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The ABCs of OCD

The ABCs of OCD

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For most people, checking the stove before leaving the house involves nothing more than looking at the knobs and heading out the door. But for some the ritual can stretch on almost endlessly, as one worry leads to another. "What if the red indicator bulb is burned out?" they may wonder, or "What if the 'Off' position isn't really off?" When anxiety of this type begins to feel like an insurmountable obstacle, or makes it difficult for a person to leave the house at all, there's something else at work beyond ordinary caution. It's distressing and debilitating, and a common symptom of Obsessive-Compulsive Disorder, or OCD.

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Ken DuBois is a marketing guru by day and a freelance writer by night. He has written film reviews for, and worked for a time as a theater critic. He is passionate about working out: When he's not in the pool, he's hiking, biking, walking and, weather permitting, working on his backhand.

"People with OCD tend to do a lot of 'What if?' thinking," says Dr. James Hancey, an Assistant Professor of Psychiatry at Oregon Health Sciences University who has run OCD support groups for the past 15 years. "They are looking for all the possible bad outcomes and trying to safeguard against them." And checking, he says, is the most common compulsive behavior. Beyond the rituals with stoves and door locks, some OCD sufferers have to check that they haven't harmed another person with something they've said--or hurt them physically, despite a complete lack of evidence. "They think 'Maybe I hit somebody [with my car]. I'd better go back and look and make sure there's not an injured pedestrian lying by the side of the road,' " Dr. Hancey says. "It's fairly common."

Obsessive-compulsive disorder is often regarded as a single behavioral problem, but it's actually defined by two distinct sets of symptoms. The "obsessive" parts of OCD are the types of recurrent thoughts, ideas, images, or impulses that keep coming back to a person's mind. The compulsions, on the other hand, are the behaviors that people engage in excessively or in a ritualized fashion. Recurrent worries about germs and contamination, for example, would be considered obsessive, while repeated hand washing--to the point of causing skin rashes or sores--is the compulsive half of the disorder.

In many cases, however, the symptoms of OCD are not associated with an obsessive fear, and are difficult to diagnose, especially when exhibited by children as young as two years old. Repetitive counting, tapping, rubbing and touching are symptoms of the disorder in some cases, though in children repetition and a sense of order, such as lining up toy cars, is usually normal behavior.

A traumatic event, such as a death in the family, wartime experience, or marital discord is the root cause of OCD in many cases, says Dr. Hancey, but neurological damage caused by an infection is also believed to be a common cause. A genetic inclination toward anxiety disorders may also be a factor. But whatever the cause, inclination or age, Dr. Hancey treats all of his patients with a combination of cognitive therapy, behavioral therapy, and medication, and he sees life-changing results. The disorder may wax and wane throughout a person's life, sometimes exacerbated by stress, but the worst symptoms often disappear, never to return. In some cases, Dr. Hancey says, a person may even manage the problem on their own with great success.

"It's very common," Dr. Hancey says. "It's very treatable. And I like to characterize it as a disorder of the highly successful. Because a lot of those traits serve people very well up to a point. Eighty to 90 percent of individuals have isolated obsessions or compulsions at one time or another in their lives." In most of those cases--especially if the symptoms don't interfere with work or relationships, or cause distress--he believes professional mental health care may not be necessary at all. "If it's not causing a problem," Dr. Hancey says simply, "we don't treat it."

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