OCD: an extreme manifestation of behaviors

Nearly 25,000 people in the Pittsburgh region may suffer from obsessive-compulsive disorder, or OCD.

And while some people may joke that “I’m so OCD” because they like to be neat or follow certain rituals, the real illness is nothing to laugh about, says Susanne Ahmari, a University of Pittsburgh psychiatrist who researches the disease.

People with severe OCD are imprisoned by intrusive thoughts or compulsive actions that can take hours out of each day, she said.

And yet, OCD may be the least well known of major psychiatric disorders. “People with OCD are much less likely to come to treatment,” Dr. Ahmari said. “They tend to be much better at hiding their symptoms.”

In one form of the illness, people are afraid of causing harm to others, and will repeatedly check to make sure they have not removed a knife from the kitchen, for instance. “If you’ve got someone with these taboo thoughts and they are checking such things, maybe they are waking up three hours early each day to do the checking but no one is going to see that. Sometimes they are very functional at work but it is completely messing up their home life. It can be a very devastating illness.”

Traditionally, psychiatrists have listed five forms of OCD, although recently, one of them — hoarding — is now seen as a separate illness involving different circuits in the brain.

Besides the fear of harming others, which falls into the general category of having taboo thoughts, the remaining categories are:

• Fear of contamination — These patients may wash their hands repeatedly, refuse to touch others or even avoid leaving the house so they won’t be exposed to germs.

• Doubt and fear of general harm — These people worry that they may cause something bad to happen by failing to take certain precautions, so they obsess about whether they have turned off an appliance, locked the doors or left something dangerous out in the open.

• Need for symmetry and order — These OCD patients have a strong desire to make sure everything in their environment is under control. They may need to line up every item on their desks repeatedly, or they may have to take the same route to work or home each day, fearing something bad will happen if they don’t.

Recent research in England has suggested that OCD patients have problems with the parts of their brains that are normally used to form habits. Dr. Ahmari says that makes sense, but “my working hypothesis, based on my years of experience working with patients, is that OCD patients’ habits aren’t the primary driver when they are performing their rituals. When they are carrying out their compulsions, they’re very aware. When you’re doing something habitually, you’re not aware of what you’re doing. But when people are performing their compulsions they’re intensely aware of doing this.”

In one sense, OCD is an extreme manifestation of behaviors we all have, she said.

“We all wash our hands because we get grossed out. We all have fears that bad things are going to happen. We all more or less want things to be orderly. And we all have intrusive thoughts, but for most of us, when these thoughts pop into our heads, they don’t latch on.

“When I touch something sticky on my desk, I go and wash my hands and wash the sticky spot off and I move on, and it doesn’t stick in my head. If I have that weird thought when I’m leaning over the subway tracks, ’What if I jumped?’, I don’t jump. Someone with taboo thoughts wonders if maybe this means they’re going to do it, and they constantly revisit the experience in their mind..”

While she conducts basic research on OCD, Dr. Ahmari also continues to see patients, partly because they give her valuable insights.

“It’s really important for me personally, because talking to patients in a detailed way helps us know what questions we need to ask in the lab.”



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