Obsessive Compulsive Disorder OCD

©Peter Smith 2011 (#1)
 
Obsessive and compulsive behaviours are not necessarily obsessive-compulsive disorder. Many people may be a bit obsessive and/or compulsive at certain times or in certain situations, and yet have a healthy functioning personality and life. Obsessive perfectionism and compulsive attention to proper procedures could be positively useful and desirable qualities in a surgeon or an accountant for example. 
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There are no medical diagnostic tests for OCD, when obsessive/compulsive behaviours start to harm a person’s life it’s considered to be obsessive-compulsive disorder. OCD may cause intense internal distress and worry and the behaviours can significantly interfere with everyday activities like a person’s relationships, health, social or occupational functioning. Obsessive hygiene and fear of germs for example may prevent a person from being able to go to work or have physical contact with other people. When checking light switches, window and door locks takes say an hour every time you leave the house this would be considered OCD.

Up to 70 per cent of people with OCD report problems with family relationships, and more than half report interference with social and work relationships.
 
Symptoms of OCD
 
OCD is a type of anxiety disorder which can take many different forms. With OCD people suffer from recurrent, unwanted, worrying and stressful thoughts or ideas (obsessions). such thoughts are not just excessive worries or stress about actual problems. 
These thoughts can be simple like fear of germs, or very elaborate like thinking you might harm someone in some specific way. In adults with OCD the person knows (at least some of the time) that these thoughts are not real, in other words they are not suffering from delusions, despite this they are unable to switch off or dismiss the unwanted thoughts. The obsessional thoughts can literally 'hijack' and take over one's mind. Children with OCD may not understand that their obsessional thoughts are unreasonable or unreal. 
 
Without the combined treatment of psychotherapy (cognitive behavioural therapy, cognitive hypnotherapy or behavioural therapy are recommended) and balancing brain chemistry the obsessional thoughts can be virtually impossible to stop. 
 
Common examples of obsession all thinking include repeated thoughts about contamination (by dirt or germs); worrying about whether one has locked a door or left an appliance on; a need for order or exactness; a fear of harming someone; inappropriate or frightening sexual thoughts or imagery; and constant thoughts of certain images, words, or sounds. It is possible although very rare for someone with OCD to have only obsessions or compulsions.  The obsessional thoughts build-up feelings of anxiety and stress, temporary or partial release from this stress is obtained by engaging in compulsive behaviours or mental acts. Common examples of compulsions include frequent or excessive hand-washing (it's not uncommon for this to lead to badly damaged even bleeding skin), repeated checking to make sure doors are locked; checking light switches, sometimes this checking has to be done a specific number of times and in a specific order, if the sequences interrupted it has to be restarted from the beginning, neatly rearranging objects for order or symmetry, and counting items over and over. 
 
Many years ago an old friend of mine used to take an unusually long time to choose what he wanted from a menu, holding up and annoying the waitress and everyone else that the table. Not understanding OCD at that time, and thinking I was doing him a tough-love favour, I took it upon myself to point out to him that he was holding up and annoying everyone, eventually he explained to me that he couldn't choose something until he had added up the cost of all the items on the menu, divided the total by the number of items and then done some other calculations involving the number of pages or columns in the menu. Having to carry out this compulsive behaviour made it difficult for him to enjoy eating out with other people. 
 
Carrying out the compulsive behaviour tends to ease the feelings of anxiety.
Trying to repress and stop the compulsive behaviour can be unbearably stressful, so much so that even when the behaviour may be inconvenient, inappropriate or embarrassing carrying it out is less stressful than trying to stop it. Learning to lessen the amount of time it takes to complete one is compulsive rituals can form part of the strategy for learning to live with the condition.
 
OCD may affect just over 2% of the US population between the ages of 18 to 54, although it may often go undiagnosed in children it is thought that the condition typically begins during childhood or early adolescence; it affects males and females equally.  
 

What Causes OCD

The exact cause of OCD is unknown. It is generally considered unlikely that OCD develops purely psychologically as a consequence of the way we are brought up. This isn't to say however that psychological treatments are not useful, as indeed they are.
 

Genetics and Physiology

It is generally accepted that OCD arises from differences in the physiology of the brain in people with the condition. These differences appear to be genetic rather than developmental in origin as studies have shown that people who have a first-degree relative (i.e., parent, sibling) with OCD have a 4-5 fold greater risk of developing the condition themselves. 
 

