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The phrase 'obsessive-compulsive' is often used casually to describe someone who is a perfectionist, excessively meticulous and/or absorbed in a cause

The phrase 'obsessive-compulsive' is often used casually to describe someone who is a perfectionist, excessively meticulous and/or absorbed in a cause. But, in fact, obsessive-compulsive disorder, or OCD, is a serious mental disorder with a range of symptoms that can make life a misery for millions of sufferers.

OCD is said to be the fourth most common mental disorder, and is nearly as common as asthma and diabetes (Am Fam Physician, 1994; 49: 1129-37, 1142-4). It involves having unreasonable thoughts and fears (obsessions) that lead to repetitive behaviours (compulsions). As an example, a fear of being contaminated by germs can drive someone with OCD to compulsively wash their hands until they are sore and chapped. Other compulsions include excessive cleaning, counting, checking, touching, arranging, measuring and hoarding.

OCD sufferers generally recognize that their obsessions and compulsions are irrational, but that awareness only adds to their feelings of distress and anxiety.

The standard treatment for OCD is anti-depressant drugs or psychotherapy-or a combination of the two-but up to 40 per cent of patients continue to suffer with disabling symptoms despite such therapy (Curr Psychiatry Rep, 2000; 2: 327-34). With drugs, even if they help at first, psychiatrists often find that many patients either cannot cope with the side-effects or the medications lose their effectiveness over time (Prog Neuropsychopharmacol Biol Psychiatry, 2010; 34: 362-5).

Fortunately, however, a number of researchers have been looking into alternative therapies for the treatment of OCD-with promising findings.

Nutrition
Some evidence suggests that OCD may be linked to a nutritional deficiency, particularly a deficiency in B vitamins. In a controlled study of 30 OCD sufferers by researchers at Tel Aviv University in Israel, 20 per cent of the group had abnormally low levels of vitamin B12. This was a significantly higher rate than was found in the control groups, which were made up of 30 schizophrenics and 30 healthy people (Acta Psychiatr Scand, 1988; 78: 8-10).

Another study, this time in Turkey, discovered that OCD patents had significantly lower folate (vitamin B9) levels compared with controls (Psychiatry Clin Neurosci, 2005; 59: 616-20).
We don't yet know whether correcting any nutritional deficiencies by taking supple-ments will actually help to alleviate OCD, but this may be worth investigating with the help of a qualified nutritionist or naturopath.

One supplement that has been tested in OCD is inositol, a carbohydrate that was once considered part of the vitamin B-complex family. It was found to significantly reduce the severity of OCD symptoms when pitted against a placebo. The dose used was 18 g/day of inositol for six weeks (Am J Psychiatry, 1996; 153: 1219-21).

Exercise
Something as simple as exercise might be able to help OCD sufferers, according to one study. Researchers at Brown Medical School in Providence, RI, looked at the impact of a moderate 12-week aerobic exercise programme on 15 OCD patients who were receiving conventional treatment, but who were still experiencing symptoms. By the end of the study period, patients saw their
OCD symptoms significantly improve-an effect that was still apparent six months later. Exercise also appeared to improve the patients' overall sense of wellbeing (J Nerv Ment Dis, 2007; 195: 514-20).

Herbs
The herb Silybum marianum (L.) Gaertn., better known as milk thistle, is showing promise for treating OCD. Scientists from Jundishapoor University in Iran compared it with the drug fluoxetine, an antidepressant commonly used to treat OCD, in a group of 35 OCD sufferers. For eight weeks, half the group received S. marianum extract (600 mg/day), while the other half took fluoxetine (30 mg/day). By the end of the study, the results showed that both the drug and herbal treatments were equally effective at reduc-ing the severity of OCD symptoms (Prog Neuropsycho-pharmacol Biol Psychiatry, 2010; 34: 362-5). St John's wort, often used to treat depression, may also be beneficial for OCD-although the evidence is conflicting. A preliminary trial suggested that the herb can significantly improve OCD symptoms (J Clin Psychiatry, 2000; 61: 575-8), but a follow-up study reported that it was no better than a placebo (Int Clin Psychopharmacol, 2005; 20: 299-304).

Magnets
A non-invasive technique called 'repetitive transcranial magnetic stimulation' (rTMS)-which uses magnetic fields to stimulate nerve cells in the brain-has recently been trialled for the treatment of OCD. Researchers at New York City's Columbia University took a group of OCD sufferers, whose symptoms had proved to be resistant to conventional drug treatment, and randomly allocated them to receive either rTMS or a sham treatment. After just four weeks, the patients receiving the rTMS showed, on average, a 25-per-cent reduction in the severity of their symptoms compared with a 12-per-cent reduction in those receiving the sham therapy (Int J Neuropsycho-pharmacol, 2010; 13: 217-27).Another trial, however, found no significant effects (Am J Psychiatry, 2001; 158: 1143-5), and there are also some concerns that rTMS could cause seizures in some individuals (Int J Neuropsycho-pharmacol, 2008; 11: 131-47).

Meditation
A couple of studies have suggested that mindfulness meditation-a technique that involves focusing your mind on the present-may be useful for OCD. In one trial, it had a "significant and large effect" on OCD symptoms, according to the researchers (J Nerv Ment Dis, 2008; 196: 776-9). In another study, however, meditation techniques from Kundalini yoga-known as the 'yoga of awareness'-were more effective than mindful-ness meditation. Students of Kundalini yoga saw significant improvements in OCD symp-toms as well as in mood and stress levels compared with the mindfulness group (CNS Spectr, 1999; 4: 34-47).

Joanna Evans

Factfile: Do you have OCD?
We all suffer from worrying or unwanted thoughts from time to time, but someone with OCD can't ignore them, and they can dominate their lives and become an 'obsession'. To cope with the anxiety this causes, OCD sufferers make up rules or rituals to follow, known as 'compulsions'.

  • Obsessive signs and symptoms may include:
    • fear of being contaminated by shaking hands or touching objects that others have touched
    • doubts that the front door is locked or the oven is off
    • thoughts that you've hurt someone in a traffic accident
    • a desire to swear in inappropriate situations
    • intense feelings of stress when objects aren't placed in the right order or facing the same way
    • skin lesions because of repeated skin-picking
    • hair loss or bald spots because of hair-pulling.
  • Compulsive signs and symptoms may include:
    • checking doors repeatedly to make sure they're locked
    • handwashing until the skin has become painful
    • counting in certain patterns
    • arranging objects in a certain order
    • repeatedly turning lights on and off
    • excessively requesting or demanding reassurance.

Factfile: Can bugs cause OCD?

Scientists at the US National Institutes of Mental Health (NIMH) are investigating whether bacteria might be a cause of OCD in children. Streptococcal bacteria, which cause strep throat, scarlet fever and other infections, can have effects on the brain that may trigger a syndrome similar to OCD.
The research so far suggests that an antibody against streptococcal bacteria sometimes mistakenly acts on a brain enzyme, thus disrupting communications between neurons, and causing a form of obsessive-compulsive and related tic disorder in children known as 'paediatric autoimmune neuropsychiatric disorders associated with streptococci' (PANDAS).
NIMH researchers are now trying to find out how many cases of OCD in children are related to strep infections (www.newscientist.com/article/dn21635-bacteria-could-be-significant-cause-of-ocd.html).

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