Posted on: Saturday, January 15, 2005
PRESCRIPTIONS
Obsessive-compulsive disorder quite common
By Landis Lum
Q. I saw a great movie — "The Aviator" — and like Leonardo DiCaprio, often have disturbing thoughts or images I can't put out of my mind, like germs, hurting people and needing to have things like clothing, groceries and tools perfectly arranged. I feel driven to do certain things over and over. Could I have obsessive-compulsive disorder?
A. Yes on both counts — Paul Clinton of CNN has called "The Aviator" the best film of 2004. The disorder is common, affecting 2 percent to 3 percent of the population, but despite effective drug and behavioral treatments, many people never mention their symptoms to their doctor because of embarrassment. The disorder causes as much or more misery as diabetes and hypertension and yet is underdiagnosed and undertreated by physicians.
Do you worry a lot about contamination or getting a serious illness like AIDS? Or have repeating and troubling religious or sexual thoughts? Do you wash, clean or groom excessively? Do you keep checking light switches, stoves or locks? Or keep doing things over until they feel right? Collect useless objects or check the garbage before it's thrown out? Intrusive thoughts or images are called obsessions while behaviors that are hard to resist are called compulsions, which also include mental acts you feel driven to perform such as praying, counting or repeating words silently.
We all have these to some extent, but if any of them take up more than one hour a day or significantly interferes with work, school or social functioning or causes marked distress, then it's obsessive-compulsive disorder. Many patients also have depression. Anxiety, bipolar disorder and tics (involuntary motor movements) are not uncommon. Further tests may be needed if the disorder starts after age 40.
Antidepressants such as fluoxetine, sertraline, fluvoxamine and clomipramine also work for this disorder, reducing symptoms 30 percent to 40 percent in adults or children, and are needed for most patients. Higher doses are usually needed for this disorder and may take three months to work. Everyone with obsessive-compulsive disorder should be referred for behavioral therapy or cognitive behavior therapy, either individual or group. Anxiety generally decreases after enough exposure to the feared object. In therapy, a patient worried about germs, for instance, would remain in contact with a "contaminated" object while being coached to avoid rituals or other inappropriate responses and to tolerate the temporary increase in anxiety until the anxiety goes away. Practicing such exposures repeatedly eventually results in loss of contamination fears.
To find a therapist, try www.aabt.org. The Oct. 27, 2004 issue of the Journal of the American Medical Association found that in teens and children, such therapy led to excellent control of symptoms in 39 percent of patients, therapy combined with drugs was 54 percent effective, but drugs alone only worked in 21 percent.
They concluded that for this age group, you could either start with therapy alone or with therapy plus drugs.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Ho-nolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.
