Tormenting Thoughts and Secret Rituals: The Hidden Epidemic of Obsessive-Compulsive Disorder - Softcover

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Ian Osborn, M.D., is a practicing psychiatrist at State College, Pennsylvania, and a specialist in the treatment of OCD. He lectures frequently to mental health professionals and to the general public.

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While on vacation, Raymond incessantly checked the carpets of Disney World looking for poison he had seen spilled there -- in his mind....Sherry was terrified of her thoughts about stabbing her baby daughter....Jeff couldn't silence a mental voice urging him to have sex with men and animals....

Howard Hughes had it. So did historical figures Martin Luther and Ignatius of Loyola. They all suffered from obsessive-compulsive disorder (OCD) -- as do over five million Americans who need to know that there is now hope and help. Ian Osborn, M.D., a specialist in OCD and a sufferer himself, has written the first comprehensive book on the experience, diagnosis, and treatment of OCD. He reveals recent discoveries about the disease as a biological disorder -- a physical, not a psychological abnormality -- and the exciting new therapies that have dramatically changed the future for OCD sufferers. His wise, compassionate book includes:
-- Pencil-and-paper tests for self-diagnosis
-- Six steps to conquering OCD
-- Medication that works
-- Early signs that show OCD in children
-- Guidelines for family members
-- A comprehensive listing of where to find organizations and support groups...and more

Aus dem Klappentext

While on vacation, Raymond incessantly checked the carpets of Disney World looking for poison he had seen spilled there--in his mind.... Sherry was terrified of her thoughts about stabbing her baby daughter.... Jeff couldn't silence a mental voice urging him to have sex with men and animals....
Howard Hughes had it. So did historical figures Martin Luther and Ignatius of Loyola. They all suffered from obsessive-compulsive disorder (OCD)--as do over five million Americans who need to know that there is now hope and help. Ian Osborn, M.D., a specialist in OCD and a sufferer himself, has written the first comprehensive book on the experience, diagnosis, and treatment of OCD. He reveals recent discoveries about the disease as a biological disorder--a physical, not a psychological abnormality--and the exciting new therapies that have dramatically changed the future for OCD sufferers.
His wise, compassionate book includes:
Pencil-and-paper tests for self-diagnosis
Six steps to conquering OCD
Medication that works
Early signs that show OCD in children
Guidelines for family members
A comprehensive listing of where to find organizations and support groups--and more

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Prologue: A Personal Perspective

I suffered obsessive -compulsive disorder myself while in medical training. Terrifying, tormenting thoughts often popped unbidden into my mind, causing surges of panic and piercing discomforts. The thoughts usually took the form of vibrant, violent images, for instance, of a knife being thrust into my flesh, or of my nose being scraped right off in a car accident. A particularly frequent one was that of my hand being punctured by a phlebotomy needle. I would have the sudden, intrusive image of me standing at a patient's bedside ready to draw a sample of blood: I unsheath a large-bore phlebotomy needle, menacing, daggerlike in its appearance, and then inexplicably, instead of inserting the needle into my patient's vein, I thrust it to the hilt into the thenar eminence of my hand. Upon the occurrence of this frightful fantasy, my hand would ache in a manner that seemed indistinguishable from genuine pain. I would shake it to make it feel better.

It was fortunate that these troublesome intruders into my consciousness rarely struck when I was engaged in important activities and that therefore they did not upset my medical career because they were impossible to fend off. The more I resisted them, the worse they became. I often used counter-ideas, or restorative images, to neutralize them. To counteract the phlebotomy-needle thought, I would imagine an impenetrable cream covering my hand. The needle would strike and promptly burst into pieces. The image would fade. Yet the tormenting fantasy would always return at another time.

What I suffered, I learned later, was a typical form of obsessive-compulsive disorder. My tormenting thoughts were obsessions, and my counteractive ideas were compulsions. I know now that by fearing them and fighting them, I only made them worse. But back then I didn't know any better.

What did I do for help? Since I later went on to study psychiatry, you'd think that I might have gotten therapy: probed into my unconscious, teased apart my ego defenses, scrutinized my childhood--at the very least, come to some sort of an understanding of my problem. Nothing of the sort. When my obsessions were not bothering me, I didn't want to think about them. I kept my tormenting thoughts a secret, as most OCDers do. Given the treatments that were available back then, it was probably just as well.

