¶ … dysfunctional behavior that strikes 1 out of 40 or 50 adults and 1 out of 100 children or 2-3% of any population. It can begin at any age, although most commonly in adolescence or early adulthood - from ages 6 to 15 in boys and between 20 and 30 in women -- according to the National Institute for Mental Health. This behavioral affliction is, therefore, more common than schizophrenia or panic disorder and affects people of all ages, gender, race, occupations, religions and socio-economic ranks. Its impact on the mental and emotional states of such numbers in the United States alone has been so strong that it accounts for more than $8 billion worth of social and economic losses - which is 6% of the country's total mental health bill, according to authoritative sources. As if not depressing enough, these millions afflicted know that something is wrong with how they behave, yet do not know what it is that binds them to perform irrational and uncontrollable acts. What is worse, each of them feels alone and helpless. And ironically, this affliction is treatable with various modern and effective therapies.

This behavioral ailment is called Obsessive-Compulsive Disorder (OCD), a neurobiological mental illness, which is characterized by obsessions and usually followed by compulsions to quiet the obsessions. Obsessions are strong, repetitious, unreasonable, frightening and intruding impulses or images that cause great anxiety in the affected person. Compulsions are odd and ritualistic acts that the person feels must be performed in response to the obsessions. Both the obsessions and the compulsions are senseless, shameful and exasperating to the person, who nevertheless finds the behavior difficult to control or overcome. A person with OCD may have obsessions or compulsions only, but 90% of those affected have both.

Common obsessions are fears of contamination (dirt or germs), harming another person, making a mistake, social misbehavior, a lack of symmetry, sexual thoughts and impulses, doubt, repulsive religious thoughts or images, violent or terrifying thoughts that may occur to a loved one. These obsessive thoughts are then followed by the performance of compulsive acts meant to respond to these thoughts. Common compulsive acts or compulsions include repetitious washing of the hands or cleaning, too frequent showers, checking, reordering, collecting, organizing, counting, touching things. The afflicted person keeps repeating a particular compulsion until he or she feels gratified that his or her fear is gone and things are all right. They are performed rigidly to reduce or eliminate the agony presented by the obsessions, although these acts are not directly connected to the thing feared and, therefore, cannot prevent or minimize it. They are also clearly exaggerated.

This pattern should not be confused with the normal or admirable cautiousness exercised when assuring accuracy as regards measurements and counting; double-checking locks, ovens and electrical or gas equipment for safety; or insuring desirable hygiene and order. The person afflicted with OCD, in time, becomes conscious that his or her pattern of behavior is exaggerated, unreasonable and un-directed at the disturbance. Both his or her obsession and compulsion are distressing, lengthy - at least an hour a day -- and tiresome and disturb normal activities to his or detriment and embarrassment. Obsession over cleanliness, for example, can drive a person to compulsively wash hands, take a shower or perform some other sanitary actions in order to eliminate or avoid getting infections or passing them on. Obsession over order and harmony can impel the person to count repetitiously, keep organizing and reorganizing details, aim at perfect alignment of things in the house or office, testing and retesting exaggeratedly. A child may miss his lessons because he or she is preoccupied with counting the teacher's syllables. Or he may be avoiding pointing instruments for fear of hurting someone.

In the past, psychiatrists believed that OCD developed out of a person's traumatic past, such as the over-emphasis on cleanliness or order in a child by his or her parents. Sigmund Freud theorized that it proceeded from traumatic toilet training. Modern research, however, points to OCD as a neurobiological dysfunction when the difference between the brain neurons of OCD patients and those without OCD: the brain neurons of OCD patients appeared much more sensitive to serotonin, a chemical that sends signals to the brain. Modern psychiatrists assume that the over-communication between the frontal lobe (of the brain) and deeper parts of the brain accounts for the repetitive and excessive behavior (compulsion). This, they see as resulting in a kind of jammed transmission in a car, a condition that may conduce to the development of rigid thinking and repetitious movements. Persons with OCD have abnormal frontal lobes, basal ganglia and cingulum. The basal ganglia are involved in automatic behavior,...

