What is OCD? – Obsessive Compulsive Disorder
People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Frequently, the rituals end up controlling them.

For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get “caught” in the mirror and can’t move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.

The difference between those with OCD and people who may have the tendency to “check and recheck” certain things is that people with OCD perform their rituals even though doing so interferes with daily life, and the repetition of doing so is distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.

What causes Obsessive Compulsive Disorder or OCD?
There is growing evidence that OCD represents abnormal functioning of brain circuitry, most likely involving a part of the brain called the striatum. OCD is not caused by family problems or attitudes learned in childhood, such as an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable.

Research does indicate that OCD can run in families, suggesting that there may be a genetic link to the disease.

Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioral therapy and medication produce changes in the striatum.

Who Gets OCD?
OCD affects about 2.2 million American adults, and the problem can be accompanied by eating disorders, other anxiety disorders, or depression. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children.

How Is OCD Diagnosed?
There is no laboratory test to diagnose OCD. The doctor bases his or her diagnosis on an assessment of the patient’s symptoms, including how much time the person spends performing his or her ritual behaviors.

What are the Symptoms of OCD?
The symptoms of OCD, which are the obsessions and compulsions, may vary. Common obsessions include:

  • Fear of dirt or contamination by germs
  • Fear of causing harm to another
  • Fear of making a mistake
  • Fear of being embarrassed or behaving in a socially unacceptable manner
  • Fear of thinking evil or sinful thoughts
  • Need for order, symmetry, or exactness
  • Excessive doubt and the need for constant reassurance

Common compulsions include:
Repeatedly bathing, showering, or washing hands.*Refusing to shake hands or touch doorknobs.*Repeatedly checking things, such as locks or stoves.*Constant counting, mentally or aloud, while performing routine tasks.*Constantly arranging things in a certain way.*Eating foods in a specific order.*Being stuck on words, images or thoughts, usually disturbing, that won’t go away and can interfere with sleep.*Repeating specific words, phrases, or prayers.*Needing to perform tasks a certain number of times.*Collecting or hoarding items with no apparent value.

How Is OCD Treated?

OCD will not go away by itself, so it is important to seek training.

Neurofeedback: This type of behavior (OCD) is neurologically kin to Tourette Syndrome (TS). Almost everything we say about Neurofeedback for Obsessive-Compulsive Disorder (OCD) applies to TS and vice versa. The techniques are identical, and with industry breakthroughs with respect to OCD also apply to TS. This condition benefits greatly from training of the pre-frontal lobes because it centrally involves the dopamine circuits that project there. It also benefits greatly from the tailoring of the protocol to the person, which is what has made the recent clinical gains possible. The most intractable cases of OCD appear to respond to training at very low frequencies. The implication in the neurophysiological realm is that we are dealing with a condition of extreme over-arousal. The implication in the psychodynamic realm is that we may be dealing with a condition grounded in a trauma history. Both considerations call for training at very low frequencies as part of the protocol.

Cognitive behavior: The goal of cognitive behavior therapy is to teach people with OCD to confront their fears and reduce anxiety without performing the ritual behaviors (called exposure therapy or exposure and response prevention therapy). Therapy also focuses on reducing the exaggerated or catastrophic thinking that often occurs in people with OCD.

Medication: Tricyclic antidepressants, such as Anafranil, and selective serotonin reuptake inhibitor (SSRI) antidepressants, such as Paxil, Prozac and Zoloft may be helpful in treating OCD.

In severe cases of OCD and in people who do not respond to medical and behavioral therapy, electroconvulsive therapy (ECT) or psychosurgery may be used to treat OCD. During ECT, electrodes are attached to the patient’s head, and a series of electric shocks are delivered to the brain, which induce seizures. The seizures cause the release of neurotransmitters in the brain.

 

For a comprehensive article on OCD and Neurofeedback by Cory Hammond Ph.D
Please go to:
Neurofeedback with Affective and Anxiety Disorders
D Corydon Hammond
ABSTRACT: A robust body of neurophysiologic research is reviewed on functional brain abnormalities associated with depression, anxiety, and obsessive-compulsive disorder. A review of more recent research finds that pharmacologic treatment may not be as effective as previously believed. A more recent neuroscience technology, electroencephalographic (EEG) biofeedback (neurofeedback), seems to hold promise as a methodology for retraining abnormal brain wave patterns. It has been associated with minimal side effects and is less invasive than other methods for addressing biologic brain disorders. Literature is reviewed on the use of neurofeedback with anxiety disorders, including posttraumatic stress disorder and obsessive-compulsive disorder, and with depression. Case examples are provided.

Child and Adolescent Psychiatric Clinics of North America 02/2005; 14(1):105-23, vii.

 

Social Signs of Obsessive Compulsive Disorder: What To Look For