It’s one of those abbreviations that gets tossed around freely in conversation, but OCD (Obsessive Compulsive Disorder) is a chronic, long-lasting disorder that plagues many people with uncontrollable, reoccurring thoughts and requires they repeat behaviors over and over just to get through the day.
“People oversimplify OCD, using it as a term to describe someone who is extremely clean and organized,” says David Tolin, PhD, director of the Anxiety Disorders Center at Hartford Hospital’s Institute of Living. “That may be true, but it is more extreme than that, to the point where the obsessions or uncontrollable thoughts and compulsions become very debilitating.”
Dr. Tolin and Dr. Andrew Winokur are paired as local investigators on a study recruiting people with OCD to test a new medication that promises help for patients who have not had relief from any other treatment in the past. The study, being conducted at two dozen sites across the country, is examining the effect of a medication developed by Biohaven of New Haven.
“This is the first significant study in quite some time. There hasn’t been a new medication out in years,” Dr. Winokur says, adding that, “This could help as many as half of the people with OCD. That’s how many do not respond adequately to standard treatment.”
Living with OCD
More than 6.5 million Americans suffer some form of OCD, grappling with such obsessions as:
- Religion or guilt about moral or religious issues
- Symmetry or exactness
“Behavior that may seem excessive to us is driven by a need within the person with OCD to prevent or reduce distress or prevent a dreaded event,” Dr. Tolin explains, adding that activities are performed according to rigid rules set by the person.
Obsessions often drive the compulsions in OCD, forcing such behavior as:
- Cleaning, washing
- Ordering or arranging
Someone with OCD, for example, might be compelled to wash their hands repeatedly or check over and over to see if a door has been locked or a light turned off. Such activities are uncontrollable, take hours each day and lead to severe anxiety, physical ailments like tics, depression and an increased risk of suicide.
“OCD greatly affects an individual’s self esteem, ability to maintain a relationship and perform well in school or at work,” Dr. Tolin notes.
As with many other behavioral health disorders, OCD has genetic and biological roots and can be linked to brain function and family history of anxiety disorders, although it hasn’t been connected to a specific gene. Various medication and therapeutic treatments such as therapy, deep brain stimulation and neurosurgery have proven effective.
“We have several ways to help people with OCD, including cognitive behavioral therapy and medications. Often, we recommend a combination for the greatest effect,” Dr. Tolin says.
Another option is exposure therapy in which the patient is exposed to whatever sparks their obsessions – whether it’s an oven left on, “bad” numbers, dirty objects, a mistake or worst-case scenario – in a safe environment. The patient ranks the level of fear and how they feel if they refrain from their typical OCD response to the obsession.
“We help them see what will or will not happen if they do not clean the object, check the lights or seek constant reassurance,” Dr. Tolin says.
Testing a new option
For many people with OCD, however, these treatments have little or no effect, Dr. Winokur says. Currently available medications boost the body’s serotonin levels. The research trial, which launched a few months ago, is testing an investigational medication which targets a different brain chemical, glutamate.
“There has been a lot of interest in recent years in drugs that act on glutamate for a variety of psychiatric disorders,” he says. “This medication has been used to treat depression and there’s data suggesting that modulation of glutamate can be helpful for OCD, too.”
If successful, the research promises life-changing results for some people struggling with OCD.
“These people often spend hours a day on the compulsions because they’re driven to do it,” Dr. Winokur says. “It significantly drags down the quality of their life. This could be a tremendous advance for thousands of people.”