In the early I970S, mental health professionals knew next to nothing about obsessive-compulsive disorder. The field had come no further than had the great psychoanalyst Sigmund Freud, who candidly admitted that OCD baffled him. His own theories on the subject, Freud once said, were no more than "doubtful assumptions and unconfirmed suppositions."

When I was in training, the psychiatrists, psychologists, social workers, nurses, and counselors who treated OCD sufferers had trouble just identifying obsessions when they saw them. The self-tormenting thoughts were considered rare, and as a result they were rarely recognized. Severe cases were routinely misdiagnosed as hallucinations; mild ones were written off as examples of obscure unconscious conflicts.

On those occasions when OCD was correctly diagnosed, treatment was next to worthless. They tried years of psychoanalysis, counseling, and group therapy; they prescribed antidepressant medications, antipsychotic medications, even shock therapy; but therapists themselves believed that OCD was a dark and mysterious illness, essentially incurable. That's what I was taught in medical school. If a patient had severe OCD, my professors would just shake their heads, intimating, "We'll do our best, but don't expect much." One clinician of that era wrote, "Most of us are agreed that the treatment of obsessional states is one of the most difficult tasks confronting the psychiatrist, and many of us consider it hopeless."

The good news is that times have changed.

The study of OCD has undergone a truly remarkable shift in emphasis, as researchers have turned away from unproven theories and jumped with both feet into the research lab. As a result of this dramatic change, our understanding of OCD has leaped forward. At a recent meeting of the American Psychiatric Association, more special reports were presented on OCD than on any other topic. OCD has been referred to as the "hot topic" of the I99OS, and professional journals are overflowing with updates on the chemistry, genetics, psychology, and treatment of obsessions and compulsions. The great news for OCD sufferers is that obsessive-compulsive disorder is now recognized as a common, physical disease for which effective treatment is available.

OCD: The Hidden Epidemic

When I was in training, psychiatrists estimated the incidence of a given mental disorder in the general population by extrapolating from the number of people known to be in treatment. Since back then only a tiny number of patients were diagnosed as having obsessive-compulsive disorder, OCD was thought to be very rare. The figure most commonly quoted for its overall incidence was a minuscule .05 percent.

What was not appreciated back then, however, was how adept OCDs are at keeping their disorder hidden. The effort they expend in scheming and lying often rivals that spent on the disorder. Afraid people will think they are crazy, OCD sufferers don't tell anyone about their illness--not their families or their friends, and certainly not their therapists. As Freud, who did not get much else right about OCD, astutely noted: "Sufferers [from OCD are able to keep their affliction a private matter. Concealment is made easier from the fact that they are quite well able to fulfill their social duties during a part of the day, once they have devoted a number of hours to their secret doings, hidden from view."

The true incidence of obsessive-compulsive disorder was not uncovered until 1983, when the National Institutes of Health announced the findings of the first large-scale study on the rate of occurrence of mental health disorders in the general population of the United States. Researchers went from door to door in five different areas of the country, carefully interviewing 18,500 randomly selected people. The results took mental health professionals completely by surprise: OCD was found to occur in 1.9-3.3 percent of the population! Although some researchers have questioned the reliability of the NIMH study on the grounds that its diagnostic criteria were not sufficiently stringent, there is general agreement that OCD's incidence is at least in the range of 1-2 percent.

The experts had misjudged OCD's incidence by a factor of more than twenty. Instead of 150,000 people having the disorder, millions have it. OCD turns out to be one of the most common of all mental illnesses, with large numbers of people suffering the disease in silence. Harvard's Michael Jenike, a leader in OCD research, has referred to it as mental health's "hidden epidemic."

OCD As a Biological Disorder

When I was in medical school, the leading theory on the cause of obsessive-compulsive disorder was Freud's: Obsessions and compulsions arise from unconscious conflicts between instincts, particularly the sex drive, and attempts at self-control. Once widely accepted, this theory no longer holds sway. Extensive research in biochemistry, pharmacology, radiology, and genetics has now demonstrated beyond a doubt that OCD results directly from an abnormality in the brain's chemistry, a malfunction that leads to faulty firing of the brain's neurons. As succinctly put by Yale Medical School Professor Richard Peschel, "Recent neuroscience research proves that obsessive-compulsive disorder is a physical, neurobiological disease of the brain."

That a physical, not a psychological, abnormality accounts for OCD...