OCD. Article.
Taken from The Sunday Times. November 16 2003
Obsessive-compulsive disorder traps sufferers in a world of strange rituals and irrational perfectionism. Could a new therapy finally end their nightmare, asks Sharon Walker.
Less than a year ago, David Smith, 33, was seriously questioning the point of his life. I was a marketing director for a blue-chip company, but from the way I behaved, youd have thought I worked for M16, he says. 1 was secretly taping all my conversations, I refused to sign my name - everything had to be paid in cash - and I couldnt even send an e-mail without my secretary checking it. Anything I wrote was photocopied and kept as evidence. I couldnt stop thinking that I might mistakenly sign some sort of death threat or blurt out something menacing, says Smith, who would spend up to 2 hours driving a 10-mile journey on a traffic-free road because he was convinced that every minor bump was a dead body, and that he had run someone over by mistake. Yet this straight-talking, conscientious man would be the last person to commit an atrocity - even by accident. He isnt mad, or even mildly eccentric, but he suffers from responsibility OCD, one of the more common forms of obsessive-compulsive disorder, or OCD, as it is usually known.
For all its comic value (think of the Jack Nicholson character in the film As Good as It Gets, who cant step on the cracks of a pavement), OCD is a serious problem. Up to 20% of sufferers are housebound or hospitalised at some point, says India Haylor, the director of the new OCD Centre in Knightsbridge. Its also extremely common. OCD is now recognised as the second most prevalent mental-health problem, after depression - and the number of reported cases is soaring. Experts estimate that 2%-3% of the population suffer from the full-blown syndrome, with as many as one in five suffering from a milder form. And nobody is immune to the misery of OCD. Jane Horrocks has admitted to making herself ill with obsessional swallowing, Harrison Ford has a fixation about colour-coding his socks, and David Beckham is said to suffer from a mild form of the condition - he prefers the cans in his fridge to be arranged just so (and in equal numbers). Now Martin Scorsese is making a film, The Aviator, about the cleanliness-obsessed recluse Howard Hughes.
OCD sufferers are tortured by obsessional thoughts, such as worrying that their hands are contaminated by germs. It very quickly narrows the world you can move in, explains Haylor. It starts with fairly obscure fears, but quickly morphs to everyday situations, and gets progressively worse. The terrible anxiety is only relieved by performing a particular set of behaviours. Unfortunately, any sense of relief is short-lived, which is why the behaviour must be repeated again and again. In contrast to those with psychotic delusions, OCD sufferers know their behaviour is irrational, yet feel powerless to stop.
Common treatments include antidepressants such as selective serotonin reuptake inhibitors (SSRIs), including Prozac, or old-school behavioural methods that expose the patient to their fear while preventing them from carrying out the compulsion. About 60% of patients show some improvement, but neither therapy is ideal: 20%-30% find the idea of behavioural treatment too traumatic, and SSRIs can have distressing side effects. More recently, practitioners have had greater success with cognitive behavioural therapies that teach patients to challenge self-defeating beliefs and develop positive new ones. -
However, a new treatment from America is bringing fresh hope to sufferers. Pioneered by the OCD guru and neuropsychiatrist Jeffrey Schwartz - the man Scorsese called in to help Leonardo DiCaprio prepare for the role of Howard Hughes - the Four Steps programme employs meditation techniques with the goal of teaching sufferers to manage OCD symptoms by themselves. Schwartz, who is research professor of psychiatry at the UCLA School of Medicine, and also works with Haylor at the OCD Centre in London, believes that we can literally force our brains to override dysfunctional circuits by choosing what we focus on.
The goal is to learn to override false brain messages, explains Schwartz. Patients might be encouraged to engage in conversation rather than follow through with their usual compulsion, such as repetitive washing.