Modern drugs that now raise the brain's serotonin level and consequently reduce OCD symptoms and the surgical cutting of the cingulum that has relieved or cured OCD link OCD to the brain chemical. This is called the Serotonin Hypothesis. A device, called a positron emission tomography (PET) scanner is used to examine the brain for OCD.
Risk factors for the development of OCD are genetics, postpartum delivery, and environmental stressors. A 25% predisposition rate among family members of an OCD person indicates that it is probably inherited. It has been observed to be prevalent among identical twins (70%) and 50% for fraternal twins. Medical researchers theorize that multiple genes are involved in the condition, while there is as yet no clear evidence or understanding of OCD's genetic make-up and mechanism.

Pregnant and newly-delivered women undergo a worsening of OCD symptoms, probably owing to unstable hormone levels, a recent study of 30% of observed women suggests. The arrival of a new baby means new responsibility, new concerns, changes in habits and even views and activities. This event causes normal anxiety but it can create disturbing thoughts and extreme behavior in those already predisposed. The obsessions and compulsions are observed to occur at four to six weeks after delivery.

Environmental stressors can be a depressing event like the death of a loved one or a divorce, which can trigger the beginning of OCD. Or if it is already existing, it can be made worse by physical, emotional or verbal abuse; changes in living conditions or situations; illness' changes or problems at work; relationship problems; and problems in school. Puberty may also enhance the development of OCD. Leading cognitive and developmental theorists and psychoanalysts provide us with their concepts on why and how mental and psychological dysfunctions, such as OCD, happen to a person. These theorists are Donald and Miller, Bandura, Berne, Piaget, Jung, Adler, Freud, From, Erikson and Murray.

In addition to genetic predisposition, a person's environment, beliefs and attitudes are considered linked to the development of OCD. Researchers and other experts also assume that those with OCD process information differently from those without OCD.

Other psychological disorders often accompany OCD, such as depression, eating disorders, substance abuse, dysfunctional personalities, attention deficit disorder or any of the anxiety disorders that pre-exists OCD, and can cloud or make the detection of OCD difficult.

The symptoms of other neurological conditions may also be observed in a person with OCD. A person with Tourette's Syndrome, for example, is likely to have a greater predisposition to or an increased rate of developing, OCD. A patient or person with Tourette Syndrome shows "tics" or involuntary muscular contractions and vocalizations.

Other illnesses or conditions linked or associated with OCD are trichotillomania (the urge to pull out scalp hair, eyelash, eyebrows or other hairs from the body); body dysmorphic disorder (undue preoccupation with body defects); and hypochondriasis (undue fear of contracting disease).

People with OCD are not lunatics, although they suspect that they are because of their uncontrollable impulses. Many of them hide their condition from others out of embarrassment. And out of embarrassment and inadequacy, they are not inclined to seek treatment for the condition. They cleverly manage to "mask" symptoms until these are "unmasked" by some disastrous event or experience. By then, the compulsions shall have become deeply rooted and harder to treat. In many cases, the condition is poorly diagnosed, as it often takes many years from the time it began to the time it is finally and correctly diagnosed and appropriate treatment administered.

Having OCD is not a sign of a weak nature of a lack of strong will. What is quite unfortunate is that these sufferers erroneously believe that they are alone in their condition and that there is no remedy. For them.

The truth is that, at present, OCD can be, and is, remedied or managed pharmacologically (or by drugs) through the use of serotonin reuptake inhibitors (SRIs); psychotherapy and cognitive-behavior therapy (CBT); neurosurgery; natural treatments; other therapies, including exercise; and the use of nutritional supplements. #

II. CASE PRESENTATION a. Presenting Problem

The patient is a 48-year-old unmarried Caucasian working housewife. She was admitted on an urgent basis and for the first time to the Adult Out-Patient Program of…