Obsessive-Compulsive Disorder and Related Mental Disorders

The concept of Obsessive-Compulsive Disorder (OCD) has changed through time. In the seventeenth century, obsessions and compulsions were often described as "symptoms of religious melancholy." In 1838, Jean-Étienne Esquirol (French psychiatrist) described that OCD is "a form of monomania, or partial insanity" ("History"). For many years, OCD was incorrectly assumed as a result of personality defects or bad parenting, such as overly strict toilet training or experience of insecure attachment in infancy and early childhood. However, over the last 20 years, a large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain or how the brain chemical serotonin, a neurotransmitter helping nerve cells communicate, is distributed among the brain's synapses. In a recent report from National Institute of Mental Health, it is estimated that more than two percent of the U.S. population, or about one out of every 40 people, will suffer from OCD at some point in their lives; it strikes men and women in roughly equal numbers; and it usually appears in childhood, adolescence, or early adulthood ("OCD- NAMI"). Effective treatments for OCD patients vary just as the symptoms of OCD vary from person to person. In some cases, doctors use behavior therapy, which is more effective than medication alone, but the most successful treatment is the combination of the two ("OCD-Hopkins").

What is OCD and how will you know if it affects you? Obsessive-compulsive disorder "is characterized by recurrent, unwanted and unpleasant thoughts (obsession), and/or repetitive, ritualistic behaviors, which the person feels driven to perform (compulsions)" (Shimberg: 77). People with OCD are aware that their obsessions and compulsions are irrational and excessive, but they have little or no control over them. They usually keep their rituals secret, the secrecy resulting in a substantial delay of diagnosis and treatment ("The Evolutionary"). When OCD is suspected, American Academy of Family Physicians are using these three screening questions during an office visit: "Do you have repetitive thoughts that make you anxious and that you cannot get rid of regardless of how hard you try? Do you keep things extremely clean and tidy or wash your hands frequently? Do you check things to excess?" ("Management Strategies").

The typical OCD obsessions often involve "the cognitive anticipation of situations that are perceived as dangerous and need to be controlled." It typically revolves around fear of contamination or dirt, repeated doubts, having things orderly and symmetrical, and aggressive or horrific impulses. The symptoms may include fear of being contaminated by shaking hands or by touching objects others have touched, doubts that you've locked the door or turned off the stove, repeated thoughts that you've hurt someone in a traffic accident, or intense distress when objects aren't orderly, lined up properly or facing the right way ("OCD- Mayo clinic"). In addition to obsessive thoughts, individuals with OCD also experience compulsions, which are "repetitive behaviors that you feel driven to perform and are meant to prevent or reduce anxiety or distress related to your obsessions". The typical compulsions revolve around cleaning and grooming, such as washing hands, showering or brushing teeth over and over again; checking drawers, door locks and appliances to be sure they are shut, locked or turned off; ordering and arranging items in certain ways; saving newspapers, mail or containers when they are no longer needed; and seeking constant reassurance and approval ("OCD-Family Org").

One of the most common activities of individuals with OCD is hoarding, which is described as "the acquisition of and inability to discarditems, even though they appear (to others) to have no value." American Journal of Psychiatry estimates about 30% to 40% of OCDpatients have hoarding and saving symptoms; andabout 10% to 15% have hoarding as their most prominent symptomfactor. Compulsive hoarding and savingleads to clutter that in severe casecan produce health risks from infestations and fires ("Is Compulsive").

Patients with OCD are often found to have comorbid (co-existing) major depression and other anxiety disorders. Reports of body dysmorphic disorder and eating disorder in OCD patients are also prevalent as well as Trichotillomania, and Tourette's syndrome ("OCD- Stanford"). Tourette's syndrome, TS, is a chronic neurological disorder, named after the French neurologist Georges Gilles de la Tourette (1885). This disorder is characterized by sudden, brief, intermittent, involuntary or semi-voluntary movements (motor tics) or sounds (vocal or phonic tics). Phonic tics may include sniffing, throat clearing, screaming, coughing, and sometimes shouting of obscenities or profanities. Motor tics manifest as blinking, nose twitching, and head and limb jerking. TS affects males approximately three times as frequently as females; and it usually begins anywhere from early childhood to adolescence, between the ages of two and sixteen ("Tourette's"). According to the TS Association, TS may affect up to one person in every 2,500, with perhaps three times that number showing partial expressions such as chronic tic disorder and OCD (Shimberg: 29). Evidence suggests that some forms of OCD may be genetically linked to Tourette's with males inheriting the genetic vulnerability to be more likely to display tics, while females are more likely to display obsessive-compulsive traits ("Tourette's").

Eating disorder can be classified to either anorexia nervosa or bulimia nervosa. People with Anorexia Nervosa, called anorexics, are preoccupied with food but ignore hunger and control their desire to eat; and when they eat, they restrict it to less than 1,000 calories per day. They also exercise excessively due to the fear of gaining weight. Due to nutritional deprivation, their bones, nails and hair become brittle; their skin may become dry and yellow; and worst, the starvation can cause damage to vital organs such as the heart and brain, leading to death. Anorexia nervosa has the highest mortality rates among the psychiatric conditions, killing up to six percent of its victims. About 90% of reported anorexics are adolescent girls and young adult women, although, it also occurs in men and older women ("Anorexia-NAMI"). Anorexia is different than OCD as most anorexics do not regard their obsessive-like symptoms as senseless, and often they do not attempt to ignore or suppress these thoughts. Even their compulsion-like behaviors, such as persistent exercising and ritualized eating, might not be designed to neutralize or prevent discomfort" ("The Relationship"). On the other hand, Bulimia nervosa is associated with bingeing and purging activity. People with bulimia nervosa, called bulimics, consume large amounts of food (binge), and then try to prevent weight gain by getting rid of the food (purge) by fasting, excessive exercise, vomiting, or using laxatives. This disorder affects over two million adolescent girls and young women in America, with ten to 15 percent of affected individuals are male. Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones; and in rare cases, it may be fatal ("Bulimia-Gale"). Studies indicate that about 50 percent of those who begin an eating disorder with anorexia nervosa later become bulimic ("Bulimia-NAMI").

