Just Because You Do Not Suffer From The Textbook Symptoms Of OCD,
Does Not Mean That You Do Not Suffer From OCD
Believe it or not you do not have to be a germophobe or a hoarder to have obsessive compulsive disorder. Obsessions and compulsions come in many different varieties, and if you have OCD, you know just how crippling and lonely it can be.
The problem with most of the information about OCD is that it tends to focus on just a few 'typical' symptoms. However if you are consumed and distressed by thoughts and compulsions other than cleaning and hoarding, then you too may suffer from OCD. I once visited an OCD discussion forum and shared that I couldn't stop throwing things away, whereupon one hoarder replied, "oh how delightful, aren't you lucky." I felt so alone then, like my symptoms weren't real because they weren't typical. Any incessant rumination that is driven by the OCD circuit of the brain, will suck your time, your energy and your joy, and is no less torturous than cleaning and hoarding. Don't ever let anyone tell you otherwise !!
In the story, A Life Lived Ridiculously, you'll meet Maxine who's symptoms are not textbook, but they are every bit as painful. Maxine is embarrassed about her symptoms and feels isolated and frightened, and wherever she turns, she finds no comfort.
The problem with most of the information about OCD is that it tends to focus on just a few 'typical' symptoms. However if you are consumed and distressed by thoughts and compulsions other than cleaning and hoarding, then you too may suffer from OCD. I once visited an OCD discussion forum and shared that I couldn't stop throwing things away, whereupon one hoarder replied, "oh how delightful, aren't you lucky." I felt so alone then, like my symptoms weren't real because they weren't typical. Any incessant rumination that is driven by the OCD circuit of the brain, will suck your time, your energy and your joy, and is no less torturous than cleaning and hoarding. Don't ever let anyone tell you otherwise !!
In the story, A Life Lived Ridiculously, you'll meet Maxine who's symptoms are not textbook, but they are every bit as painful. Maxine is embarrassed about her symptoms and feels isolated and frightened, and wherever she turns, she finds no comfort.
What is OCD?
Obsessive compulsive disorder (OCD) is an anxiety disorder that is characterized by recurrent, unwanted thoughts (obsessions), that produce a sense of dread or alarm. Persons then engage in repetitive behaviors (compulsions) in an attempt to rid themselves of the obsessive thoughts and calm the anxiety.
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OBSESSIONS are:
COMPULSIONS are:
Although the patient realizes that their obsessions and compulsions are "unwanted, unreasonable and excessive," they cannot stop the thoughts, nor can they stop acting on them, because of the pure feeling of dread experienced until the compulsions are correctly performed. The problem is that the relief brought about by the compulsions is temporary, and the obsessions and anxiety always return. If you suffer from OCD you know what it's like to be trapped in a vicious cycle of:
OBSESSIONS - COMPULSIONS - RELIEF - OBSESSIONS, ETC...
When the brain is in this repetitive, hyperexcited mode of generating and ruminating intrusive thoughts, it is in a state of "brain lock."
To release patients from "brain lock," physicians typically either prescribe selective serotonin reuptake inhibitors (SSRI’s such as fluoxetine, fluvoxamine, sertraline, and paroxetine) or cognitive-behavioral therapy (CBT) or both. The aim of both mechanisms is for patients to physically change their brain chemistry and pathways. Medications alter brain chemistry and decrease the intensity of OCD signals, while in CBT, patients attempt to alter their brain chemistry by changing their responses to obsessive thoughts. Of course, CBT is much harder work, and results vary.
OCD is the fourth most common neuropsychiatric illness in the United States, with as many as one in forty, or 2.5 % of the population, afflicted. OCD is classed in the family of anxiety disorders, as sufferers experience severe anxiety along with the obsessive thoughts. Anxiety disorders are prolonged exaggerations of our normal reaction to fearful or stressful events, and include panic disorder, phobias, social anxiety disorder, post traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and obsessive compulsive disorder.
