At some point in life, almost everyone develops an odd ritual: checking the mirror continually, brushing teeth four times in the morning, repeating a private prayer or mantra for good luck. In about two out of 100 cases, the habit spins out of control, becoming a full-blown compulsion, feeding on itself and consuming hours of each day.
Most people afflicted are well aware that the rituals are excessive and irrational, but there's nothing they can do. They have developed obsessive-compulsive disorder, or OCD, a condition of heightened anxiety that can strike in the teen years and last a lifetime.
"A washing compulsion is the most common: continually washing and showering to avoid contamination," said Gerald Tarlow, director of psychiatric services for the OCD program at UCLA. "Next is checking -- making sure the windows are closed, the stove is turned off, over and over again."
Psychiatrists have tried a variety of treatments for OCD. Cognitive-behavioral approaches, sometimes called "thought-blocking" therapy, teach patients to slow down their repetitive cycles by questioning the logic of their thinking: "My immune system is built to handle germs; no one else has gotten sick." Antidepressant medications, such as Prozac, Paxil and Zoloft, also help many people. In recent years, doctors have found that antipsychotic drugs and mood stabilizers help many patients who don't get better on antidepressants. Doctors report that drugs often are most effective when combined with some form of talk therapy.
One of the most promising of these is called exposure response prevention, or ERP. The principle behind ERP is simple: Show people that their fear is unjustified by exposing them directly to its source. In one exercise, for example, people who fear contamination touch faucets without washing their hands afterward. When the patients then see they don't get sick, their anxiety lessens. Each day the exercise gets easier, and they hold out longer. The therapy usually takes about six weeks, said Tarlow.
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