|
 |
|
|
|
|
|
|
|
|
|
What is Obsessive Compulsive Disorder?
Obsessive Compulsive Disorder (OCD) is a chronic and often disabling medical condition that often begins in childhood or adolescence. Patients with OCD have obsessions and/or compulsions that interfere with their functioning and cause distress. Obsessions are thoughts, images or impulses that are seen as unwanted and senseless. For example, the thought that "I have killed someone" may recur dozens or hundreds of times each day, in spite of no conceivable basis for such concern. Compulsions are repetitive intentional behaviors that are carried out in a stereotyped fashion. For example, a patient might wash his/her hands many times a day, spend hours checking locks or appliances, or rearrange objects symmetrically. Usually a patient realizes that these thoughts or behaviors don't make sense, and, therefore, they often are secretive and anxious about the problem.
The diagnosis of OCD requires not only knowledge of this disorder itself, but a comprehensive knowledge of the range of other neuropsychiatric disorders that are frequently comorbid (coexisting) with OCD or that must be differentiated from OCD. Because many patients with OCD have comorbid conditions, identifying other disorders is extremely important.
Etiology
Athough the precise etiology of OCD is unknown, research supports the presence of a dysfunction in the brain's basal ganglia. There are three characteristics of OCD that support its classification as a neurobiological disorder: (1)OCD symptoms are similar in children and adults; (2) OCD is more prevalent in relatives of those with the disorder than in the general population; and (3) a strong link exists between OCD and other neurobiological disorders.
Comorbidity
The most frequent comorbid conditions are mood and anxiety disorders. When these other disorders are severe, as in the case of Bipolar Disorder, the OCD may be manageable only when the mood has been stabilized. It is striking that for OCD a variety of neurological disorders such as Sydenham's chorea and Tourette Syndrome may co-occur. In fact, approximately one fifth of OCD patients manifest tic symptoms. In children and adolescents, there is frequent Comorbidity with Tourette Syndrome, which may represent a subtype of OCD requiring different treatment methods. For all these reasons, the diagnosing clinician should be familiar with these disorders as well.
Severity
With or without comorbid conditions, OCD may be severely disabling. When obsessions or compulsions are severe, the patient is unable to get to work or attend school. For example, perfectionism may prevent any work from being completed, or repetitive checking may stop the person from even leaving the home. Treatment is indicated when there is such significant interference with productivity or sense of well being.
Treatment
Due to the high rate of comorbidity, treatment plans for patients with OCD should be customized to meet individual needs. Typically, patients are treated with a combined approach of medication and behaviorally-oriented psychotherapy. Behavior therapy typically requires 15 or more sessions of planned direct exposure to feared situations, while having the patient refrain from carrying out rituals. Trained and experienced therapists are needed to assist patients through this often difficult but highly effective approach. Individual and family therapy may be necessary as well to help the child and family adjust to the child's disorder.
A range of medications are also available for OCD, and the prescribing physician will need to see the patient regularly over several months to establish which medications are effective and at what doses. The serotonin reuptake inhibitors have been found uniquely helpful, but, on occasion, other drugs including antianxiety agents and low doses of antipsychotics are beneficial.
Support groups have greatly benefited people with this disorder by making them feel less isolated and often helping them find appropriate treatment. Family members should also receive counseling. They need to understand the physical basis of the disorder and to see that, despite the partial voluntary control that patients with OCD may have, succumbing to their symptoms is not due to "stubbornness" or "selfishness."
Insurance Coverage and Reimbursement
Because OCD improves with treatment and is often comorbid with psychiatric disorders, patients with OCD should expect their insurance to cover evaluation and treatment in a manner similar to that for any other medical condition.
The organizations listed below are concerned that some benefit plans do not provide adequate coverage for the children and adolescents with obsessive compulsive disorder (OCD). This document, endorsed by the organizations listed below, provides information on obsessive compulsive disorder and explains the impact and importance of covering treatment for this disorder.
AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
AMERICAN ACADEMY OF NEUROLOGY
AMERICAN ACADEMY OF PEDIATRICS
AMERICAN ASSOCIATION FOR MARRIAGE AND FAMILY THERAPY
AMERICAN ASSOCIATION FOR PARTIAL HOSPITALIZATION
AMERICAN ASSOCIATION OF CHILDREN'S RESIDENTIAL CENTERS
AMERICAN ASSOCIATION OF PSYCHIATRIC SERVICES FOR CHILDREN
AMERICAN PSYCHIATRIC ASSOCIATION
ANXIETY DISORDERS ASSOCIATION OF AMERICA
CHILDREN AND ADULTS WITH ATTENTION DEFICIT DISORDERS
NATIONAL ALLIANCE FOR THE MENTALLY ILL
NATIONAL ASSOCIATION FOR RURAL MENTAL HEALTH
NATIONAL ASSOCIATION OF SOCIAL WORKERS
NATIONAL MENTAL HEALTH ASSOCIATION
NATIONAL ORGANIZATION OF RARE DISEASES
NATIONAL TREATMENT CONSORTIUM
OBSESSIVE COMPULSIVE FOUNDATION
TOURETTE SYNDROME ASSOCIATION
©2007 Tourette Syndrome Association, Inc. 42-40 Bell Boulevard / Bayside NY 11361 / 718-224-2999