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
The severity of a patient's OCD is most commonly measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). This questionnaire, conducted between patient and doctor, assesses the types of obsessions and compulsions and their severity. Severity is graded based on the patient's answers to the following points:
1) Time occupied by obsessive thoughts
2) Interference due to obsessive thoughts
3) Distress associated with obsessive thoughts
4) Resistance against obsessions
5) Degree of control over obsessive thoughts
6) Time spent performing compulsive behaviors
7) Interference due to compulsive behaviors
8) Distress associated with compulsive behaviors
9) Resistance against compulsions
10) Degree of control over compulsions
11) Insight into obsessions and compulsions
12) Degree of avoidance
13) Degree of indecisiveness
14) overvalued of responsibility
15) Pervasive slowness, disturbance or inertia
16) Pathological doubting
The patient's OCD is then graded as subclinical, mild, moderate, severe or extreme.
You can download a copy of the Y-BOCS scale HERE, though bear in mind that it is not intended to be used in self diagnosis, but rather with your doctor.
References
(1) Westwood Institute for Anxiety Disorders
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OBSESSIONS are:
- Thoughts, impulses or images that are distressing and anxiety provoking
- Intrusive and persistent
- Often personally repugnant and occur against one's will
COMPULSIONS are:
- Conscious behaviors or rituals that are done to alleviate the anxiety caused by the obsessions
- Carried out even though the person is aware that the behaviors are senseless or excessive
Although the patient realizes that their obsessions and compulsions are "unwanted, unreasonable and excessive," they cannot stop the thoughts, nor can they stop acting on them, because of the pure feeling of dread experienced until the compulsions are correctly performed. The problem is that the relief brought about by the compulsions is temporary, and the obsessions and anxiety always return. If you suffer from OCD you know what it's like to be trapped in a vicious cycle of:
OBSESSIONS - COMPULSIONS - RELIEF - OBSESSIONS, ETC...
When the brain is in this repetitive, hyperexcited mode of generating and ruminating intrusive thoughts, it is in a state of "brain lock."
To release patients from "brain lock," physicians typically either prescribe selective serotonin reuptake inhibitors (SSRI’s such as fluoxetine, fluvoxamine, sertraline, and paroxetine) or cognitive-behavioral therapy (CBT) or both. The aim of both mechanisms is for patients to physically change their brain chemistry and pathways. Medications alter brain chemistry and decrease the intensity of OCD signals, while in CBT, patients attempt to alter their brain chemistry by changing their responses to obsessive thoughts. Of course, CBT is much harder work, and results vary.
OCD is the fourth most common neuropsychiatric illness in the United States, with as many as one in forty, or 2.5 % of the population, afflicted. OCD is classed in the family of anxiety disorders, as sufferers experience severe anxiety along with the obsessive thoughts. Anxiety disorders are prolonged exaggerations of our normal reaction to fearful or stressful events, and include panic disorder, phobias, social anxiety disorder, post traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and obsessive compulsive disorder.
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
The severity of a patient's OCD is most commonly measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). This questionnaire, conducted between patient and doctor, assesses the types of obsessions and compulsions and their severity. Severity is graded based on the patient's answers to the following points:
1) Time occupied by obsessive thoughts
2) Interference due to obsessive thoughts
3) Distress associated with obsessive thoughts
4) Resistance against obsessions
5) Degree of control over obsessive thoughts
6) Time spent performing compulsive behaviors
7) Interference due to compulsive behaviors
8) Distress associated with compulsive behaviors
9) Resistance against compulsions
10) Degree of control over compulsions
11) Insight into obsessions and compulsions
12) Degree of avoidance
13) Degree of indecisiveness
14) overvalued of responsibility
15) Pervasive slowness, disturbance or inertia
16) Pathological doubting
The patient's OCD is then graded as subclinical, mild, moderate, severe or extreme.
You can download a copy of the Y-BOCS scale HERE, though bear in mind that it is not intended to be used in self diagnosis, but rather with your doctor.
References
(1) Westwood Institute for Anxiety Disorders
What Is The Difference Between Obsessive Compulsive Disorder And Addiction
Disorder?
A common confusion
Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts (obsessions) that produce anxiety, followed by repetitive behaviors (compulsions) that are performed for the sole purpose of reducing the anxiety.
