Komoróczky Tamás La Biennale di Venezia (Venice, 2001)

For many years, mental health professionals thought of QCD as a rare, hissas» because only a small minority of their patients hah the condition The disorder often went unresognired because many of those afflicted with QCO. in efforts to keep the«' repetitive thoughts and behaviors secret, tailed to seek treatment This led to underestimates of the number«! people with the illness However, a survey conducted m the early 1980s by the National Institute of Mental Health (NIMH) - the Federal agency that supports research nationwide on the fern mental illnesses, art mental health - prowled new knowledge about the prevalence of 0C0, The NIMH survey showed that QCO affects mare than 3 percent of the population, meaning that ÖCO is more common than such severe mental Obsesses as schuophrtnia, bipolar disorder, or pane disorder OCD strikes people of all ethnic groups Mate and females are equally affected. The social art economic costs of OCQ were estimated to be $8 .4 billion n 1990 (DuPont at al, 1994). Although QCO symptoms typically begin dunng the teenage years or early adulthood, recent research shows that some children develop the illness at earlier ages, even during tha preschool years Studies indicate that at least one-third ot cases of QCO in adults began in childhood. Suffering from OCQ during early stages of a child's development can cause severe problems for the child It is important that the chid receive evaluation and treatment by a knowledgeable chmoan to prevent the child from missing important opportunities because of this disorder Kay Features of OCD Obsessions These are unwanted ideas or impulses that repeatedly well up in the mmd of the person with OCQ Persistent fears that harm may come to self or a loved one. an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common Again art again, the individual experiences a disturbing thought, such as, "My hands may be contaminated -1 must wash them'; "I may have left the gas on”; or *l am going to Injure my child ' These thoughts art intrusive, unpleasant, and produce a high deg* of anxiety Sometimes tha obsessions are of a violent or a sexual nature, or concern in Compulsions In response to them obsessions, most people with DO) resort to repetitive behaviors called compulsions The most common of these are washing art checking. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging obiects m an effort to keep them in precise alignment with each other Mental problems, such as mentally repeating phrases. Iistmaking, or checking are also common These behaviors generally are intended to ward oft harm to the person with OCD or others Some people with OCQ have regimented rituals white others have rituals that are compte and changing. Performing rituals may give the person with OCQ some relief from anxiety, but it is only temporary. Insight People with OCQ show a rang# of insight into the senselessness ot the«' obsessions Often, especially when they are not actually having an obsession, they can recognu» that their obsessions and compulsions are unrealistic At other rimes they may be unsure about their (ears or even believe strongh in their validity Resistance Most people with OEM struggle to banish their unwanted, obsessive thoughts art to prevent themselves from engaging m compulsive behaviors. Many are able to keep the«' obsessive-compulsive symptoms under control during the hours when they are at work or attending school But over the months or years, resistance may weaken, and when this happens. 003 may become so severe that Wne-amsummg rituals take over the sufferers’ lives, mattig it impossible for them to continue activities outside the home Shims and Secrecy OCO sufferers often attempt to hide their disorder rather than seek help. Often they are successful in concealing their obsessive-compulsive symptoms Iram friends and eowerkers An unfortunate consequence of this secrecy is that people with OCO usually do not receive professional help untä years alter the onset of the«' disease. By that time, they may have learned to work their lives - art family members' lives ■ around the rituals long-luting Symptoms OCO tends to last for years, even decades, Tha symptoms may become less severe from time to rime, and there may be long intervals when the symptoms are mild, hut tor most individuals with DIM, the symptoms are chronic INIwt Causes OCD? ft« old belief that OCO was the result ol life experiences has been weakened before the growing evidence that biological tactors are a primary contributor to the disorder. The feet that OCO patients respond well te spéciim medications that affect the neurotransmitter serotonin suggests the disorder has a neurobiological basis For that reason. OCO is no longer attributed only to attitudes a patient learned in childhood for example, an «îordinate emphasis on steadiness. or a beket that certain thoughts ore dangamus or unacceptable, instead, the search lor causes now focuses on the interaction of neurobiologiMl factors and environmental influences, as well as cognitive processes OCQ is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Co-enstmg disorders can make QCO more difficult, both to diagnose and to treat. In an effort to identity specific Woiogical factors that may he important in the onset or persistence of OCO, NIMH-suppoited investigators have used a device called the positron emission tomography (PET! scanner to study the brains of patients with OCQ. Several groups of investigators have obtained findings from PET scans suggesting that OCQ patients have patterns of hram activity that differ from those of people without mentei illness or with some other mental illness Brain-imaging studies of OCO showing abnormal neurochemical activity m regions known to play a rote m certain neurological disorders suggest that these areas may be crucial in the origins of QCO. There is also evidence that treatment with medications or behavior therapy induce changes m the brain coincident with clinical improvement Recent preliminary studies ot the brain using magnetic resonance imaging showed that the subsets with obsessive-compulsive disorder had significantly less white matter than did normal control subjects, suggesting a widely distributed brain abnormality in OCO Understanding the significance ot this finding will he lurcher explored by functional neuroimaging and neuropsychological studies IJemke et si, 19961 Symptoms of OCO are seen m association with some other neurological disorders. There is an increased rate of QCO in people with Tourette’s syndrome, an illness charactenied by involuntary movements art vocataarions. investigators are currently studying the hypothesis that a genetic relationship exists between OCO and the tic disorders Other illnesses that may be linked to QCO are trichotillomania (the repeated urge to putt out scalp hair, eyelashes, eyebrows or other body haW, body dysmorphic disorder (excessive preoccupation with imaginary or exaggerated defects in appearance!, and hypochondriasis (the fear of having - despite medical evaluation and reassurance - a serious disease). Genetic studies of OCO and other related conditions may enable scientists to pinpoint the molecular basis ol these disorders. Other theories about the causes of OCO focus on the interaction between behavior and the environment and on beliefs and attitudes, as well as how information is processed These behavioral and cognitive theories are not incompatible with biological explanations Do I Haw OCO?

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