May 08, 2011, Knight Ridder/Tribune Business News
May 08--'She's so anal-retentive,' or 'he's so OCD' are common catch-phrases in the American lexicon. The term 'OCD,' short for 'obsessive-compulsive disorder,' is bandied about so frequently that most people joke about having 'OCD moments' or 'OCD tendencies.'
Some of them might not be joking.
Anxiety disorders, of which OCD is one, are the most common mental illnesses in the United States. An estimated 19.1 million Americans are affected. According to research published in the Journal of Clinical Psychiatry, the economic burden of anxiety disorders is $42 billion annually.
Gene Galbraith, a licensed psychologist with Cumberland Valley Counselling Associates, 1200 Walnut Bottom Road, has been in the mental health field for more than 30 years and treats a variety of OCD, anxiety, panic and mood disorders
The difference between normal levels of attentiveness and caution and true obsessive-compulsive disorder is when the behavior begins to interfere with the person's life, he said.
"Think of a doctor in a hospital. There, frequent hand-washing is a good thing. Or, checking your pockets for your wallet and your keys. This is normal. It's when the behavior interferes with your lifestyle that it becomes a problem," he said.
And like so many other diseases, the longer it is left untreated, the harder it is to treat.
"The longer the behavior is evident, the more difficult it is to change," he explained.
"The main thing is dealing with avoidance," he said.
People who have anxiety disorder in the form of social phobia might be very uncomfortable in public places and seek to avoid situation where escape would be difficult, he explained.
As an example, he cited a movie theatre, which is very quiet, so if someone had to leave, they would have to make noise and disrupt other patrons in the aisle with them.
"It's not easy to just get up and walk out. They feel like everybody is watching them. One of their primary concerns is that they don't want everyone to know and they feel that everyone does," he said.
One of the ways OCD and other anxiety disorder are treated is to get the patient "out of their head," Galbraith explained.
Obsessive thoughts and compulsive behaviors are rooted in the brain and often occur due to some kind of external situation.
"For kids, they might get poor grades and fear that their parents are going to ground them or that they're not going to be successful, and the more they think about those things, the harder it is to focus," he said, highlighting the cycle of anxiety disorders.
In some cases, OCD and other anxiety disorders have been linked to a deficit of serotonin, a monoamine neurotransmitter found in the central nervous system. It is a well-known contributor to feelings of happiness, and is therefore sometimes called the 'happiness hormone' despite the fact it is not a hormone.
When a deficit of serotonin is suspected -- and often anxiety will co-present with depression, leading to this diagnosis -- a drug called a selective serotonin re-uptake inhibitor (SSRI), such as Prozac, is prescribed.
Because of the co-morbidity, Galbraith explained, medicines like Prozac can treat both the anxiety and the depression.
Part of any treatment plan for anxiety disorder is to bring the obsessive thoughts and compulsive behavior under control and then develop a plan to reduce the anxiety.
"The main thing is compulsive behavior, such as repeatedly washing your hands to avoid germs or stepping on cracks," Galbraith said. "In some places, avoiding germs is good. But when the behavior becomes exaggerated to the point of interfering with one's life, or taking too much time, this is not normal.
"Anxiety and tension are important in everyone's life. It's what keeps us motivated to do things."
It's when the behavior interferes with other activities, or doing/not doing it causes stress and tension in and of themselves that people should seek treatment.
Theresa Myers has been diagnosed with OCD and is bipolar. She manages her conditions through medication and various stress management routines such as breathing exercises.
"When you are so overwhelmed with thoughts of just trying to get by, it can make it difficult to focus on the task at hand," said Myers, who is president of the board of directors at the National Alliance on Mental Illness for Cumberland and Perry Counties.
"It's very difficult," she added. "I have many conditions and depending on my stress level, some of my different conditions will come forward."
On the extreme end of the OCD spectrum are the hoarders, the people who live in filth and squalor because they can't bear to throw anything away and even thinking about doing so causes them stress and anxiety.
Much more common, according to Galbraith, are low-level, lower-grade OCD tendencies.
If you suspect a loved one is struggling with OCD or anxiety, the key is to dialogue with that person, he said.
"If you notice that a behavior is interfering with their life, comment that you've notice more behavior and ask, 'Doesn't that interfere with things you like to do?' If it appears that it's taken of a life of its own, that opens the person up to the fact that other people are noticing," he said.
Bring under control
Once a patient is in therapy, the first step is to try to bring the symptoms under control, then use cognitive behavioral therapy and learned relaxation techniques to address the underlying issues.
"There's the difference between people who are significantly impaired by their diagnosis and others who are able to function relatively well," Myers explained. "With proper support and resources, people can learn to do that."
Cognitive behavioral therapy, or CBT, is "looking at behavior, all aspects of behavior, and indicating how it's interfering with one's life. What is the behavior? How often do you do it? When?" Galbraith explained.
Therapists and their patients will try to get to the root of whatever cause the development of the behavior in the first place, he said.
"You get to that tension, then you develop a plan. It's a thinking process. Is it a matter of avoidance or is it a real problem? It's a matter of determining what is realistic and what isn't. Often, anxiety is caused by a faulty thought pattern," thinking that if you do a certain behavior, certain things will or won't happen.
To re-wire this thinking, he said, it's a matter of "just looking at the probability of things happening. You associate thoughts with behavior, and if you change your thinking, you change your behavior."
He encourages his patients to be mindful of what they're doing. By focusing on an activity, they can block out obsessive, compulsive or anxious behavior.
"It's a matter of distracting themselves from the thought whenever possible," he said.
In CBT, often a 'cue' is taught, such as imagining a stop sign to mentally trigger the reminder to stop doing the compulsive behavior or having the obsessive thoughts.
"It's a 'Stop. Refocus. Then continue with your activity,'" Galbraith said.