Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, April 23, 1990 TAG: 9004210419
SECTION: EXTRA PAGE: E-3 EDITION: METRO
SOURCE: JANE E. BRODY
DATELINE: LENGTH: Medium
Or the times you lined up your toys in a particular order and became furious if anyone disturbed them?
Now imagine trying to live your entire life obeying far stronger compulsions.
Imagine being like the man who was chronically late to work because if he stepped on a crack, he had to go back home and start over.
Or the driver who often became overcome by the thought that he might have hit someone and had to keep turning back to find his imagined victim.
Or the woman who washed for hours a day and, when people came to her home, later scrubbed anything they had touched.
Psychiatrists used to think such obsessive-compulsive disorders were rare, but were misled because many patients desperately tried to conceal their bizarre symptoms and rarely sought professional help.
Many psychotherapists also thought that obsessive-compulsive disorder, or OCD, stemmed from unresolved childhood conflicts or emotional traumas, like overly rigid toilet training. Yet, despite traditional psychotherapy or psychoanalysis, patients rarely overcame it.
In the last few years a dramatically different picture of this crippling disorder has emerged, bringing with it effective methods of treatment that thus far offer significant and in some cases complete relief to three-fourths of those afflicted.
Recent surveys of adults and youngsters conducted by the National Institute of Mental Health found that from 1 to 2.5 percent of the population, or up to 5 million Americans, are afflicted, making the problem more common than schizophrenia or anorexia.
Using modern analytical techniques like CAT scans and magnetic resonance imaging, researchers found evidence of physical and biochemical aberrations in the brains of OCD patients.
Dr. Judith L. Rapoport, chief of child psychiatry at the National Institute of Mental Health, describes the problem as "a kind of hiccup in the brain" that creates a chronic sense of self-distrust.
Patients cannot trust their eyes, knowledge or good judgment. Rather, they must repeatedly check and recheck and repeat peculiar acts over and over again to be sure everything is OK in order to relieve repeated overwhelming attacks of anxiety.
Others afflicted with the disorder do not behave peculiarly but are chronically obsessed by irrational thoughts and fears that can cause crippling anxiety.
If not for this disorder, recent studies have shown, OCD patients would be otherwise normal, able to function effectively at work and in social situations.
And while many people with the disorder are depressed, sometimes to the point of contemplating suicide, their depression seems to be the result, not the cause, of the problem.
In the early 1970's, Swedish physicians discovered that the drug clomipramine could greatly relieve or reverse the symptoms of OCD.
This drug, an antidepressant, specifically affects cells in a certain part of the brain that take up a chemical messenger called serotonin.
Last December the Federal Food and Drug Administration finally approved clomipramine, marketed as Anafranil, for the treatment of OCD.
At the same time, behavior therapists began to show that their techniques could also relieve and, in some cases, permanently reverse the symptoms of OCD.
Patients in behavior therapy must be highly motivated and agree to and stick with a treatment "contract," even though not indulging in their compulsion, even for a few minutes, may make them painfully anxious.
Rapoport and others urge patients to try behavior therapy first and only if that does not work to seek drug treatment, which may need to be continued indefinitely.
However, in most patients a combination of behavior and drug therapy, sometimes in concert with psychotherapy to help them cope with anxiety or depression, is most effective and most likely to result in lasting relief.
For more information, contact the Obsessive Compulsive Foundation by writing to P.O. Box 9573, New Haven, Conn. 06535, or by calling (203) 772-0565 or (203) 772-0575.
by CNB