Body dysmorphic disorder (BDD) is defined as "a preoccupation with an imagined defect in appearance in a normal-appearing person or an excessive preoccupation with appearance in a person with a small physical defect." The most frequently reported body parts of excessive concern are the overall appearance, like shape size or shape of nose, moles or freckles perceived as too large or noticeable, acne and blemishes, minor scars or skin abrasions, and too much facial or body hair. Patients displayed compulsive behaviors, including recurrent mirror checking, reassurance seeking by means of repetitive questioning of others, and excessive use of cosmetics ("A Socio-Demographic"). BDD also may be present with an eating disorder, such as anorexia nervosa or bulimia nervosa, especially if it involves a weight-related part of the body, such as the waist, hips or thighs. Some people with BDD tend to aggressively seek unnecessary and excessive medical care and procedures, such as cosmetic surgery, in an attempt to correct or significantly improve an actual or perceived physical flaw. This disorder causes people excessive anxiety and distress which may result to social phobia and social isolation, often impairing their social life, in school or at work. It tends to be chronic and can bring about other health problems like depression which can lead to a downward spiral of disability, dependency and suicide ("BDD-Mayo Clinic").

Trichotillomania, or TTM or sometimes called hair-pulling disorder, is a type of mental illness in which people have an irresistible urge to pull out their hair, whether it is from their scalp, their eyebrows or other areas of their body. Although TTM may seem like an obsession or compulsion, it is actually classified as a type of "impulse control disorder" as affected individual can not resist a temptation or drive to perform a harmful act ("TTM- Mayo"). It is estimated to affect one to two percent Americans, and strikes most frequently in the pre- or early adolescent years. People with TTM may also experience other compulsive behaviors such as nail biting or skin picking. In contrast to OCD though, individual with TTM tend not to have obsessive thoughts; they do not engage with any other rituals but hair pulling; and more likely to affect women while OCD has a more even gender distribution ("TTM-Trich").

This very limited research shows that Obsessive-compulsive disorder, as well as its comorbid disorders, is not uncommon in America. The advancement in technology (allowing medical professionals to study the human brain) helps to better understand these disorders resulting to a more effective treatment. In addition, the high quality of information about these disorders is available to the public, via Internet for example. This will help individuals affected with these disorders (and their families) learn more aboutmental illnesses, develop coping strategies, or find the needed support - people just need to seek out.

Works Cited

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Anon. "History." Psychiatry: Obsessive-Compulsive and Related Disorders Research Program. Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA.

http://ocd.stanford.edu/treatment/history.html

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http://www.hopkinsmedicine.org/ocd/treatment.html Anon. "Obsessive-compulsive disorder." NAMI (National Alliance on Mental Illness), Arlington, VA. http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23035

Anon. "Obsessive-Compulsive Disorder: What It Is and How to Treat It."American Academy of Family Physicians. Reviewed/Updated: 09/06. Created: 4/94 http://familydoctor.org/133.xml

Brune, Martin. "The evolutionary psychology of obsessive-compulsive disorder: the role of cognitive metarepresentation." Perspectives in Biology and Medicine49.3 (Summer 2006).: 317(13).
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Jankovic, Joseph. "Tourette's syndrome." The New England Journal of Medicine. Boston: Oct 18, 2001. Vol. 345, Iss. 16, p. 1184-1192 (9 pp.). http://proquest.umi.com/pqdweb?did=84533487&Fmt=4&clientId=68323&RQT=309&VName=PQD

Lamb, Jennifer. "Bulimia Nervosa." Gale Encyclopedia of Medicine. December, 2002. Gale Group. Updated on 08-14-2006

Mayo Clinic. "Obsessive-compulsive disorder (OCD).." Mental Health. Dec 21, 2006, http://www.mayoclinic.com/health/obsessive-compulsive-disorder/DS00189/DSECTION=2 Mayo Clinic. "Trichotillomania (hair-pulling disorder).." Mental Health. Jan 25, 2007 http://www.mayoclinic.com/health/trichotillomania/DS00895/DSECTION=7

Saxena, Sanjaya, M.D. "Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification." American Journal Psychiatry 164:380-384, March 2007, 2007 American Psychiatric Associationhttp://ajp.psychiatryonline.org/cgi/content/full/164/3/380 Shah, Anjali. "The Relationship Between Anorexia Nervosa and Obsessive Compulsive Disorder." N.D. Psychology Department, Vanderbuilt University. http://www.vanderbilt.edu/AnS/psychology/health_psychology/anorexiaocd.html

Shimberg, Elaine Fantle. "Recognizing OCD, ADHD and Other Related Problems." Living with Tourette Syndrome. New York, NY: Simon & Schuster, 1995.

Zepf, Bill. "Management Strategies for Obsessive-Compulsive Disorder." American Family Physician. Kansas City:Oct 1, 2004. Vol. 70, Iss. 7, p. 1379-1380 (2 pp.). http://proquest.umi.com/pqdweb?did=730025631&Fmt=4&clientId=68323&RQT=309&VName=PQD