OCD Disease

It was 9:30 a.m., and Nancy, a 36-year-old attorney, had arrived late for work
again. Nancy knew she needed to catch up on her legal assignments, but a
familiar worry nagged at her. No matter how hard she tried, Nancy could not
dislodge the thought that she had left a pot burning on the stove. The image of
her home engulfed in flames was so vivid she could almost smell the smoke. Nancy
tried to shut the thought out of her mind, reassuring herself that she had
turned the gas jet off. But even remembering her hand touching the cool stove
burner-a precaution she took whenever she left the house-still left her
wondering whether she had checked carefully enough. The pot and stove were not
all that had been on Nancy’s mind that morning. For Nancy, leaving the house
entailed a time-consuming routine designed to ensure that no major or minor
disaster-such as a fire, burglary, or household flood-would strike while she was
away. Like a pilot preparing for take-off, she would spend more than an hour
checking and rechecking that all appliances were turned off, all water faucets
shut, all windows closed, and the doors to the house securely locked. Except for
necessities such as work, Nancy avoided going out because it meant performing
this arduous routine. But even these measures were not enough to keep her from
worrying. A few weeks earlier, Nancy had hit on the idea of documenting that
everything was safe before she left home. Now, sitting at her desk, she pulled a
completed checklist from her purse and reviewed it to see if the "stove and
oven" item and been marked off. At first, she felt relieved to see that it
was. But then a new thought struck: What if this wasn’t today’s checklist?

Panic overtook reason. Nancy dialed the local fire department and asked that
truck be sent to investigate a fire at her house. (Goodman, 1994, pp 103, 104)

The first modern description of OCD was provided in 1838 by Jean-Etienne

Dominique Esquirol, a French psychiatrist. Esquirol called the disorder the
folie de doute, or doubting madness, and suspected it was rooted in a physical
problem in the brain. During much of the 1900’s, psychoanalytic theories
dominated the study of OCD. Many psychoanalytic theorists believed OCD
originated from conflicts early in a child’s development over such issues as
toilet training. (Goldman, 1994, p.104) Researchers theorize that an antibody
may actually cause OCD. The antibody called D8/17, is produced to fight
streptococcus bacterium that causes rheumatic fever. However D8/17 may attack
healthy cells in the brain’s basal ganglia region, which helps control basic
movement sequences, such as walking or eating. (Klobuchar, 1998, p.266) The
obsessions or compulsions must cause marked distress, be time consuming (take
more than 1 hour per day), or significantly interfere with the individual\'s
normal routine, occupational functioning, or usual social activities or
relationships with others. Obsessions or compulsions can displace useful and
satisfying behavior and can be highly disruptive to overall functioning. Because
obsessive intrusions can be distracting, they frequently result in inefficient
performance of cognitive tasks that require concentration, such as reading or
computation. In addition, many individuals avoid objects or situations that
provoke obsessions or compulsions. Such avoidance can become extensive and can
severely restrict general functioning. (Diagnostic and Statistical Manual of

Mental Disorders, 1994). Symptoms of OCD include repetitive, ritualized
behavior, such as counting, hoarding objects, or handwashing; obsessive fear of
threats, such as germs; or a fear of committing violent acts. (Klobuchar 266)

The American Psychiatric Association classifies OCD as an anxiety disorder.

People with OCD suffer from persistent and disturbing thoughts, images, or
impulses, called obsessions. They relieve the anxiety caused by their obsessions
through compulsions-repeated behaviors that they feel driven to perform.
(Goodman, 1994, p.104) The DSM-IV defines obsessions as recurrent thoughts,
images, or impulses that are anxiety-provoking and are perceived as intrusive or
senseless. (Gragg & Francis, 1996, p.1) The intrusive and inappropriate
quality of the obsessions has been referred to as "ego-dystonic." This
refers to the individual\'s sense that the content of the obsession is alien, not
within his or her own control, and not the kind of thought that he or she would
expect to have. However, the individual is able to recognize that the obsessions
are the product of his or her own mind and are not imposed form without (as in
thought insertion). (Diagnostic and Statistical Manual of Mental Disorders,

1994). Obsessions typically fall within seven major categories. i.e.

Contamination obsessions, which typically involve excessive concerns about
germs, disease, and cleanliness. Somatic obsessions, which are persistent,
repetitive thoughts about physical concerns. Children may