O.C.D., a Disorder That Cannot Be Ignored

O.C.D., a Disorder That Cannot Be Ignored

By

JANE E. BRODY

OCTOBER 13, 2014 12:10 PMOctober 13, 2014 12:10 pm

In the 1997 film “As Good As It Gets,” Jack Nicholson portrays Melvin Udall, a middle-aged man withobsessive-compulsive disorderwho avoids stepping on cracks, locks doors and flips light switches exactly five times, and washes his hands repeatedly, each time tossing out the new bar of soap he used. He brings wrapped plastic utensils to the diner where he eats breakfast at the same table every day.

Though the film is billed as a romantic comedy, Melvin’s disorder is nothing to laugh about. O.C.D. is often socially, emotionally and vocationally crippling.

It can even be fatal.

Four years ago, John C. Kelly, 24, killed himself in Irvington, N.Y., after a long battle with a severe form of obsessive-compulsive disorder. Mr. Kelly was a devoted baseball player, and now friendshold an annual softball tournamentto raise money for the foundation established in his honor to increase awareness of the disorder.

Obsessive thoughts and compulsive behaviors occur in almost every life from time to time. I have a fair share of compulsive patterns: seasonings arranged in strict alphabetical order; kitchen equipment always put back the same way in the same place; two large freezers packed with foods just in case I need them.

hold onto a huge collection of plastic containers, neatly stacked with their covers, and my closets bulge with clothes and shoes I haven’t worn in years, and probably never will again — yet cannot bring myself to give away.

But these common habits fall far short of the distressing obsessions and compulsions that are the hallmarks of O.C.D.: intrusive, disturbing thoughts or fears that cannot be ignored and compel the sufferer to engage in ritualistic, irrational behaviors to relieve the resulting anxiety.

An excessive fear of germs may prompt repetitive hand-washing or a refusal to touch doorknobs or use objects handled by another person. But the rituals may be unrelated to the anxieties that trigger them: opening and closing doors an exact number of times, for example, or stepping over every crack or line, or counting to a certain number before performing an activity.

People with O.C.D. know that their thoughts and actions are not realistic, but they cannot stop themselves from behaving as if they were grounded in fact. Performing compulsive rituals does not give them pleasure and only temporarily relieves their anxiety, resulting in a need to re-enact them again and again.

Both the obsessive thoughts and resulting compulsions can take up an inordinate amount of time, making it impossible to meet the demands of a normal life. Mr. Kelly’s daily struggles with his illness, as revealed in his journal, did not fully come to light until after his untimely death.

In a recent article in The New England Journal of Medicine intended to better inform doctors about the disorder, Dr. Jon E. Grant, a psychiatrist at the University of Chicago’s Pritzker School of Medicine, described a 19-year-old man who “washes his hands a hundred times a day, will not touch anything that has been touched by someone else without scrubbing it first, and has a fear of germs that has left him isolated in his bedroom, unable to eat, and wishing he were dead.”

Over just two years, the man’s disorder had “gradually become completely disabling,”the man’s father reported.

Between 1 percent and 3 percent of people will develop O.C.D., starting in childhood or young adulthood. Often the condition is hereditary, though its severity can vary greatly within a family.

Although what causes O.C.D. is still poorly understood, Dr. Grant noted that abnormalities in several brain structures and functions seem to be involved, including deficits in certain cognitive abilities, like being able to change behavior based on new information.

Without proper treatment, the condition is unlikely to resolve on its own. The earlier it is diagnosed and treated, the better the results.

“Only approximately one third of patients with O.C.D. receive appropriate pharmacotherapy, and fewer than 10 percent receive evidence-based psychotherapy,” Dr. Grant wrote. Effective therapy is often stymied by a misdiagnosis of depression or anxiety; symptoms of both may accompany O.C.D.

In an earlier report in the same journal, Dr. Michael A. Jenike, a psychiatrist at Massachusetts General Hospital,suggested three screening questionsthat can help identify patients with the disorder:

■ “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?”

■ “Do you check things to excess?”

Affected individuals and their families should know that treatment works, even if therapy is done by telephone or over the Internet. When properly treated, 60 percent to 85 percent of patients improve significantly and remain better for years, although booster sessions often are needed to maintain improvement.

The techniques of cognitive behavioral therapy have proved most effective. The preferred method, called exposure and response prevention, is done once or twice a week for up to 30 hours total.

