People With OCD

People with OCD:

• have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly neat.

• do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again.

• have unwanted thoughts and behaviors they can’t control.

• don’t get pleasure from the behaviors or rituals, but get brief relief from the anxiety the thoughts cause.

• spend at least an hour a day on the thoughts and rituals, which cause distress and get in the way of daily life.

For many people, OCD starts during childhood or the teen years. Most people are diagnosed at about age 19. Symptoms of OCD may come and go and be better or worse at different times.

There is help for people with OCD. The first step is to go to a physician or health clinic to talk about symptoms. People who think they have OCD may want to bring this booklet to the physician, to help them talk about the symptoms in it. The physician will do an exam to make sure that another physical problem isn’t causing the symptoms. The physician may make a referral to a mental health specialist.

Physicians may prescribe medication to help relieve OCD. It’s important to know that some of these medicines may take a few weeks to start working. Only a physician (a family physician or psychiatrist) can prescribe medications. (In 2 states, psychologists with specific training and certification may prescribe medications for anxiety disorders.)

The kinds of medicines used to treat OCD are listed below. Some of these medicines are used to treat other problems, such as depression, but also are helpful for OCD.

• antidepressants,

• antianxiety medicines, and

• beta-blockers.

Physicians also may ask people with OCD to go to therapy with a licensed social worker, psychologist, or psychiatrist. This treatment can help people with OCD feel less anxious and fearful.

There is no cure for OCD yet, but treatments can give relief to people who have it and help them live a more normal life. If you know someone with signs of OCD, talk to him or her about seeing a physician. Offer to go along for support. To find out more about OCD, call 1-866-615-NIMH (1-866-615-6464) to have free information mailed to you.

Who pays for treatment?

Most insurance plans cover treatment for anxiety disorders. People who are going to have treatment should check with their own insurance companies to find out about coverage. For people who don’t have insurance, local city or county governments may offer treatment at a clinic or health center, where the cost is based on income. Medicaid plans also may pay for OCD treatment.

OCD sometimes runs in families, but no one knows for sure why some people have it, while others don’t. When chemicals in the brain are not at a certain level it may result in OCD. Medications can often help the brain chemicals stay at the correct levels.

To improve treatment, scientists are studying how well different medicines and therapies work. In one kind of research, people with OCD choose to take part in a clinical trial to help physicians find out what treatments work best for most people, or what works best for different symptoms. Usually, the treatment is free. Scientists are learning more about how the brain works, so that they can discover new treatments

“I couldn’t touch any doors or countertops in public areas. I knew it didn’t make any sense, but I was terrified of getting germs that could kill me. I almost couldn’t go out in public, I was so afraid. If I thought I had touched anything, I would have to wash myself for hours. Sometimes I washed so much that my skin would get red and raw and bleed.

“At first I was too embarrassed to get help, but a friend told me to call the doctor. I’m so glad I did. I took the medicine my doctor gave me. I also talked with a counselor, in therapy. I learned to cope with my fear of germs and to stop washing so much

Dialectical Behavior Therapy (DBT) reduced suicide attempts by half compared with other types of psychotherapy available in the community in patients with borderline personality disorder, an NIMH-funded study has found.

DBT also excelled at reducing use of emergency room and inpatient services and more than halved therapy dropout rates compared to the mostly traditional approaches, report Marsha Linehan, Ph.D., University of Washington, and colleagues in the July 2006 issue of Archives of General Psychiatry.

"All treatments are not equal for such suicidal patients," said Linehan.

Borderline personality disorder is a difficult-to-treat mental illness affecting up to two percent of adults, 5.8-8.7 million Americans, mostly young women. People with this disorder of emotion regulation experience intense bouts of anger, depression, and anxiety that may last only hours, often in response to perceived rejection.

They typically have tumultuous work and family life and may engage in risky, impulsive behaviors. Cutting, burning and other forms of self-harm are common, with up to 9% ultimately killing themselves. Although they account for at least 20 percent of psychiatric inpatient admissions, and frequently seek mental health services, patients with the disorder often fail to respond to commonly available treatments.

Hence, NIMH has supported the development and testing of DBT by Linehan and her colleagues over the past two decades. This variation on cognitive behavioral therapy specifically targets suicidal behavior, behaviors that interfere with treatment, and risky social behaviors. While previous controlled trials had demonstrated DBT's usefulness, whether this was attributable to psychotherapy generally rather than to specific features of DBT remained unclear.

To help resolve this issue, the researchers created a more tightly-defined comparison condition. They treated for one year 101 female patients with borderline personality disorder, ages 18-45, in the Seattle area with either currently available "Treatment By Experts" (TBE) in the community, or therapists specifically trained in DBT.

The 52 patients randomly assigned to the DBT group received one hour of individual therapy and 2.5 hours of group skills training each week, in addition to phone consultations. DBT focused on improving patients' coping skills and motivation by helping them reduce interfering emotions and thinking and reinforce functional behaviors. Their 16 DBT therapists also met weekly to enhance their motivation and skills.

The 49 patients who received TBE were offered one weekly therapy session plus additional treatment as needed, at the therapists' discretion. Most of them received psychodynamic therapy that focused on gaining insight into unconscious motives, needs and defenses rather than directly on behavior change. Their 25 therapists, nominated by community mental health leaders for their skill in dealing with difficult patients, had the option of attending a weekly supervisory group convened at a prestigious local psychoanalytic institute.

Although DBT patients were provided with significantly more therapy within the study, the two groups ended up with about the same total therapy hours, since TBE patients were more prone to switching therapists and seeing therapists outside the study.

The risk of dropping out of therapy was nearly three times higher among the TBE group — 59 percent dropped their first assigned therapist, compared to 25 percent of DBT patients. More than twice as many of the former also dropped out of the study entirely. Fewer DBT patients continued taking psychotropic medications during the study year, perhaps reflecting their therapists' behaviorally-focused treatment philosophies.

While there were no completed suicides, 46.7 percent of the TBE and 23.1 percent of the DBT patients attempted suicide during the study year. Among TBE patients, 57.8 percent visited emergency rooms for psychiatric problems, compared with 43.1 percent among DBT patients; 48.9 percent of TBE patients had at least one psychiatric hospitalization, often for suicidal thoughts, in contrast to 19.6 percent of DBT patients. No significant differences emerged between the groups in proneness to non-suicidal self-injury. And both therapies reduced patients' suicidal thinking and strengthened their appreciation of it.

Noting that DBT is the only psychosocial treatment shown in multiple randomized clinical trials to be effective for borderline personality disorder, the researchers suggested that "DBT may be uniquely effective in treating suicidal individuals.