Obsessive-compulsive disorder: Part II

Treating the symptoms and studying the brain.

A diagnosis of obsessive-compulsive disorder (OCD) may be delayed for years because a person with the disorder suffers from shame or obsessional doubt or is reluctant to undertake anything new. But Dr. Michael Jenike of Harvard Medical School has said that a general practitioner can identify the vast majority of cases by asking three questions: Do you have any repetitive thoughts that interfere seriously with your life? Do you wash excessively? Do you constantly check to see that things are right?

OCD should be distinguished from related symptoms that occur in other disorders. In depression, ruminations are always guilty and sad. In generalized anxiety disorder, brooding is not constantly about one subject and not accompanied by compulsive rituals. And unlike obsessions, anxious and depressed thoughts are not usually regarded as alien intrusions. In eating disorders, obsessions are confined to food and body size. Autism or schizophrenia may cause ordering and arranging rituals, but they are usually less complex and seemingly purposeful than the compulsions of obsessive-compulsive disorder, and the patient does not try to resist them.

Nor is OCD identical with (or necessarily related to) obsessive-compulsive personality: conscientious, orderly, morally rigid, fussy about details, indecisive, perfectionistic. The symptoms of OCD are not character traits, although it can be difficult to tell the difference if a person has many obsessions and rituals.

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