Learn About Obsessive Compulsive Disorder

Speaker: We will discuss, what is Obsessive Compulsive Disorders, with Doctor Las Lahat. Dr. Las Lahat: Hi, this is a common condition. It is not -- sometimes it is hidden. There are married couples for example, where a spouse doesn't realize for years that his or her spouse suffers from this. Speaker: Are people born with Obsessive Compulsive Disorders? Dr. Las Lahat: Well, there is evidence of genetic contribution to it, and this is of course true with lot of illnesses. So in a sense they maybe born with some previous disposition. Speaker: How would you define or use the term, what is in your life, from Psychiatrist point of view, Obsessive Compulsive Disorder, why is it little obsessive at times? Dr. Las Lahat: It's an excellent question because it's that kind of thing. We use the word compulsion in a lot of ways that are kind of sloppy, for example, compulsive gambler is a term, but that's not a true compulsion. This is what a true compulsion; a true compulsion is a behavior or a thinking pattern that is intended to neutralize some danger. So I have a patient who has to have his towels lined up just even, and he says, he feels like his family is going to die if he doesn't do it. That's a compulsion. Compulsive liars, so to speak, or compulsive gamblers are not doing their "compulsion," because of danger, they are doing it for some gain, obviously, gambling is supposed to give you a winning hand, and you win and of course you get some advantages if you can pull off his lie. So it is repetitive and that's why it is used, the term is used, the term compulsion is used, but it is not a compulsion. A compulsion as I said is an effort to neutralize a danger. People who go around the house, and check locks, and the gas are doing a compulsion. Now we don't Obsessive Compulsion Disorder though, unless it causes significant distress or impairments. So some people do these things before they go to sleep they check the house, it is a compulsion, but if it is not causing impairment we don't consider it a disorder. There is another condition that's related that I want to explain, and that's Obsessive Compulsive Personality, and that I think is best illustrated by the Odd Couple. Those of you who remember the characters Felix and Oscar. Oscar was the was a slob, and Felix was the neat freak. Now Felix the neat freak, did not suffer from his neatness, his cleanliness, Oscar did, he was driving Oscar crazy and vice versa. Oscar's sloppiness drove Felix off the wall, but -- this you are talking now about Felix, the neat freak, the compulsive one, he didn't have Obsessive Compulsive Disorder. It was not impairing his life, just annoying Oscar, but he could work, and he wasn't spending hours doing rituals. Often we use the criteria, how many hours a day the person is involved in compulsion for the diagnosis of Obsessive Compulsive Disorder. So Obsessive Compulsive personalities don't suffer, they just feel better doing these things, and they do it. Speaker: Are there any known causes for Obsessive Compulsive Disorder? Dr. Las Lahat: Well, the Streptococci infection is --. Speaker: Might be, not sure. Dr. Las Lahat: Is known to contribute in some cases to an exacerbation of symptoms, probably genetic causes. Speaker: Is there any good treatment for Obsessive Compulsive Disorders? Dr. Las Lahat: Yeah, there is a medicine and it's an non-medication, and they are both effective. I will give you a quick example, I saw a girl who was about was eight years old, and her brother was about four. Anything that her brother touched now became contaminated and she would not touch it, she would not go to the bathroom that he had got into, until her mother went in and cleaned it. Now, this was a big problem, the family was being sort of held hostage by the girl's OCD. What I did -- and this is a dramatic and very quick therapy story, I told Mom and Dad to bring in a pair of her son's underpants when they brought the kids in the next time, and we had her wear his underpants. She squirmed, and was very uncomfortable, but by the end of the session she was okay, and after that she can touch him. It was important to treat this, because the borrowing was tormenting the parents, but the boy was -- got terrible, anything he touched. Isaac Marks is a British Psychiatrist; he is the one who figured this out. He said that, Obsessive Compulsive Disorder is like a phobia in the following way, a person with the phobia makes himself or herself feel better by not going into the public situation. So if you are afraid to go on airplanes, you don't fly, and you feel better. And what Isaac Marks said is that, the way to treat this though is you got to get on a plane or if you fall from a horse on your face, you got to get on another horse. You have to go do the thing that makes you scared if you want to over come it. You can go to a Psychiatrist forever and talk about this forever, but until you say, go into that elevator that you are afraid of, you are still going to be afraid, no matter how much you talk about the elevator, and how it resembles something that scared you, you got locked in a closet, or something, you still have to develop a certain insight by living, otherwise you have to see that I can survive in the elevator, you get in the elevator, and I tell people, if you can do this, that they must stay over there, they can't go one flight door is open, and they get out and they are feel like they did something. They didn't, all they did was prove to themselves that getting off the elevator is the greatest thing they could do. They had to stay in the elevator right up and down till they are sick and tired of this, and is no longer scaring them, and they just, they had enough. Then they can get off the elevator, then they have learned that getting off the elevator is not a great thing, riding in the elevator isn't really dangerous. So Isaac Marks said that the person who does a compulsion is making himself feel better, say by washing his hands, and as long as they do that they feel better, but it is like staying out of the elevator. Nothing gets better really, you just feel better for the time. He said, they need to not wash. Now I have had one patient he came in, I brought in a bucket of mud, he was hand washer and I had him put up his hands in the mud. He was very uncomfortable and wanted to take them off and wanted to wash his hand, but I had explained this to him, and he intuited this. Sometimes I will go home and wash immediately, but I told him it is important not to go home and wash. He had paper towel, so he could wipe off the mud and not drag it all over the place, but to go through the rest of the day without washing. I have used the word insight before, there are different kinds of insight, I can explain to you that you don't get sick from mud, or you don't -- touching your brother, he is not making everybody sick, he goes to school, the school is not dying, that may not really get through, just like if you are afraid of flying on airplanes, you know maybe that most people don't die. If you look at an airplane, you don't think that is going to fall out of the sky, but you feel like if you are in that airplane you are going to fall from the sky. Speaker: If the behavior therapy don't work, medicines sometimes does help? Dr. Las Lahat: Yeah, they are approximately equally effective, and interestingly there was a famous study done with some brain scans that use radioactive glucose, and that shows where the brain is more active. People with Obsessive Compulsive Disorder, their fore brain is active, and when they are treated with medicine, effectively, and they stop or they have less OCD, that scan becomes normalized. But, by this treatment which has a name I was describing, it's called Exposure and Response Prevention. You expose the person to the contamination or whatever, and they prevent themselves from doing the cleaning. With Exposure and Response Prevention you get the same result on the scan, fore brain normalizes. So it's an interesting thing, the medicine and this non-medication treatment, work approximately, equally. The best result actually tends to be using bo