed by inappropriate methods of weight control, such as self-induced vomiting (purging), abuse of laxatives and diuretics, or excessive exercise. Purging and nonpurging are the two types of bulimia. There are five basic criteria in the diagnosis of bulimia.
Mental illness is any disease or condition affecting the brain that influence the way a person thinks, feels, behaves, and/or relates to others. Mental illness is caused by heredity, biology, psychological trauma and environmental stressors.
Characteristics of binge eating disorder include eating more quickly than usual, eating until uncomfortably full, eating a lot of food despite not being hungry, eating alone due to embarrassment, and feeling disgusted by overeating. Depression may be a cause of binge eating disorder. Risks of binge eating include weight gain, diabetes, high blood pressure, high cholesterol, heart disease, and some cancers.
Prader-Willi syndrome is a condition characterized by severe floppiness (hypotonia), poor growth, delayed development, and poor feeding problems in early infancy later followed in infancy by excessive eating that may lead to extreme obesity. The genitals in both females and males are underdeveloped and most are infertile. Prader-Willi syndrome is related to chromosome 15.
Asperger syndrome (AS, Asperger's syndrome) is an autism spectrum disorder. Asperger syndrome is characterized by a degree of impairment in language and communication skills, and repetitive or restrictive thoughts or behaviors. The most common symptom of Asperger syndrome is the obsessive interest in a single object or topic. Other conditions that may co-exist with Asperger syndrome include: ADHD, tic disorders, depression, anxiety disorders, and OCD. Diagnosis of Asperger syndrome is complicated, and treatment is generally directed toward minimizing the symptoms of the syndrome and behavioral and educational interventions.
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