Obsessive-Compulsive Disorder
One common question about OCD is, 'Since everyone has weird habits, how is this any different?' With some exceptions, most people with OCD realize that they have these unusual habits but often feel powerless to do anything about them. The difference between habits and obsessive compulsions is that the latter take inordinate amounts of time to be completed, and patients must often follow strict self-enforced rules to enact the compulsions. For example, a patient with OCD may worry about the symmetry of objects enough that they can not do the next task in their day until all the items in a room are rearranged to become symmetrical. This kind of attention to detail may regularly take an hour or more each day.
Epidemiology
The Obsessive Compulsive Foundation estimates a 3% prevalence of OCD in the U.S. population, which equates to five million to six million people.1 OCD is more common in boys than in girls but roughly evens out in adulthood.2 This increased diagnosis in adult women could be because women are seen for health care appointments more often than men.
Approximately 30% of OCD patients have symptoms of hoarding. Hoarding is defined as the inability to throw away things of little to no value, combined with the continued accumulation of new items. In Massachusetts, health and public service agencies found that 0.26 cases of compulsive hoarding were reported per population of 1,000 in a five-year period.3 Certainly, not every patient who hoards is reported, so this likely represents the most severe cases.
Many elderly hoarders are female, unmarried and live alone. Some researchers hypothesize that this is a problem that only gets worse when patients with a tendency to hoard live by themselves, with no one to help curb this behavior. Never-married patients tend to have much worse hoarding symptoms. Also, some propose that this condition gets worse as people age.3
Hoarding
Most OCD patients who have hoarding behaviors tend to collect things such as newspapers, papers, food containers, food, clothing, books and sometimes items from other people's trash. In a 2001 study on 62 elderly hoarders, the authors report that nearly all clients had severe clutter in their living rooms, dining rooms, kitchens and bedrooms (92% to 96%).3 Thirty-six percent of study clients were described as having clean personal hygiene, while 17% were extremely dirty, even having 'blackening of the skin, filthy hair and soiled clothing.'3 This was presumed to be because clutter was severely restricting the client's access to the shower, bathtub or sink. Clutter in the 70% of the homes was found to be chaotic or very chaotic with no apparent organization. Another issue is that many patients who hoard do not want anyone coming in their homes for repairs, either from embarrassment if they have insight into the hoarding, or because some patients have accused service providers of stealing their possessions.3
'In some cases clutter was knee-high or higher, requiring elderly clients to climb over possessions to reach another location. One client was described as literally swimming over the top of clutter to reach other rooms. Nearly 70% of elderly hoarders were unable to use their furniture (for example bed or sofa).'3
Clutter could also prevent patients from performing normal food preparation or storage and could present major hazards to patients' health, in the manner of a fire hazard due to excessive flammable material. There is also the likelihood of tall piles of collected materials falling down on the patient. Conceivably, if patients live in apartments, the fire hazard could spread to other nearby dwellers. While this amount of clutter would be dangerous in any age group, the elderly are already more susceptible to limited mobility and falls. In any situation where a younger person could run to the door to escape a fire, a patient with a walker would be slower navigating a narrow escape path with piles of newspaper in the way.
Steketee, Frost and Kim hypothesized that they would find the clients had problems with memory and cognition. However, 76% were found to have no problems with cognition, and 67% had no problems with memory.3 This observation leads to the conclusion that these were true OCD patients without comorbidities of dementia.
Even though most OCD patients are aware that their obsessions and resultant compulsions are excessive, some patients, including many hoarders, are not very aware that they have a problem, or that they are not in control of the problem. This lack of insight in hoarders, and various other OCD patients has led to a poorer prognosis, probably due to decreased treatment seeking on the part of patients.4
Etiology-Pathophysiology
OCD is thought to be related to an imbalance of serotonin in the brain, partly because SSRIs have been found to be effective in this disorder. Serotonin acts to connect nerve impulses from one neuron to the next and also has an impact on repetitive behaviors. No specific genes have yet been found to explain the origins of OCD, but there seems to be a familial connection.2 Interestingly, it is the diagnosis of OCD that tends to get passed on and not all the same symptoms.2
About two-thirds of OCD patients have experienced major depression in their history. There is some debate in the field about whether OCD causes the depression or whether these are simply common comorbidities. A majority of patients report the OCD symptoms first, with the depression occurring after the OCD is out of control.2
Rarely, neurologic changes may be present in the OCD patient due to previous problems from an autoimmune reaction to a strep infection, a history of encephalitis or a head injury, but this is very unusual. However, there are some changes that can be seen on brain scans of OCD patients. One study even found that OCD patients had significantly more gray matter and less white matter than controls did. Positron emission tomography and functional magnetic resonance imaging have shown increased brain activity in the frontal lobes, basal ganglia and cingulum in OCD patients as compared to controls.2
To beat your Obsessive Compulsive Disorder
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