Many people confuse obsessive compulsive disorder with addiction disorders, yet they couldn’t be more different. Persons with addictive disorders such as gambling, overeating, drugs and alcohol abuse typically experience at least some pleasure from their activity. OCD sufferers experience no pleasure from performing their rituals and do so only because it provides a kind of temporary relief from the obsessions. The obsessions and anxiety then return as soon as the ritual stops.
Addiction disorder
The actions of drugs of abuse (amphetamines, cocaine, morphine, nicotine, PCP and cannabis) are rewarding because they activate dopaminergic cells in the ventral tegmental area (VTA) of the brain. The VTA is known as the brain's reward center. Each addiction acts at different cell receptors, and even in different brain areas, but in all cases the ultimate result is activation of the VTA (Reference 1).
Obsessive compulsive disorder
The OCD circuit is different altogether, and is currently thought to involve over-activation of cells in both the orbitofrontal cortex (OFC) and the anterior cingulate cortex of the brain. The OFC and anterior cingulate cortex function as the brain’s error detection centers, and become active when something is amiss or contrary to expectations and needs to be corrected. In healthy persons, once the error has been corrected, the cells in the OFC and anterior cingulate cortex quiet down. In OCD, though, the cells of the OFC and anterior cingulate cortex never quiet down, thus generating a persistent feeling that something is wrong and needs to be fixed. This explains the intrusive obsessive thoughts, followed by the compulsive need to repeatedly correct one's actions even when no error has been made. A deficiency of serotonin action is thought to be responsible for the malfunction in these brain areas (Reference 2).
OCD is further aggravated by the anxiety that accompanies it, as the anterior cingulate cortex is directly wired into the gut-control centers of the brain, known as the limbic system (Specifically a nucleus called the amygdala). The limbic system is responsible for generating the sense of anxiety, fear and dread associated with danger and, oddly enough, error detection (Reference 2).
In a nutshell
Addicts are trying to turn on the reward parts of their brains.
Obsessive compulsives are trying to turn off the error parts of their brains.
References
(1) Brain reward circuitry: insights from unsensed incentives
(2) The Mind and the Brain: Neuroplasticity and the Power of Mental Force by J Schwartz
Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts (obsessions) that produce anxiety, followed by repetitive behaviors (compulsions) that are performed for the sole purpose of reducing the anxiety.
Many people confuse obsessive compulsive disorder with addiction disorders, yet they couldn’t be more different. Persons with addictive disorders such as gambling, overeating, drugs and alcohol abuse typically experience at least some pleasure from their activity. OCD sufferers experience no pleasure from performing their rituals and do so only because it provides a kind of temporary relief from the obsessions. The obsessions and anxiety then return as soon as the ritual stops.
Addiction disorder
The actions of drugs of abuse (amphetamines, cocaine, morphine, nicotine, PCP and cannabis) are rewarding because they activate dopaminergic cells in the ventral tegmental area (VTA) of the brain. The VTA is known as the brain's reward center. Each addiction acts at different cell receptors, and even in different brain areas, but in all cases the ultimate result is activation of the VTA (Reference 1).
Obsessive compulsive disorder
The OCD circuit is different altogether, and is currently thought to involve over-activation of cells in both the orbitofrontal cortex (OFC) and the anterior cingulate cortex of the brain. The OFC and anterior cingulate cortex function as the brain’s error detection centers, and become active when something is amiss or contrary to expectations and needs to be corrected. In healthy persons, once the error has been corrected, the cells in the OFC and anterior cingulate cortex quiet down. In OCD, though, the cells of the OFC and anterior cingulate cortex never quiet down, thus generating a persistent feeling that something is wrong and needs to be fixed. This explains the intrusive obsessive thoughts, followed by the compulsive need to repeatedly correct one's actions even when no error has been made. A deficiency of serotonin action is thought to be responsible for the malfunction in these brain areas (Reference 2).
OCD is further aggravated by the anxiety that accompanies it, as the anterior cingulate cortex is directly wired into the gut-control centers of the brain, known as the limbic system (Specifically a nucleus called the amygdala). The limbic system is responsible for generating the sense of anxiety, fear and dread associated with danger and, oddly enough, error detection (Reference 2).
