Obsessive-Compulsive Disorder (OCD)
OCD is a particularly severe form of anxiety. It has a lifetime prevalence of approximately 2-3 percent and is the fourth most common psychiatric disorder1,2. Most patients with OCD develop symptoms in childhood or adolescence2,3. The mean age of onset of symptoms, across several studies, is 10 years4. The classic example of repeated handwashing is but one manifestation of a complex interplay of thoughts, feelings, and behaviors that patients with OCD experience. At the heart of OCD are obsessions (thoughts) and compulsions (behaviors). Obsessions are thoughts that create anxiety for the patient. They are often intrusive – forcing their way into a patient’s mind when the patient is relaxing, actively enjoying themselves, or concentrating on a task. These obsessive thoughts can be logical and consistent with a patient’s sense of self or values. But obsessive thoughts also can be very illogical, fantastic, or repulsive to the patient. In whatever form they take, obsessive thoughts lead to anxiety. When the thoughts occur repeatedly, the patient becomes more and more anxious. The anxiety can risk to intolerable levels and then the patient must do something to relieve the anxiety.
The action that the patient does is the compulsion. Since the obsessive thoughts increase the anxiety and the compulsion decreases the anxiety, a vicious cycle of rising anxiety and attempts to reduce the anxiety can, and often do, develop. For example, a patient has the intrusive thought that they did not turn off a stove burner leading to a fear of fire and the need to check and re-check the burner. Or a child who takes an uneven step has the intrusive (and irrational) thought that this misstep will cause something bad to happen to his mother and so feels compelled to spin around two times to the left to prevent this harmful outcome.
Over time, the patient learns to do this compulsive behavior at lower and lower levels of anxiety. This can result in highly repetitive compulsive behaviors. Indeed, patients may be unaware of what they fear or of the rising anxiety. In this case, the association between the obsessive thought and the compulsive behavior has become automatic. Most of the time, the feared event has no basis in reality, but sometimes a real event can trigger a new obsessive-compulsive association. For example, a man who has a near miss accident may fear another accident and then repeatedly redrive his commuting route to sure that he did not cause an accident or which he was unaware. Interestingly, children often involve their parents in the compulsive behavior, such as repetitive questions that need to be answered in a specific manner.
OCD is often considered difficult to treat and many clinicians settle for merely reducing symptoms. For example, SSRI’s often are prescribed for OCD, but research shows that SSRI’s only reduce symptoms by about 25-30% and only 40-50% of patients respond to SSRI’s5-8. However, Dr. Henderson takes a different approach to OCD, just as with most mental illnesses. Dr. Henderson’s goal in treatment is – “no room for improvement”. With this philosophy, Dr. Henderson uses a combination of medications, education, cognitive behavioral therapy (CBT) and parent coaching (when treating children). By careful evaluation, Dr. Henderson is able to tailor the medication treatment regimen to each patient’s individual neurophysiology.
1) Apter et al., Obsessive-compulsive characteristics: from symptoms to syndrome. 1996, J Am Acad Child Adolesc Psychiatry, 35: 907-91.
2) Zohar, The epidemiology of obsessive-compulsive disorder in children and adolescents. 1999. Child Adolesc Psychiatr Clin N Am, 8: 445-460.
3) Douglass et al., Obsessive-compulsive disorder in a birth cohort of 8-year-olds: Prevalence and predictors. 1995, J Am Acad Child Adolesc Psychiatry, 34: 1424-1431.
4) (American Academy of Child & Adolescent Psychiatry, 1998).
5) DeVeaugh-Geiss et al., Clomipramine hydrochloride in childhood and adolescent obsessive-compusive disorder – A multicenter trial. 1992. J Am Acad Child Adolesc Psychiatry, 31: 45-49.
6) March et al., Sertraline in children and adolescents with obsessive-compulsive disorder. 1998. JAMA, 280: 1752-1756.
7) Riddle et al., Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. 1992. J Am Acad Child Adolesc Psychiatry, 40: 773-779.
8) Riddle et al., Fluvozamine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled, multicenter trial. 2001. J Am Acad Child Adolesc Psychiatry, 40: 222-229.