Obsessive-Compulsive Disorder Health Article

Diagnosis

People with obsessive-compulsive disorder feel ashamed of their problem and often try to hide their symptoms. They may avoid seeking treatment. Because they can be very good at keeping their problem from friends and family, many sufferers do not get the help

they need until the behaviors are deeply ingrained habits and harder to change. As a result, the condition is often misdiagnosed or underdiagnosed. All too often, it can take more than a decade between the onset of symptoms and proper diagnosis and treatment.

While scientists seem to agree that OCD is related to a disruption in serotonin levels, there is no blood test for the condition. Instead, doctors diagnose OCD after evaluating a person's symptoms and history.

Treatment

Because OCD sometimes responds to selective serotonin reuptake inhibitors (SSRI) antidepressants, herbalists believe a botanical medicine called St. John's wort (Hypericum perforatum) might have some beneficial effect as well. Known popularly as "Nature's Prozac," St. John's wort is prescribed by herbalists for the treatment of anxiety and depression. They believe that this herb affects brain levels of serotonin in the same way that SSRI antidepressants do. Herbalists recommend a dose of 300 mg, three times per day. In about one out of 400 people, St. John's wort (like Prozac) may initially increase the level of anxiety. Homeopathic constitutional therapy can help rebalance the patient's mental, emotional, and physical well-being, allowing the behaviors of OCD to abate over time.

Other alternative treatments for OCD are intended to lower the patient's anxiety level; some are thought to diminish the compulsions themselves. Alternative recommendations include the following:

• Bach flower remedies: White chestnut, for obsessive thoughts and repetitive thinking.
• Traditional Chinese medicine: a mixture of bupleurum and dong quai, to strengthen the spleen and regulate the liver. In Chinese medicine, obsessive-compulsive disorder is due to liver stagnation and a weak spleen.
• Aromatherapy: a mixture of lavender, rosemary, and valerian for relaxation.
• Yoga: Yogis in India developed a special technique of yogic breathing specifically for OCD. The specific yogic technique for treating OCD requires blocking the right nostril with the tip of the thumb; slow deep inspiration through the left nostril; holding the breath; and slow complete expiration through the left nostril. This is followed by a long breath-holding out period.
• Schuessler tissue salts: for OCD, 10 tablets of Ferrum phosphorica 30X and 10 tablets of Kali phosphorica 200X, twice daily.
• Massage therapy: with special emphasis on loosening the muscles in the neck, back, and shoulders.

Cognitive-behavioral therapy (CBT) teaches patients how to confront their fears and obsessive thoughts by making the effort to endure or wait out the activities that usually cause anxiety without compulsively performing the calming rituals. Eventually their anxiety decreases. People who are able to alter their thought patterns in this way can lessen their preoccupation with the compulsive rituals. At the same time, the patient is encouraged to refocus attention elsewhere, such as on a hobby.

Allopathic treatment

Obsessive-compulsive disorder can be effectively treated by a combination of cognitive-behavioral therapy and medication that regulates the brain's serotonin levels. Drugs that are approved to treat obsessive-compulsive disorder include fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft), all SSRIs that affect the level of serotonin in the brain. Drugs should be taken for at least 12 weeks before deciding whether or not they are effective.

In a few severe cases where patients have not responded to medication or behavioral therapy, brain surgery may be attempted to relieve symptoms. Surgery can help up to a third of patients with the most severe form of OCD. The most common operation involves removing a section of the brain called the cingulate cortex. The serious side effects of this surgery for some patients include seizures, personality changes, and decreased ability to plan.

Expected results

Obsessive-compulsive disorder is a chronic disease that, if untreated, can last for decades, fluctuating from mild to severe and worsening with age. When treated by a combination of drugs and behavioral therapy, some patients go into complete remission. Unfortunately, not all patients have such a good response. About 20% of people cannot find relief with either drugs or behavioral therapy. Hospitalization may be required in some cases.

BOOKS

Dumont, Raeann. The Sky is Falling: Understanding and Coping with Phobias, Panic and Obsessive-Compulsive Disorders. New York: W.W. Norton & Co., 1996.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Anxiety." New York: Simon & Schuster, 2002.

Schwartz, Jeffrey. Brain Lock. New York: HarperCollins, 1996.

Schwartz, Jeffrey. Free Yourself from Obsessive-Compulsive Behavior: A Four-Step Self-Treatment Method to Change Your Brain Chemistry. New York: HarperCollins, 1996.

Swedo, S.E., and H. L. Leonard. It's Not All In Your Head. New York: HarperCollins, 1996.