In a nutshell
Addicts are trying to turn on the reward parts of their brains.
Obsessive compulsives are trying to turn off the error parts of their brains.
References
(1) Brain reward circuitry: insights from unsensed incentives
(2) The Mind and the Brain: Neuroplasticity and the Power of Mental Force by J Schwartz
The OCD Circuit
Neuronal circuits implicated in OCD
1) A direct loop (red arrow) linking the orbitofrontal cortex (brain's error detection center) to the thalamus is excitatory and bidirectional.
This pathway activates the cortex.
2) An indirect loop (blue arrows) linking the orbitofrontal cortex to the striatum's caudate nucleus to the thalamus is inhibitory and is thought to serve as a counterweight to the excitatory loop described above.
This pathway inhibits the cortex.
3) A pathway linking the prefrontal cortex and anterior cingulate cortex (also involved in error detection and processing) to the amygdala (which processes emotions including fear) (green arrows), is hypothesized to contribute to the affective anxiety component of OCD symptoms.
Bringing together these three components of the circuit, OCD symptoms occur when:
1) There is abnormal increased activity in the orbitofronto-thalamic excitatory loop (too much activation).
2) This is, in turn, inadequately inhibited by the cortex-striatum-thalamus inhibitory loop (too little inhibition).
3) The two incidents above cause abnormal, increased activity in the PFC, anterior cingulate cortex and amygdala.
From a therapeutic standpoint, decreasing activity of the excitatory loop or increasing activity of the inhibitory loop would be expected to decrease symptoms of OCD. Furthermore, decreasing activity in the limbic component of the circuit would decrease the distressing emotional effects associated with obsessions.
Medication
Selective serotonin reuptake inhibitors (SSRIs) are currently the most popular and most effective pharmachological treatment for OCD. SSRI's include fluoxetine (prozac), fluvoxamine (luvox), sertraline (zoloft), paroxetine (paxil), citalopram (celexa) and escitalopram (lexapro).
Two types of neurosurgery exist for OCD
Deep brain stimulation (DBS), to disrupt activity in the excitatory loop fibers that connect the orbitofrontal cortex with the thalamus, thus, in theory, disrupting that pathological circuit.
Cingulotomy. Lesioning of the anterior cingulate cortex has been reported since the 1940s, with Freeman and Watts reporting that severing fibers from the anterior cingulate cortex led to an improvement of anxiety symptoms. Currently stereotaxic,bilateral lesioning of the cingulate cortex is the most common neurosurgical procedure for treatment of refractory psychiatric syndromes, specifically OCD. In a cingulotomy, the anterior portion of the cingulate cortex is lesioned, interrupting tracts between the anterior cingulate cortex and the prefrontal cortex.
References
(1) Functional Neurosurgery in the treatment of severe obsessive compulsive disorder and major depression: Overview of disease circuits and therapeutic targeting for the clinician by Shah DB et al
(2) The Mind and the Brain by Jeffrey M. Schwartz
(3) Westwood Institute for Anxiety Disorders
1) A direct loop (red arrow) linking the orbitofrontal cortex (brain's error detection center) to the thalamus is excitatory and bidirectional.
This pathway activates the cortex.
2) An indirect loop (blue arrows) linking the orbitofrontal cortex to the striatum's caudate nucleus to the thalamus is inhibitory and is thought to serve as a counterweight to the excitatory loop described above.
This pathway inhibits the cortex.
3) A pathway linking the prefrontal cortex and anterior cingulate cortex (also involved in error detection and processing) to the amygdala (which processes emotions including fear) (green arrows), is hypothesized to contribute to the affective anxiety component of OCD symptoms.
Bringing together these three components of the circuit, OCD symptoms occur when:
1) There is abnormal increased activity in the orbitofronto-thalamic excitatory loop (too much activation).
2) This is, in turn, inadequately inhibited by the cortex-striatum-thalamus inhibitory loop (too little inhibition).
3) The two incidents above cause abnormal, increased activity in the PFC, anterior cingulate cortex and amygdala.
