Ocd

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that is the fourth most common mental illness in the U.S. (8). OCD affects five million Americans, or one in five people (3). This is a serious mental disorder that causes people to think and act certain things repetitively in order to calm the anxiety produced by a certain fear. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure; rather, the rituals are performed to obtain relief from the discomfort caused by obsessions (2). OCD is more common than schizophrenia, bipolar disorder, or panic disorder, according to the National Institute of Mental Health (6). This disorder can be therapeutically treated, but not cured. The causes of OCD are not completely understood, and warrant further exploration of self-control and autonomy.

There are many branches or types of OCD. Within all branches, ninety percent of people suffer from both obsessions and compulsions, rather than solely one or the other (1). One category of OCD sufferers tend to check and recheck items from 10-100 times - such as a locked door. The overwhelming impulse to recheck remains until the person experiences a reduction in tension despite the realization that the item is secure (1). OCD sufferers also tend to habitually wash due to fear of contamination. Another form of OCD is hoarding, which is excessive saving of typically worthless items such as shoes or computer disks due to an overwhelming fear that one day these items might be of use. People who suffer from the ordering branch of OCD, feels compelled to place items in a designated spot or order to alleviate worries of disorder and mayhem. Pure-O sufferers are those people who grapple with unwanted and unethical thoughts. They tend to be superstitious and compulsively do problem solving in order to control their thoughts. OCD sufferers can also be subject to hyperscrupulosity, which involves extreme worry and anxiety for the safety of others. Another form of OCD is body dysmorphia. This is a condition where people become excessively focused on some body part which they perceive to be grossly malformed (1). Hypochondriacs -people who have an extreme fear of sickness - fall into this category of OCD. General behaviors that may indicate OCD are: excessive washing, repeating, checking, touching, counting, ordering/arranging, hoarding, or praying (2). OCD patients live in a vicious cycle. They have obsessions about certain things and cause anxiety. To relieve this anxiety, compulsions are performed, and then attention can be paid again to the obsessions that have not truly been alleviated. The difference between OCD sufferers and other people, is the OCD sufferer use up at least an hour of their day thinking or doing these incessant tasks and they interfere with the person's work, social life, and relationships (2).

If OCD is found in conjunction with another disorder, it is usually found with a ticking disorder or depression. Ticking is involuntary motor behavior that results from a feeling of discomfort (much like the compulsions of OCD), and depression usually is exemplified from the person's disappointment or shame for having the OCD. Sixty to ninety percent of people with OCD have suffered from at least on major episode of depression at some point in their lives (3). However, OCD is usually easy to distinguish from schizophrenia, delusional disorders, and other psychotic conditions because unlike psychotic individuals, people with OCD continue to have a clear idea of what is real and what is not (4). People with OCD are painfully aware that their behaviors are unreasonable and irrational (1). The person seems to be suffering from a separation between self and behavioral instincts. Their self is no longer in control of their actions or thoughts, is this separation possible? What is the purpose of the 'self,' the person, in patients with OCD if they have lost control over their mind and body?

In order to better understand the changes that have overcome a person with OCD, it is helpful to analyze what is going on in their brains, even though there is no single cause for OCD. OCD involves problems in communication between the orbital cortex, the front part of the brain, and the basal ganglia, deeper structures. These parts of the brain are used in motor control, and have been found in OCD patients to have impaired inhibitory mechanisms. The inhibition is shown by lower levels of synchronization of the prefrontal area and basal ganglia after simple self-paced movement, and may extend the concept of reduced inhibition in OCD patients to refrain from performing impelling actions (9). These parts of the brain use the messenger seratonin, and when there are low levels of seratonin, the symptoms of OCD increase. When there are high concentrations of seratonin, the communication between these two areas of the brain involved in processes that in some way mediate OCD behaviors is increased, and the symptoms of OCD decrease (2). Drug therapy is one answer to OCD. Medicines that function as seratonin reuptake inhibitors are most affective at relieving the compulsions of OCD patients. The purpose is to increase the availability of seratonin in the synapses of the brain so that the orbital cortex and basal ganglia can communicate more efficiently. If OCD is treated by a drug that acts as a selective seratonin reuptake inhibitor (SSRI) the symptoms of OCD typically decrease from forty to ninety-five percent (3).

An overly sensitive amygdala, the small portion of the brain stem that responds to emergency circumstances, is also thought to play a large role in OCD patients. Brain mapping studies tests were used on OCD patients. The brain activity of the amygdala increased dramatically when an OCD patient was presented with a 'stressor' or a fear that would provoke a habitual compulsive response to mediate and relieve that fear (8). Because OCD patients have a heightened response to emergency situations, the innate response to seek a soothing and relieving action or thought is made. The OCD patients find relief from their overly active emergency response by habitual and calming compulsions. Because the amygdala is not involved in cognitive and rational abilities, not responding to obsessive thoughts can only be learned by contradictory, repetitive acts (8). This is one form of cognitive behavioral therapy (CBT); it is called exposure and response prevention (E/RP) (7). The person suffering from OCD is presented with his/her fear and is forced to inhibit their usual, calming response. The OCD patient could be made to rub their hands on the floor before eating a sandwich to prove to them that their fear of germs is irrational and does not really cause sickness or death. The person clearly can understand that his/her fears are superfluous and uncalled for, but they cannot control their response or fears. The

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