There are different theories about what causes the disorder. Most experts recognise a genetic element that can be triggered by a stressful event. Schwartz believes that the OCD worry circuit is a direct result of faulty brain chemistry, an idea that has gained acceptance through brain scans showing overheating in the emotional areas. People with OCD have increased energy in a specific region of the brain called the orbital frontal cortex, he says. This area is involved in making emotional assessments of the environment. An increased metabolism in this part of the brain gives a sufferer the feeling that something is wrong. The good news is that once patients understand what is going on, they can start to take control of their illness and focus on more adaptive behaviours.
When someone experiences an OCD thought, one part of the brain knows quite clearly that the hands are not dirty, explains Schwartz. Some part of the brain is standing apart from the symptoms, reflecting on the sheer bizarreness of it all. The objective is to harness this impartial spectator so that patients can use the healthy part of their brain to resist the compulsions. Schwartz is keen to emphasise that his programme enhances, rather than replaces, traditional cognitive behavioural therapies and medication, and believes his Buddhism-inspired methods can be used to lower drug doses and reduce therapist intervention. At the OCD Centre, we teach you to become your own therapist. And, over a period of months, it becomes possible to lower medication doses and professionally supplied therapy. David Smith, for one, is delighted with the results. He had tried transactional therapy, hypnotherapy, behaviour therapy, even reiki, and was about to give up when he discovered Schwartzs book, Brain Lock. Schwartzs programme makes you aware of whats going on by calling it what it is - a biochemical imbalance. It alters your perception and allows you to see whats happening. For the first time, I know how my brain really works, he says. With the help of the OCD Centre and telephone counselling, Smith has reduced his intake of Prozac to the lowest possible dose.
There was a point when - although I would never commit suicide - I was so low, I thought, if all these fears do come true, nothing can be as bad as how Im feeling anyway. Now I can sign cheques without a problem, he says brightly. And I dont photocopy them, either. OCD used to feel like a huge stigma, but I dont feel handicapped by it any more. Some people have bad feet; Ive got OCD. You just deal with it.
Some names in this article have been changed
The OCD Centre, 43 Hans Place, London SW1; 020 7095 1094,
www.ocdcentre.com.
Brain Lock by Jeffrey Schwartz ( Harper Collins )
Obsessive-compulsive disorder traps sufferers in a world of strange rituals and irrational perfectionism. Could a new therapy finally end their nightmare, asks Sharon Walker.
Less than a year ago, David Smith, 33, was seriously questioning the point of his life. I was a marketing director for a blue-chip company, but from the way I behaved, youd have thought I worked for M16, he says. 1 was secretly taping all my conversations, I refused to sign my name - everything had to be paid in cash - and I couldnt even send an e-mail without my secretary checking it. Anything I wrote was photocopied and kept as evidence. I couldnt stop thinking that I might mistakenly sign some sort of death threat or blurt out something menacing, says Smith, who would spend up to 2 hours driving a 10-mile journey on a traffic-free road because he was convinced that every minor bump was a dead body, and that he had run someone over by mistake. Yet this straight-talking, conscientious man would be the last person to commit an atrocity - even by accident. He isnt mad, or even mildly eccentric, but he suffers from responsibility OCD, one of the more common forms of obsessive-compulsive disorder, or OCD, as it is usually known.
For all its comic value (think of the Jack Nicholson character in the film As Good as It Gets, who cant step on the cracks of a pavement), OCD is a serious problem. Up to 20% of sufferers are housebound or hospitalised at some point, says India Haylor, the director of the new OCD Centre in Knightsbridge. Its also extremely common. OCD is now recognised as the second most prevalent mental-health problem, after depression - and the number of reported cases is soaring. Experts estimate that 2%-3% of the population suffer from the full-blown syndrome, with as many as one in five suffering from a milder form. And nobody is immune to the misery of OCD. Jane Horrocks has admitted to making herself ill with obsessional swallowing, Harrison Ford has a fixation about colour-coding his socks, and David Beckham is said to suffer from a mild form of the condition - he prefers the cans in his fridge to be arranged just so (and in equal numbers). Now Martin Scorsese is making a film, The Aviator, about the cleanliness-obsessed recluse Howard Hughes.
