Obsessive Compulsive Disorder Can Be Devastating, But Highly Treatable
"It's my OCD." I hear that on and off from friends and patients who half-jokingly use the term to describe overly careful behavior (such as double-checking to make sure the stove is off) but don't actually have obsessive-compulsive disorder. True OCD can be a devastating disease. Patients have intrusive, uncontrollable thoughts and severe anxiety centered around the need to perform repetitive rituals. They can be physical such as hand washing or mental such as counting. The behavior significantly interferes with normal daily activities and persists despite most patients being painfully aware that the obsessions or compulsions are not reasonable.
OCD affects 2-3 percent of the world's population. We've seen characters with the disorder portrayed in television (e.g., Tony Shalhoub's Adrian Monk) and in film (e.g., Jack Nicholson's Melvin Udall in As Good As It Gets). Yet it's still associated with stigma, shame, and an alarming level of ignorance by many health professionals. On average, people look for help for more than nine years and visit three to four doctors before receiving the proper diagnosis. In an excellent review article on the subject, Dr. Michael A. Jenike, offers three helpful screening questions: "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 or wash your hands frequently?" And "Do you check things to excess?" He suggests that answering "yes" to any of these questions should prompt an evaluation for possible OCD. Of course, these are just screening questions and keeping a spotless kitchen doesn't mean you have a disorder.
For this week's CBS Doc Dot Com, I interviewed Jeff Bell, KCBS radio broadcaster and author of Rewind, Replay, Repeat: A Memoir of Obsessive Compulsive Disorder and When In Doubt, Make Belief: Life Lessons from OCD. He poignantly told me about the mental anguish associated with his illness, how it threatened to sabotage his career and personal life. His OCD focused on a fear of unintentionally harming others. He found himself unable to drive a car because every time he hit a bump he was afraid he had run somebody over; each time, he needed to get out and check. Even walking to work presented a challenge. He explained that a twig on the sidewalk could stop him in his tracks and fill him with what he knew were irrational thoughts but was powerless to control. Maybe somebody would be harmed by the twig if he didn't move it. But if he did move it then maybe somebody would be harmed who wouldn't have if he had just left it alone.
Jeff Bell sought treatment and turned his life around. His message is that others can do the same. Highly successful approaches including cognitive-behavioral therapies and medication can help the majority of patients. But only those who ask for help.
Extra Video:
Resources for OCD include: The Obsessive Compulsive Foundation, The Association for Behavioral and Cognitive Therapies, and this link.
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Jeff Bell (from Dr. LaPook's piece) here. It's great to see so many people weighing in on this. FYI.. I spend much of my time advocating on behalf of the national OC Foundation these days, so If I can answer any questions about living with OCD and/or help point you toward any resources in the OCD community, just holler. The good news about OCD is that it IS treatable, and I'm hopeful that reports like this one will help spread that message.
Thanks for weighing in. I'd like to hear more from you about the misdiagnoses you received on your journey. Why do you think it takes so long for the correct diagnosis to get established?
I went to one person who basically told me that I had no problem, and that I needed to learn coping skills. While I sought help through this person, I got progressively worse. I made fundamental changes to my life which might have been disastrous, but I managed to turn them to my advantage. Eventually I sought help from a psychiatrist, who quickly identified my problem and started treating it. I have been very happy since.
I think that the biggest barrier to people getting treatment is the perception that some of the symptoms are indicative of some sort of serious psychosis. I would say to those who suffer from the recurring disturbing thoughts that are symptomatic of this disorder that you are not crazy, nor are you about to snap. You have an anxiety disorder that is highly treatable. Find a good doctor (via referral), and tell that doctor the whole truth. Take time to assess your treatment. Are you feeling better? Be patient with the meds - they take time to work.
Today he is a changed person. He is off of all meds and his health insurance company recently informed him he is no longer considered OCD. His huge premiums dropped and he now pays the same as a healthy male in his age bracket (29).
What did he do: he used a spiritual and energy healing system and stayed with it. Here is a clip of him telling part of his story http://www.drsha.com/index.php?id=494
And I'd like to point out that this "Bach Flowers" stuff appears to be a bunch of nothing. First, it's a form of homeopathy, which is bunk. What I found in some quick research is that all studies into Bach Flowers treatment showed results that are no better than placebo. My advice: don't waste your money on this.
And homoepathy is no bunk. It works with most people. It may take a little more time than allopathy but you treat the root cause, not the symptom.
There are several different Bach Flowers to address the anxiety part as well. The choice here depends on the type of anxiety. Mechthild Scheffers book about Bach Flowers can help you choose, or a person with knowledge about Bach Flowers.
I know it sounds way too easy to be true. But it works.
I was ultimately forced to temporarily drop out of college due to excessive fatigue and my inability to concentrate on my school work or in-class lectures. Thus, I only managed to resume my degree years later after another switch in designated perscribers resulted in a more healthy dosage of 20 MG of Prozac on a daily basis, accompanied by comments from my newfound doctor, who, seemed noticeably appalled by my former psychiatrist's almost indiscriminant use of prescriptions. While symptoms remained, they became far more managable than my prior vegetation which had driven me precariously close to the brink of insanity.
Thus, my advice for any OCD contemplating medication is to choose your psychiatrists carefully. More considerate professionals will prescribe medication with discretion, culminating in discontinuation, increases or decreases of medication in gradual increments so as to elude needlessly stressful responses. However, one psychiatrist warned me of the subjects of the so-called "old school of psychiatry", who can be easily distinguished by being inattentive in conversation, and prescribe large amounts of medication without a lengthy analysis, and worse, fail to advise or warn you as to any potential side effects which you might face.
While I managed to piece some aspects of my life together, some elements have been subject to permanent damage.
Thus, at the end of the day, my only regret about my OCD was having consented to treatment in the first place.
I think this is good advice. Some doctors seem to believe that they are blowing a pill down a horse. Medications used for OCD need to be titrated with close attention. A small change in dosage can make the difference between being miserable and having something like a normal life; some medications can make the symptoms worse before they get better, and some people just don't get along with some drugs. If you have OCD, get a doctor that specializes in it, preferably one recommended by others.
Thank you for the article, Dr.
As a severely-afflicted OCD, myself, I would also like to extend advice to others who suffer from this disorder to pick and choose their psychiatrists carefully.
I intiially was perscribed medication in 8th grade, in minimal doses which seemed to yield minimal results. By 10th grade, however, my parents had hired a different psychiatrist who immediately upped the ante by coupling a daily dosage of 200 MG of Zoloft with two separate anti-psychotic drugs and four dosages of atavan (which the doctor had neglected to mention possessed not only sedating but addictive side effects as well.) Almost immediately, my OCD symptoms became exacernated, affecting both my ability to concentrate and to control many of the rituals, some of which included all-night handwashing rituals which left my fingers cracked and bleeding on every single occasion.
My grades plummetted, and many of my close friends decided to disassociate themselves from me on account of my newfound tendancy for "acting strangely".
Like one who placed too much faith in so-called "professionals", I by default assumed the drastic increase in symptoms as demonstrative of a deterioration of the disorder itself, rather than fathoming any notion that the medication might actually be part of the problem.
It's a tiny sample size, I know. But that is what I have seen of the disease.