Mansueto, of the Behavior Therapy Center in Silver Spring, has been treating those with obsessive-compulsive disorder for more than 25 years, and he says that the illness can be effectively managed.
He plans to attend the OCD Foundation's 17th annual national conference July 16-18 in Crystal City, Va., and discuss a new affiliate in the Washington-Baltimore area that will disseminate information and offer resources. More information on the conference is available at http://www.ocfoundation.org.
"Twenty years ago, many people didn't even know the disorder's name," he said. "As much as people have learned about it, it's still an underserved population."
Q. What is OCD?
A. It consists of two elements, the obsessions and the compulsions. Obsessive thoughts, images or impulses occur over and over that a person can't control. The person finds them very disturbing and doesn't want them. They may feel God is displeased with them, that they have not cleaned or organized well enough or that harm may come to them or someone else. Attempts to protect themselves lead to the compulsions, such as repetitive behaviors. People can have these features without the disorder. The "D" means it's grown to a point where it interferes with productivity and happiness.
Q. How is it diagnosed?
A. It is best diagnosed by experts in the field because it can be confusing to some without training. Many people are misdiagnosed. It's missed. To confirm, we do extended interviews. We do question-and-answer tests. We identify that it is OCD and what flavor or variety of OCD.
Q. Is there a cure?
A. This is controversial. The general wisdom is that there is no cure. I would argue that, in fact, with proper care we can remove the "D" and give people back their lives. There may be concerns left or aspects of compulsion. People may have some "O's" and "C's" left. But once the "D" is gone, and people are happy and functioning well, I consider that a cure. There is every reason to be hopeful, and that was not the case only 20 years ago.
Q. How do you treat it?
A. The big gun is exposure and response prevention. This takes anything the individual has avoided, such as thoughts or circumstances, and put the person in the presence of those cues to raise their anxiety and then inoculate their response. It's like a vaccination. The nervous system can learn to tolerate what causes the threat.
The second technique is cognitive therapy, where we educate an individual and shape their thinking in a less distorted way. The individual may have a thought of harm coming to someone, like the person might have accident because the individual thought of it. We know that's not true. Cognitive therapy reminds people and helps show them worries they have are rather baseless.
The medical community has also come up with medications that are quite helpful called selective serotonin reuptake inhibitors. These are drugs like Prozac and Paxil that are antidepressants that also have anti OCD capabilities. When OCD is severe, a combination of therapy and medication can be powerful and complementary.
Q. Who is likely to have OCD?
A. There is a pretty strong suggestion that OCD tends to run in families. Because of twin studies, one with OCD and one without, we know there is also some sort of life experience that probably crystallizes the problem. OCD tends to latch onto people with vivid imaginations, people with free-ranging minds who have very powerful feelings. Certain gifts people inherit have a downside, like when they fall into the trap of OCD.
Q. How common is OCD?
A. One in 100, maybe three in 100. That translates into millions of people. Most are not identified. We tend to see people who have gotten worse and worse. If they get better, we tend not to see them. Do some just get over it? That's probably true, but we don't know the proportions.
Q. Are there resources available?
A. The OCD Foundation in Boston has a website, http://www.ocdfoundation.org with many resources available. There is also the Anxiety Disorders Foundation of America at http://www.adaa.org.