From a therapeutic standpoint, decreasing activity of the excitatory loop or increasing activity of the inhibitory loop would be expected to decrease symptoms of OCD. Furthermore, decreasing activity in the limbic component of the circuit would decrease the distressing emotional effects associated with obsessions.
Medication
Selective serotonin reuptake inhibitors (SSRIs) are currently the most popular and most effective pharmachological treatment for OCD. SSRI's include fluoxetine (prozac), fluvoxamine (luvox), sertraline (zoloft), paroxetine (paxil), citalopram (celexa) and escitalopram (lexapro).
Two types of neurosurgery exist for OCD
Deep brain stimulation (DBS), to disrupt activity in the excitatory loop fibers that connect the orbitofrontal cortex with the thalamus, thus, in theory, disrupting that pathological circuit.
Cingulotomy. Lesioning of the anterior cingulate cortex has been reported since the 1940s, with Freeman and Watts reporting that severing fibers from the anterior cingulate cortex led to an improvement of anxiety symptoms. Currently stereotaxic,bilateral lesioning of the cingulate cortex is the most common neurosurgical procedure for treatment of refractory psychiatric syndromes, specifically OCD. In a cingulotomy, the anterior portion of the cingulate cortex is lesioned, interrupting tracts between the anterior cingulate cortex and the prefrontal cortex.
References
(1) Functional Neurosurgery in the treatment of severe obsessive compulsive disorder and major depression: Overview of disease circuits and therapeutic targeting for the clinician by Shah DB et al
(2) The Mind and the Brain by Jeffrey M. Schwartz
(3) Westwood Institute for Anxiety Disorders
Folic Acid May Increase The Effect Of Your SSRI Antidepressant
According to scientific studies, a supplement of folic acid may increase the effect of your selective serotonin reuptake inhibitor (SSRI). Studies have shown that folate concentrations are reduced in many patients with major depression, and in 2000, Coppen et al showed that co-administration of the SSRI fluoxetine (Prozac) with folic acid, not only increased folate concentrations in the body, but also significantly enhanced the antidepressant action of the SSRI (Reference 1).
Folate is a co-factor in biogenic amine biosynthesis. In other words it plays an essential role in your body's ability to synthesize certain important neurotransmitter molecules such as histamine, dopamine and, most importantly for those who require SSRIs, serotonin.
More recently, scientists have sought to assess whether folic acid could enhance selective serotonin reuptake inhibitor response among majorly depressed adults with normal levels of folic acid and yet still resistant to their SSRIs. A trial, conducted by Alpert et al in 2002, lasted 6 weeks, by the end of which all participants showed increased serum levels of folic acid and modest improvement to their depression symptoms. This was a particularly tough group, as they were selected based on the fact that they were SSRI resistant, so although the results were modest they do seem to be consistent with the previous studies, that found that folic acid will enhance the effects of your SSRI medication (Reference 2).
References
(1) Enhancement of the antidepressant action of fluoxetine by folic acid: A randomised, placebo controlled trial
(2) Folinic acid (leucovorin) as an adjunctive treatment for SSRI-refractory depression by Alpert JE et al
Folate is a co-factor in biogenic amine biosynthesis. In other words it plays an essential role in your body's ability to synthesize certain important neurotransmitter molecules such as histamine, dopamine and, most importantly for those who require SSRIs, serotonin.
More recently, scientists have sought to assess whether folic acid could enhance selective serotonin reuptake inhibitor response among majorly depressed adults with normal levels of folic acid and yet still resistant to their SSRIs. A trial, conducted by Alpert et al in 2002, lasted 6 weeks, by the end of which all participants showed increased serum levels of folic acid and modest improvement to their depression symptoms. This was a particularly tough group, as they were selected based on the fact that they were SSRI resistant, so although the results were modest they do seem to be consistent with the previous studies, that found that folic acid will enhance the effects of your SSRI medication (Reference 2).