The patient is exposed to anxiety-provoking stimuli, starting with the least provocative. The patient is taught to avoid the usual responses, until even the most feared stimulus causes little or no reaction.

Another approach, called cognitive therapy, helps patients identify automatic unrealistic thoughts and then change how these thoughts are interpreted.

For example, someone with a fear of germs might be asked to touch a range of dirty objects without washing his hands and to keep a log of how often illness follows this action. Eventually it becomes clear that the objects are not making him sick.

Medications like the antidepressants clomipramine (Anafranil) or a selective serotonin reuptake inhibitor (like Zoloft or Paxil) are also helpful, although cognitive behavioral therapy remains the treatment of choice.

A version of this article appears in print on 10/14/2014, on pageD5of theNewYorkedition with the headline: Compulsions That Cannot Be Ignored.

Author Biography (

Jane E. Brody is the Personal Health columnist for The New York Times. She joined The Times as a specialist in medicine and biology in 1965 after completing degrees in biochemistry and science writing at The New York State College of Agriculture and Life Sciences at Cornell University and the University of Wisconsin School of Journalism, respectively, and a two-year stint as a reporter for the Minneapolis Tribune. Her award-winning column is published in The Times’s Science Times section every Tuesday and in many other newspapers around the country.
Ms. Brody is the only or principal author of more than a dozen books, including two best-sellers,Jane Brody’s Nutrition BookandJane Brody’s Good Food Book.She has appeared on hundreds of radio and television programs and starred in her own 10-part show on public television, Good Health from Jane Brody’s Kitchen. She has written scores of magazine articles and won many prestigious awards for journalistic excellence.

Directions: Read the article, “O.C.D., An Order that Cannot be Ignored,” and complete an OPVL on the article for the inquiry question, “To what extent does effective therapy exist to help people with OCD?” Keep in mind the biographical information on the author that is provided. Write up the OPVL as a well-organized paragraph or paragraphs. The OPVL prompt questions are provided as a reminder/aide. Make sure that you reference the inquiry question in your write up.

Inquiry Question: To what extent does effective therapy exist to help people with OCD?

origin

• is the author a journalist or a professor? or?
• where was he/she educated?
• is it primary or secondary?
• what type of source is it? (i.e., newspaper, book, journal article, website, photograph)

purpose

• what does the source argue? what point is it trying to make?
• what evidence does the source use to support the argument?
• include a brief summary of the source’s main points

values

• in what ways does this source help you answer your question?
• why is this source valid and reliable (well-known author? well-respected sources? Expert on the topic?)
• use evidence from the source to support your claims

limitations

• in what ways is this source not helpful in answering your question?
• why is this source not particularly valid or reliable? (bias? Inexperienced author? Author who is not an expert on the topic?)
• use evidence from the source to support your claims

Remember: you aren’t answering the inquiry question, you are writing a paragraph that talks about how effectively the article would help you answer the research question, using the OPVL questions to help guide you.

OPVL

Grading Rubric – Criterion A, B, D

0 /

• Does not reach a standard described by any of the descriptors below.

1-2 / Criterion A:demonstrates basic knowledge and understanding of the source’s content and concepts with minimal descriptions and/or examples.
Criterion B: collects and records limited information from and about the source
Criterion D: describes source in terms of origin and purpose and recognizes few values and limitations; somewhat identifies different perspectives through source analysis
3-4 / Criterion A:demonstrates adequate knowledge and understanding of the source’s content and concepts through satisfactory descriptions, explanations or examples
Criterion B:collects and records mostly relevant information from and about the source
Criterion D:describes source in terms of origin and purpose and somewhat recognizes values and limitations; adequately identifies different perspectives and their implications through source analysis
5-6 / Criterion A:demonstrates substantial knowledge and understanding of the source’s content and concepts through accurate descriptions, explanations and examples
Criterion B:collects and records appropriate relevant information from and about the source
Criterion D:effectively describes and analyzes source in terms of origin and purpose, and effectively evaluates values and limitations, somewhat supporting evaluation with examples; effectively interprets a range of different perspectives and their implications throughsource analysis
7-8 / Criterion A: demonstrates detailed knowledge and understanding of the source’s content and concepts through accurate descriptions, explanations and examples
Criterion B:collects and records appropriate, varied, and relevant information from and about the source
Criterion D: expertly describes and analyzes source in terms of origin and purpose, and effectively evaluates values and limitations, supporting evaluation with relevant examples; expertly interprets a range of different perspectives and their implications through source analysis