Obsessive-compulsive behaviors worsen under stress

It is estimated that anywhere between two and seven million Americans have obsessive-compulsive disorder (OCD).

OCD has two parts: unreasonable obsessions plus the compulsive acting out of mental or physical rituals to reduce the stress of the thoughts or to supposedly ward off negative events.

Compulsive thoughts that plague OCD sufferers are commonly a fear of getting a disease like AIDS or cancer, of being poisoned, of inadvertently causing harm to someone, of having forgotten to do something like lock the door before bed or of losing something important.

Mental rituals used to soothe the person include repetitive prayers, counting (syllables, floor tiles, streetlamps, food) or repeating certain words silently.

Physical rituals include hand washing (this is often done to the point of leaving the skin raw), tapping things a certain number of times, checking irons/doors/ovens multiple times, hoarding objects, avoiding places with specific numbers or letters in their names and driving multiple times around the block to make sure the person did not run over someone and leave a body in the street.

People with OCD know that their thoughts and rituals are bizarre. They often feel ashamed of themselves and work hard to keep their quirks a secret.

In the past, it was believed that OCD was a result of bad parenting. We can thank Freud for that. A hyper-organized mother, for example, supposedly generated obsessive hand washing or cleaning in her children. People with OCD were seen as repressed, crazy or hopelessly neurotic.

The medical community now knows that OCD is a problem in the brain. Although OCD usually worsens when the person is tired, under a lot of external stress (such as a bad day at work or family problems) or is ill, OCD is not considered psychosomatic – an illness that is an emotional response to stress and not considered a true malady.

People with OCD also tend to have problems with anxiety from a young age.

Treatment for OCD varies. Johns Hopkins Department of Psychiatry and Behavioral Sciences states that treatment is a three-pronged approach: medications, behavioral therapy and/or surgery.

Antidepressants are commonly used to mitigate the severity of obsessive thoughts.

HealthyPlace.com, a Web site about anxiety disorders, states that medications provide relief for about 80 percent of people with OCD. When the medications are stopped, there is an 85-percent relapse rate. Patients may have to try different medications before the correct dose is discovered.

Drug-free options for OCD sufferers are cognitive behavioral therapy (CBT) and cognitive therapy (CT).

In CBT the patient repeatedly confronts fears he or she otherwise avoids and is not allowed to perform any soothing rituals. Although British studies have shown the success rate of CBT to have more than 75 percent effectiveness, many OCD sufferers refuse to do it.

CT gives a person the tools to replace obsessive thinking with new, constructive thoughts. OCD is not “cured” with CT, since the thoughts do not disappear, but according to CognitiveTherapyNYC.com, 80 percent of patients who complete their CT courses show moderate to marked improvement in their obsessive thinking.

The last resort for people with OCD, and it must be crippling to get to this position, is brain surgery.

BrainPhysics.com states that the most common form of brain surgery for OCD is “radiofrequency waves to destroy a small amount of brain tissue, which disrupts a specific circuit in the brain that has been implicated in OCD.”

Long-term effects are said to be between 25 and 70 percent effective. This surgery is used only after medications and long-term CT have failed.