OCD may be associated with a chemical imbalance in the brain and is
thought by many experts to be inherited.

"Everyone who has OCD does not have a chemical imbalance, and
parents who have OCD do not necessarily pass it on to their
children," said CDR Chris Kowalsky, NNMC Adult Behavioral Health
department head. Nothing is black and white in the mental health
field."

OCD can start at any time from preschool age to adulthood. OCF
statistics say that nearly one million children and teens in the
United States suffer from OCD. OCD is more common than many other
childhood illnesses. Approximately one in every two hundred children
may have the disorder.

Researchers have found that children with OCD and or tic disorders
or Tourette's syndrome, experience worsening symptoms following
bouts of "strep throat" infections and scarlet fever. Step
infections have also been proven to be the primary catalyst in many
children with OCD and tic disorders or Tourette syndrome. This
phenomenon is known as PANDAS, an abbreviation for Pediatric
Autoimmune Neuropsychiatric Disorders Associated with Streptococcal
Infections.

Following a strep throat infection, children will have a
dramatic, "overnight" onset of symptoms, including obsessions,
compulsions, and motor or vocal tics. In addition to these symptoms,
children may also become moody, irritable or show concerns about
separating from parents or loved ones.

Experts believe that PANDAS effects the Basal Ganglia portion of the
brain, which controls movement and behavior, and produces OCD and/or
tics.

General OCD symptoms in children and adults tend to wax and wane
over time.

Most people with OCD find their thoughts and actions to be excessive
and senseless, but are unable to control them. When someone with OCD
does not recognize their beliefs and actions are unreasonable, this
is termed "OCD with poor insight."

"Generally, it can take a while for OCD patients to come to us,"
said Kowalsky. "They have slipped into a learned helplessness, and
are so protective of their own anxiety that they need a good friend
or family member to step in and encourage them to get help."

The first step in treating OCD is educating the patient and family
about OCD and its treatment. Doctors use two effective treatments
for OCD, usually in combination: cognitive-behavioral psychotherapy
(CBT) and medication with a serotonin selective reuptake inhibitor
(SSRI), which increases the concentration of serotonin, a chemical
messenger in the brain.

"In my experience, response exposure prevention or REP, a form of
cognitive or behaviorally-oriented therapy, works the best," said
Ulissi. "I let my patients know that some of the therapy will be
uncomfortable because it makes them respond to their fears without
escaping them. The medication is helpful because it helps reduce
some anxiety and allows the person to relax. In OCD therapy, when
doctors use REP and medication together, the success rate is 80
percent or higher."

Whether doctors are treating child or adult OCD patients, it is
challenging on both sides.

"I remain humble when treating children with OCD," said
Ulissi. "Children are constantly developing and changing. They are
literally 'moving targets.' They are not the best informants. I
often rely on parents and teachers to report their patterns of
behavior.

Teenage OCD patients are also challenging because they are already
at a tumultuous point in their lives. I am careful when I
distinguish between normal teenage emotions and OCD tendencies."

Old habits die hard. According to Kowalsky, that is where the
challenge lies with treating adult OCD patients.

"Studies have also found that it takes an average of 10 to 12 years
from the time OCD begins for people to seek treatment," said
Kowalsky. "When the patient finally comes to the us, they are going
to have deeply entrenched thinking patterns and habits that are
going to be extremely difficult to modify."

Treatment for OCD is not a quick fix. According to the OCF, people
with OCD see three to four doctors and spend over nine years seeking
treatment before they receive a correct diagnosis. People with OCD
may be secretive about their symptoms and doctors are sometimes
unfamiliar with the different sides of the disorder.

Part of a patient's recovery is the realization that there is no
miracle cure for his or her condition.

"The obsessions can come back and sometimes the compulsions to carry
them out will come back as well, usually within six to eight months
after a patient has recovered," said Ulissi. "The relapse rate for
most recovered OCD cases is about 80 percent.

"A patient came back and to me said, 'the speaker is still on, but
the volume is much lower now,' meaning he still sometimes has
obsessions, but they no longer consume his life. And then that
patient honestly admitted that he still wanted to adjust the fringe
on the rug, but no longer feels compelled to do it. These are signs
that the patient has dramatically improved."

There are disorders that closely resemble OCD. Obsessive Compulsive
Personality Disorder (OCPD), despite its similar name, does not
involve obsessions and compulsions. Rather, OCPD is a personality
pattern that involves a preoccupation with rules, schedules, lists,
perfectionism, excessive devotion to work, rigidity and
inflexibility.

However, when people have both OCPD and OCD, the successful
treatment of the OCD often causes a favorable change in the
patient's personality.

"OCPD is not entirely bad," explained Kowalsky. "The condition can
be ego-syntonic, meaning it fits well into the person's lifestyle.
If the person is a pilot, or works with highly sensitive
information, it would behoove them to be a bit perfectionistic. When
the condition disturbs the person's lifestyle, it's known as ego-
dystonic. People with OCPD are hard to live with and hard to work
for, but through therapy they can filter their energy into something
productive and it can become positive."

Individuals with OCD might experience bouts of depression and stress
in dealing with their disorder. They develop substance-abuse
problems, sometimes as a result of attempts to self-medicate.

"People will go with what they know first," said Kowalsky. "They
might pick up a bottle or use drugs and think that might temporarily
make their problems go away.

"The good news is that in this information age there are many great
resources available on OCD. Over the years therapy has improved and
changed many lives. As medicine continues to evolve, the road to
recovery for OCD patients will hopefully shorten as well."

Individuals with questions pertaining to OCD should contact their
primary care provider or a mental health professional.