References
(1) Enhancement of the antidepressant action of fluoxetine by folic acid: A randomised, placebo controlled trial
(2) Folinic acid (leucovorin) as an adjunctive treatment for SSRI-refractory depression by Alpert JE et al
Obsessive Compulsive Disorder In Children
The greatest tragedy is when children suffer in fear and silence because they haven’t the words to express their pain…
Thanks to the internet, there are some great resources geared towards educating parents and children about obsessive compulsive disorder.
We need to raise awareness of obsessive compulsive disorder among parents and children alike, because nothing is more frightening for a child than having their brain taken hostage and not having the maturity or the vocabulary to talk about it. Matters are only made worse by parents who are totally ignorant of the condition and will actually scold their child when they catch him acting oddly. If you are a parent, you need to learn about this silent mental torture.
If you are a child, do not wait until your childhood is over to speak up and seek help.Obsessive compulsive disorder is well understood, and treated using selective serotonin re-uptake inhibitors, cognitive behavioral therapy, or a combination of both.
PANDAS
Some children may develop obsessive compulsive disorder and/or tic disorders such as Tourette's Syndrome following streptococcal infections such as strep throat and Scarlet Fever. This type of OCD is known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).
These children usually have dramatic "overnight" onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions.
What is the mechanism behind this phenomenon?
PANDAS is a pediatric disorder, thought to be caused by antibodies generated as a result of the strep infection. In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. But in PANDAS, the antibodies mistakenly recognize and attack specific cells in the brain, and this results in OCD and/or tic symptoms. This phenomenon is called "molecular mimicry", which means that proteins on the cell wall of the streptococcal bacteria are similar in some way to the proteins on the cell walls of specific neurons.
Clinicians use the following 5 diagnostic criteria for the diagnosis of PANDAS:
1) Presence of obsessive-compulsive disorder and/or a tic disorder
2) Pediatric onset of symptoms (age 3 years to puberty)
3) Episodic course of symptom severity
4) An anti-streptococcal antibody test, to determine whether there is immunologic evidence of a previous strep. infection. An elevated anti-strep. titer (such as ASO or AntiDNAse-B) means the child has had a strep. infection sometime within the past few months, and his body created antibodies to fight the strep. bacteria.
5) Association with neurological abnormalities (motoric hyperactivity, or adventitious movements, such as choreiform movements)
PANDAS is a newly recognized condition, and no one yet knows what portion of obsessive-compulsive disorder cases may be tied to PANDAS - or even how prevalent the condition may be. Almost every child is infected with strep at some point, and most don't develop OCD symptoms. Research is taking place at The National Institute of Mental Health (NIMH) to further understand this condition.
If you are a parent or child, know that you are not alone !! Here are just a few of the MANY resources that you may find useful:
OCD website specifically for children
When OCD is a FamilyAffair
American Academy of Child & Adolescent Psychiatry
NIMH Pediatrics + Developmental
International OCD Foundation
What do you do when your brain gets stuck: A kid's guide to overcoming OCD
A Few Resources for Parents
Public Perceptions of OCD
OCD in Children
Being a parent with a kid who has OCD
Thanks to the internet, there are some great resources geared towards educating parents and children about obsessive compulsive disorder.
We need to raise awareness of obsessive compulsive disorder among parents and children alike, because nothing is more frightening for a child than having their brain taken hostage and not having the maturity or the vocabulary to talk about it. Matters are only made worse by parents who are totally ignorant of the condition and will actually scold their child when they catch him acting oddly. If you are a parent, you need to learn about this silent mental torture.
If you are a child, do not wait until your childhood is over to speak up and seek help.Obsessive compulsive disorder is well understood, and treated using selective serotonin re-uptake inhibitors, cognitive behavioral therapy, or a combination of both.
PANDAS
Some children may develop obsessive compulsive disorder and/or tic disorders such as Tourette's Syndrome following streptococcal infections such as strep throat and Scarlet Fever. This type of OCD is known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).
These children usually have dramatic "overnight" onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions.
What is the mechanism behind this phenomenon?
PANDAS is a pediatric disorder, thought to be caused by antibodies generated as a result of the strep infection. In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. But in PANDAS, the antibodies mistakenly recognize and attack specific cells in the brain, and this results in OCD and/or tic symptoms. This phenomenon is called "molecular mimicry", which means that proteins on the cell wall of the streptococcal bacteria are similar in some way to the proteins on the cell walls of specific neurons.