Serotonin

 Lack of serotonin activity appears to be involved in causing OCD. 
Serotonin is a calming and inhibitory neurotransmitter, one of its main actions is to control and put the brakes on painful, worrying or anxious thoughts. Studies appear to suggest that the lack of serotonin mediated "breaking-activity" may be predominantly only in specific regions of the brain. Unfortunately we do not yet have the ability to influence the level of neurotransmitter in only one region of the brain at a time and so we have to flood the entire brain with more serotonin just to raise the level in the specific area where it's needed. In the future drugs will probably be developed that can target their effects on specific regions of the brain and we will have to see what side effects such drugs cause. In the meantime you can increase serotonin levels using diets and supplements to help take the edge off your OCD. 
 

Autoimmune Following Streptococcal Infections 

Research has also identified another cause of OCD, particularly in children. It has been observed that some children and young people develop OCD after a strep throat or scarlet fever infection. The bacteria that causes strep-throat and scarlet fever may induce an autoimmune situation, whereby the body's own antibody defences -produced to fight the streptococcal bacteria- end up attacking the body itself. This is known as PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections). 
 
The PANDAS form of OCD is characterised by sudden onset (following an infection) as opposed to regular OCD which develops slowly over time. More research needs to be done on this. This type of OCD is most likely to develop between ages of three and puberty. 
 

Traumatic Life Events 

Traumatic emotional events such as bereavement may trigger or worsen OCD in people who already have a tendency to have the condition.
 
People with OCD often also have additional mental health problems including depression, eating disorders, personality disorders and other anxiety disorders, such as social anxiety disorder, separation anxiety etc. Paradoxically OCD can also manifest with attention deficit disorder; I say paradoxically because people with attention deficit disorder have a lack of focus and attention and people with OCD manifest obsessive, relentless focus when they are in OCD mode. Also the brain scans of people with OCD or attention deficit disorder show the exact opposite differences. Brain scans show increased activity in the pre-frontal cortex area of brain in people with OCD and decreased activity in the pre-frontal cortex in people attention deficit disorder compared to people without these conditions. Complexity like this is however common in mental health! In bipolar syndrome for example is possible for someone to be paradoxically manic and depressed at the same time, which is why I think the now outdated name manic-depression was actually more descriptive than bipolar syndrome.
 
The occurrence of concurrent conditions can make it difficult for physicians to diagnose and treat OCD. 
Major depressive disorder is a very common concurrent condition affecting up to 55% of OCD patients, bipolar disorder affects approximately 30% of OCD patients and social phobia impacts 23%. 
 

Treatment of OCD 

For best results in treating this troublesome anxiety disorder combine brain-chemistry balancing approaches with psychotherapy techniques.
 
The nutritional/herbal approach to OCD focuses primarily on boosting natural serotonin levels and to a lesser extent boosting GABA levels. These two neurotransmitters put the brakes on worrying thoughts going around and around in the mind. The vitamin inositol has been found to be specifically therapeutic for people with OCD, seen below.
 

Nutritional Therapy 

Follow the advice in the sections on serotonin deficiency depression and GABA deficient anxiety for techniques to boost serotonin and GABA.
 
Try tryptophan and St John's Wort to increase serotonin. Rhodiola has been shown to help generalised anxiety disorder however Rhodiola has the ability to raise “brain energy” (probably increasing dopamine) and therefore hypothetically may exacerbate OCD symptoms. Any worsening of symptoms would be only short lived however and it would be worth trying Rhodiola to see if it may actually be helpful to your OCD. 
 
L-theanine or just theanine for short is an amino acid found in tea that has a calming and anti-anxiety affect. Studies have shown that theanine changes brain waves within 40 minutes of ingestion, increasing alpha waves which are associated with a calm state. Theanine probably increases GABA activity in the brain and is well worth a try. 
 

The Inositol Treatment of OCD

Inositol, one of the B vitamins, has been found effective in treating OCD. Inositol is used in biochemical processes that effect serotonin receptors.
A double-blind study reported in the American Journal of Psychiatry, 1996 [153(9):1219-21] was done on 13 patients. They were given 18 grams of inositol per day (2 tsp in juice 3 times daily). At 3 weeks there were no significant effects. At 6 weeks inositol significantly reduced "OCD" scores compared with placebo. It was as effective as some drug treatment of OCD.
 