OCD sufferers are tortured by obsessional thoughts, such as worrying that their hands are contaminated by germs. It very quickly narrows the world you can move in, explains Haylor. It starts with fairly obscure fears, but quickly morphs to everyday situations, and gets progressively worse. The terrible anxiety is only relieved by performing a particular set of behaviours. Unfortunately, any sense of relief is short-lived, which is why the behaviour must be repeated again and again. In contrast to those with psychotic delusions, OCD sufferers know their behaviour is irrational, yet feel powerless to stop.
Common treatments include antidepressants such as selective serotonin reuptake inhibitors (SSRIs), including Prozac, or old-school behavioural methods that expose the patient to their fear while preventing them from carrying out the compulsion. About 60% of patients show some improvement, but neither therapy is ideal: 20%-30% find the idea of behavioural treatment too traumatic, and SSRIs can have distressing side effects. More recently, practitioners have had greater success with cognitive behavioural therapies that teach patients to challenge self-defeating beliefs and develop positive new ones. -
However, a new treatment from America is bringing fresh hope to sufferers. Pioneered by the OCD guru and neuropsychiatrist Jeffrey Schwartz - the man Scorsese called in to help Leonardo DiCaprio prepare for the role of Howard Hughes - the Four Steps programme employs meditation techniques with the goal of teaching sufferers to manage OCD symptoms by themselves. Schwartz, who is research professor of psychiatry at the UCLA School of Medicine, and also works with Haylor at the OCD Centre in London, believes that we can literally force our brains to override dysfunctional circuits by choosing what we focus on.
The goal is to learn to override false brain messages, explains Schwartz. Patients might be encouraged to engage in conversation rather than follow through with their usual compulsion, such as repetitive washing.
There are different theories about what causes the disorder. Most experts recognise a genetic element that can be triggered by a stressful event. Schwartz believes that the OCD worry circuit is a direct result of faulty brain chemistry, an idea that has gained acceptance through brain scans showing overheating in the emotional areas. People with OCD have increased energy in a specific region of the brain called the orbital frontal cortex, he says. This area is involved in making emotional assessments of the environment. An increased metabolism in this part of the brain gives a sufferer the feeling that something is wrong. The good news is that once patients understand what is going on, they can start to take control of their illness and focus on more adaptive behaviours.
When someone experiences an OCD thought, one part of the brain knows quite clearly that the hands are not dirty, explains Schwartz. Some part of the brain is standing apart from the symptoms, reflecting on the sheer bizarreness of it all. The objective is to harness this impartial spectator so that patients can use the healthy part of their brain to resist the compulsions. Schwartz is keen to emphasise that his programme enhances, rather than replaces, traditional cognitive behavioural therapies and medication, and believes his Buddhism-inspired methods can be used to lower drug doses and reduce therapist intervention. At the OCD Centre, we teach you to become your own therapist. And, over a period of months, it becomes possible to lower medication doses and professionally supplied therapy. David Smith, for one, is delighted with the results. He had tried transactional therapy, hypnotherapy, behaviour therapy, even reiki, and was about to give up when he discovered Schwartzs book, Brain Lock. Schwartzs programme makes you aware of whats going on by calling it what it is - a biochemical imbalance. It alters your perception and allows you to see whats happening. For the first time, I know how my brain really works, he says. With the help of the OCD Centre and telephone counselling, Smith has reduced his intake of Prozac to the lowest possible dose.
There was a point when - although I would never commit suicide - I was so low, I thought, if all these fears do come true, nothing can be as bad as how Im feeling anyway. Now I can sign cheques without a problem, he says brightly. And I dont photocopy them, either. OCD used to feel like a huge stigma, but I dont feel handicapped by it any more. Some people have bad feet; Ive got OCD. You just deal with it.
Some names in this article have been changed
The OCD Centre, 43 Hans Place, London SW1; 020 7095 1094,
www.ocdcentre.com.
Brain Lock by Jeffrey Schwartz ( Harper Collins )