Introduction of OCD

I was studying my quiz till I was sleepy, so I decided to surf on the net to make myself a little awake. Then I came across this:

OBSESSIVE COMPULSIVE DISORDER - a patient's guide
The Rojolie Clinic
Introduction:

Obsessive compulsive disorder or OCD was until very recently considered to be a very rare disorder, but new data has revealed that it is in fact a common illness. It has been described as the "hidden epidemic" of psychology and psychiatry. It is now generally accepted that the lifetime prevalence rate of OCD is 2-3%.

Some OCD patients check and recheck that a stove is off, a door is locked, or that some disaster has not befallen their children. Some patients do not have rituals, but endure endless hours of intrusive obsessive thoughts throughout the day. The disorder may be so severe that patients are unable to work, and their families may live from crisis to crisis. If untreated, patients may be disabled for life.

Definition of OCD:

The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM IV) requires that a patient have either obsessions or compulsions which are a significant source of distress; are time-consuming, or significantly interfere with the person's normal routine, occupational functioning, or usual social activities or relationships with others.

At some point during the course of the illness, the patient must recognise that the obsessions or compulsions are excessive or unreasonable. This is not a necessary requirement for young children. According to DSM IV, obsessions are defined by (1), (2), (3), and (4):

1) Recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and cause marked anxiety or distress.

2) The thoughts, impulses, or images are not simply excessive worries about real-life problems.

3) The person attempts to ignore or suppress such thoughts or impulses or to neutralise them with some other thought or action.

4) The person recognises that the obsessions are the product of his or her own mind, and are not imposed from without.

Clinically, the most common obsessions are repetitive thoughts of violence (e.g. harming or killing someone), contamination (e.g. becoming infected by touching something/shaking hands, and doubt such as repeatedly wondering whether one has performed some act, such as having hurt someone in a traffic accident).

Compulsions are defined by (1) and (2):

Repetitive behaviours that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.

The behaviours or mental acts are aimed at checking. This can include mental compulsions such as praying, counting and repeating words silently. Such repetitive mental actions generally serve to decrease, prevent or reduce distress or some dreaded event or situation, however, these behaviours or mental acts either are not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive.

Typical compulsions include handwashing, ordering and checking. Usually, obsessions are anxiety provoking while compulsions are anxiety relieving (at least over the short term).

Differential diagnosis and comorbidity

There is considerable comorbidity of other anxiety disorders and OCD; 27% of lifetime social phobia, 17% panic disorder and agoraphobia and 35% generalised anxiety disorder.

Specific phobias:

The essential feature of specific phobia is a persistent fear of a circumscribed object or situation, or of humiliation or embarrassment in certain social situations (as in social phobia/social anxiety disorder). Common specific phobias include fear of small animals (e.g. dogs, snakes and mice), insects, blood, closed spaces, heights, and air travel. In patients with OCD, phobic avoidance of certain situations that are associated with anxiety about dirt or contamination is frequent, but the concomitant presence of typical obsessions or rituals clarifies the diagnosis of OCD.

Depression:

Classical compulsive rituals are not generally part of the picture of depression, but occasionally depressed patients ruminate about a particular topic and may appear to have obsessions. Careful assessment will usually reveal that the depression preceded the obsessions/ruminations. In addition, the ruminations with depression will more likely have a realistic basis. It is important to keep in mind that about a third of patients with OCD develop clinically-significant secondary depression. Fortunately, the antiobsessional drugs are also, for the most part, potent antidepressant agents as well.

Psychosis:

In occasional OCD patients the obsessions become so severe that the patient seems truly uncertain as to whether his or her concerns are realistic or not. Such obsessions are termed overvalued ideas; for example, the patient may hold the almost unshakable belief that he is contaminating other people unless he washes his hands for three hours after urinating. However, the OCD patient with an overvalued idea can usually, after considerable discussion, acknowledge the possibility that his or her belief may be unfounded. In contrast, the person with a true delusion usually has a fixed conviction that cannot be shaken and also is likely to have other psychotic symptoms such as ideas of reference, paranoia, and/or hallucinations.

Tourette's disorder:

Obsessive compulsive disorder is often found in patients with Tourette's disorder and in that case both diagnoses are given. There is much confusion concerning terminology between neurologists, who often see Tourette's patients, and psychiatrists, who are more likely to see pure OCD patients. Often rituals are referred to as complex tics in the neurological literature.

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Now I know more about this disease. It is not necessary for one patient to have both obsessions and compulsions, they might have only obsessions, without doing ritual stuffs. It is hard to get rid of, I wonder if the medications can really cure it, or just relieve it. Anyway, a friend of mine in Australia told me it's hard totally get rid of it, you'll have to rely on the medicine for the serotonin which is not enough in your brain.

Pray hard. May all the people suffering from this disease get well soon.