OCD Treatment - A Brief History

Copyright 1999

Compulsion neurosis. Obsessional neurosis. These are names given to OCD earlier in this century. It was once thought to be a rare disease. Only 0.05% of the population was estimated to be affected by OCD in1964. By 1977, those numbers grew to 0.32%. Still rare. Today, major studies estimate a lifetime prevalence rate of 2.5% and a one year prevalence of 1.5%-2.1%.

Have the numbers grown in the last three decades? Are we seeing an epidemic of OCD? No, not at all. We are finding that OCD is not rare at all. There are no more people afflicted with the disorder now than in 1964. The mistaken rarity of OCD is due to the secrecy of people who have the disorder. Shame, guilt and self-blame keep us from exposing our secret struggle with obsessive thoughts and compulsive rituals.

Blaming internal conflicts and external frustration for OCD, Sigmund Freud used psychoanalysis to treat the disorder. The results of this treatment were not good, and OCD continued to be known as a perplexing disorder to treat. Even Freud admitted being puzzled by OCD. He promoted his psychological theories and they became widely used for many years. But even Sigmund Freud looked toward a future when biology and chemical substances would play an important role in psychiatric research and treatment.

That future has arrived. Today's techniques, such as positron emission tomography (PET), single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI), have moved psychology from theories to research. Scientists can now look at chemical reactions in the brain. They have found that OCD is likely caused by abnormalities in specific parts of the brain, not unconscious conflicts, poor parenting or dysfunctional families.

OCD appears to be linked to problems with a brain chemical called serotonin. Five medications have been developed to help correct this chemical imbalance - Anafranil, Prozac, Luvox, Paxil, and Zoloft. Most people can get reduction of OCD symptoms from at least one of these medications. Others get relief from a combination of medications. Why is this? Shouldn't one medication work for everyone afflicted with OCD? This tells us that the serotonin imbalance is not the only problem behind OCD. Next month I will discuss specific abnormalities of brain structure that affects OCD symptoms.

Until the 1960s, psychoanalysis was the therapy most used to treat OCD. While medications were being developed to successfully treat OCD, therapy was changing too. British psychologist Victor Meyer began using behavior therapy treat OCD in 1966. He exposed hospitalized OCD patients with severe contamination fears and cleaning ritual to feared objects and situations such as bathroom doorknobs and faucets. Meanwhile, he severely restricted their showering and washing. He turned the water off, except to areas used strictly for toileting!

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