A study in Israel compared the level of B12 in the blood of people with OCD, schizophrenia and healthy individuals. The results showed significantly lower levels of B12 in people with OCD. (Acta Psychiatr Scand. 1988; Hermesh H, Weizman A. Geha Psychiatric Hospital, Beilinson Medical Center, Sackler School of Medicine, Tel Aviv University, Israel). More research needs to be done to establish whether or not low levels of B12 are a consequence or a contributor to OCD and whether or not supplementing B12 has a therapeutic benefit. My advice is to just try it.
 

Psychotherapy. (UNDER CONSTRUCTION)

Exercise.

Numerous studies have shown the benefits of exercise upon mental health. Some studies have shown a beneficial effect of daily exercise (at least 20 minutes per day) on reducing the symptoms of general anxiety disorder. Whether or not exercise benefits of OCD is not proven.
 

Relaxation Training & Meditation 

Learning meditation and relaxation techniques may enhance one's ability to control anxiety and one's thoughts in general. However people with anxiety and OCD may find that peaceful, in active forms of relaxation and meditation makes them feel worse when they try to perform the exercises. The empty, peaceful mental space one creates during many meditation and relaxation techniques often becomes quickly occupied by anxious and obsessive thoughts. For this reason peaceful, quiet-contemplation type meditation and relaxation techniques are not recommended until you have largely brought your OCD symptoms under control using other methods. 
 
The exception to this is to use meditation techniques that do not use quiet-contemplation, but rather instead busily fill the mind by chanting mantras and performing repetitive mental exercises. The best of these techniques that I know of is kundalini yoga. A study at the University of California, San Diego found a specific Kundalini yoga protocol to be effective in treating OCD as well as a broad range of anxiety disorders (Shannahoff-Khalsa DS 2004). Kundalini yoga classes are now taught throughout the world. You could attend several classes to learn the basic techniques then tell the teacher you have OCD and anxiety and you would like to learn a meditation exercise that calms the nervous system but most importantly is one of the most complex, busy and mentally engaging to perform, the more complex the better. 
 
In kundalini yoga there are more than several hundred meditation combinations, so don't be surprised (or disappointed) if your teacher cannot give you something straight off the top of their head and need a little time to prepare something and get back to you. I did two years training as a kundalini yoga instructor and now offer private instructions with prior arrangement. 
 

Putting It All Together

  1. Follow the diet for serotonin deficient depression, and GABA deficient anxiety.
  2. Consult with a qualified therapist using behavioural rather than analytical techniques. 
  3. Do some repetitive mind-occupying/filling as opposed to mind-emptying meditations everyday.
  4. Try a six-week course of the following supplements and then evaluate your progress
 
PLEASE NOTE THE FOLLOWING DOSAGES ARE FOR ADULTS AND WILL NEED TO BE SCALED DOWN FOR CHILDREN.
 
  •          Tryptophan 1000 to 1500 mg per day.
  •          B6 100 to 250 mg per day (up to the point it induces dream recall).
  •          One or two B complex daily. (I highly recommend Higher Nature True Food B complex, despite being low dosage the vitamins are in a highly absorbable organic form. If not available Solgar multi-B50 or equivalent will do)
  •          Inositol at least 2000 mg per day. I would recommend 4000 mg three times a day as a starting point. Inositol is safe and side-effect free, for OCD buy it in powder form and take it by the teaspoon up to a total of 18 g (yes 18,000 mg) in total per day.
  •          L-theanine 200 milligrams (mg) twice daily to decrease the symptoms of OCD.
  •          St. John’s wort (standardised) 300 to 900 mg daily
  •          if generalised anxiety is also concurrent to consider supplementing GABA 500 to 2000 mg as needed up to 3 times per day.

CAUTION:
Do not take tryptophan or St John's wort at the same time as other antidepressant medications without professional supervision.Consult with your doctor before taking tryptophan if you have cardiovascular disease.
St John's wort significantly increases the risk of sunburn, take extra care.
 

And Finally 

If you're searching online for solutions for OCD you may come across a theoretical condition called histadelia also called under-methylation. You will see it claimed that histadelia is found in almost all cases of OCD, however there is little or no proper evidence or even positive anecdotal stories to support this. I learnt about this hypothetical condition 22 years ago and have never found it clinically useful, so I have relegated it to a section in the appendix for anyone who's interested. If you find that a prescription based on increasing methylation processes in the body is more effective against OCD than increasing serotonin and GABA please let me know, I would be very interested to hear from you.
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Hi my name is Peter Smith I specialise in treating and coaching people how to live well with mental health problems, digestive health problems/IBS, sleep problems and type II diabetes using natural therapies.
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