Clinicians use the following 5 diagnostic criteria for the diagnosis of PANDAS:
1) Presence of obsessive-compulsive disorder and/or a tic disorder
2) Pediatric onset of symptoms (age 3 years to puberty)
3) Episodic course of symptom severity
4) An anti-streptococcal antibody test, to determine whether there is immunologic evidence of a previous strep. infection. An elevated anti-strep. titer (such as ASO or AntiDNAse-B) means the child has had a strep. infection sometime within the past few months, and his body created antibodies to fight the strep. bacteria.
5) Association with neurological abnormalities (motoric hyperactivity, or adventitious movements, such as choreiform movements)
PANDAS is a newly recognized condition, and no one yet knows what portion of obsessive-compulsive disorder cases may be tied to PANDAS - or even how prevalent the condition may be. Almost every child is infected with strep at some point, and most don't develop OCD symptoms. Research is taking place at The National Institute of Mental Health (NIMH) to further understand this condition.
If you are a parent or child, know that you are not alone !! Here are just a few of the MANY resources that you may find useful:
OCD website specifically for children
When OCD is a FamilyAffair
American Academy of Child & Adolescent Psychiatry
NIMH Pediatrics + Developmental
International OCD Foundation
What do you do when your brain gets stuck: A kid's guide to overcoming OCD
A Few Resources for Parents
Public Perceptions of OCD
OCD in Children
Being a parent with a kid who has OCD
According to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) of the American Psychiatric Association, the clinical diagnosis of obsessive compulsive disorder (OCD) is as follows:
A) The Person Exhibits Either Obsessions or Compulsions
Obsessions are indicated by the following:
B) At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (Note: this does not apply to children).
C) The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities or relationships.
D) If another axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with drugs in the presence of a substance abuse disorder).
E) The disturbance is not due to the direct physiologic effects of a substance (e.g., drug abuse, a medication) or a general medical condition.
Obsessions are indicated by the following:
- The person has recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
- The thoughts, impulses, or images are not simply excessive worries about real-life problems
- The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action
- The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
- The person has repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
- The behaviors or mental acts are aimed at preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
B) At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (Note: this does not apply to children).
C) The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities or relationships.
D) If another axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with drugs in the presence of a substance abuse disorder).
E) The disturbance is not due to the direct physiologic effects of a substance (e.g., drug abuse, a medication) or a general medical condition.
Useful Links
The Mind and The Brain by J M Schwartz. A great book for those who wish to learn more about the neuroscience of OCD
Devil in the Details, by Jennifer Traig. Simply an excellent memoir of one girl's struggle with OCD
National Institute of Mental Health . Excellent resource for OCD, plus all the latest news and research
Brain Physics. Excellent resource for OCD and Anxiety disorders
Always be aware of hypnosis scams
Other people's great OCD Blogs
The Beat OCD Blog
The OCD Diaries. The blog that kicks fear, anxiety, depression and addiction in the teeth!
Wiping the Crazy off My Face
OCD Blogger Girl. OCD, life and other misunderstandings
The Lunatic Cafe
The Mind and The Brain by J M Schwartz. A great book for those who wish to learn more about the neuroscience of OCD
Devil in the Details, by Jennifer Traig. Simply an excellent memoir of one girl's struggle with OCD
National Institute of Mental Health . Excellent resource for OCD, plus all the latest news and research
Brain Physics. Excellent resource for OCD and Anxiety disorders
Always be aware of hypnosis scams
Other people's great OCD Blogs
The Beat OCD Blog
The OCD Diaries. The blog that kicks fear, anxiety, depression and addiction in the teeth!
Wiping the Crazy off My Face
OCD Blogger Girl. OCD, life and other misunderstandings
The Lunatic Cafe
If you need a safe environment to share your emotions, discuss your symptoms or brain-storm with others who understand what you are going through, the internet offers many great OCD discussion forums.
These are some of the most active...
These are some of the most active...
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