European Stars And Stripes (Newspaper) - January 10, 1989, Darmstadt, Hesse                                Obsessive compulsive disorder More prevalent than thought by Daniel Goleman new York times Hen James was 3, he began a strange habit whenever he crossed the Street he would walk in circles around the manhole covers. In kindergarten he would sit for hours drawing circles on pieces of paper. At 8, he would stand up and sit Down 17 times before finally sitting in a chair and would go Back and Forth through a door 17 times before finally exiting. James suffered from obsessive compulsive disorder. Scientists have assumed that the problem is extremely rare. But a new National Survey of households has found that the disorder is 25 to 60 times More common than had been thought afflicting perhaps one in 40 americans. The disorder is vastly under reported researchers say because Many who suffer from it keep their symptoms secret. While their symptoms Are Seldom As severe or obvious As James millions of people find their lives dominated by desperate attempts to fight off strange impulses and bizarre thoughts. The most widely accepted previous estimates put the prevalence of obsessive compulsive disorder at about one person in every 2,000. The new study published in the december Issue of the archives of general psychiatry estimates that from 1.9 percent to 3.3 percent of americans will have the disorder at some Point in their lives. The obsessive compulsive is at the extreme end of a continuum that begins with the person who for instance is scrupulously neat about his desk said Blanche Freund a psychologist at the program for the clinical study of anxiety disorders at the medical College of Pennsylvania in Philadelphia. The program is one of several across the United states that specialize in treating the disorder. Being especially neat is not a problem a compulsive style like that can be a distinct asset in some ways Freund said. More serious is the compulsive personality someone who gets completely lost fussing Over details and who for example needs everyone to be equally neat in order to make him feel comfortable. And at the extreme Are people who spend most of their Day obsessing or performing compulsive  obsession and compulsions Are symptoms of the same disorder. Obsessions Are thoughts that completely preoccupy a person while compulsions Are actions that the person feels he or she must perform. Although obsessive compulsive disorder has Long been regarded by psychotherapists As one of the most difficult problems to treat new techniques using medication or behaviour therapy have proved highly effective in recent years. Between drugs and behaviour therapy about 70 to 80 percent of those with the most extreme symptoms can have significant improvement or be cured said or. Judith l. Rapaport chief of the child psychiatry Branch at the National Institute of mental health. Rapaport who has been studying obsessive compulsive disorder for 15 years reported on Progress in drug treatment of the disorder in the nov. 18 Issue of the journal of the american medical association. Jashes is a pseudonym Rapoport gave for one of the children who have been successfully treated for the disorder at her facility. The most promising new treatments for obsessive compulsive disorder Are three drugs developed As anti depressants Clomis praline flu Ometine and flu examine All of which Are undergoing testing. In the most effective behavioural techniques the patient is methodically exposed to things he dreads while being forbidden to indulge in his compulsions. The world of the obsessive compulsive is often nightmarish and bizarre. One form it May take for instance is the compulsion to Pluck one s hair out strand by strand. Young women with this compulsion often Pluck their hair to baldness. Some obsessive compulsive people will take hours to leave their Homes because they Check and recheck every appliance in the House to be sure that it is off. Others feel compelled to perform private rituals such As the Man who spent hours circling the same route in his car fearing he had struck a pedestrian. If you ask someone with extreme obsessions How much of the Day their thoughts Are free of the obsession they will say almost never or. Freund said. Though people with obsessions realize that their thoughts Are strange or unwanted they feel unable to Stop them. Similarly people with compulsions say that although they often do not want to go through with the act anxiety builds until they give in. Often though the disorder is less debilitating confining itself to compulsive rituals done in secret or those that interfere Little with what is otherwise a Normal life. Typical of these is another of Rapaport s patients a 16-year-old girl who every sunday spent hours removing everything from her room then washed the Walls and floors. In other respects her life was not unusual she did Well in school and led a Normal social life. Researchers believe that such circumscribed symptoms Are one reason the estimates for the prevalence of obsessive compulsive disorder have All the medications for obsessive compulsive disorder Are still under experimental investigation psychiatrists who want to prescribe them can obtain them Only from the manufacturers been so Low the symptoms Are often concealed from family or friends. The new higher estimates come from part of a National Survey of 18,572 men and women conducted door to door in five areas new Haven Baltimore St. Louis the Piedmont Region of North Carolina and los Angeles. One question meant to detect obsessive compulsive disorder concerned some of the most common obsessions. These included having had persistent unpleasant thoughts such As that they might harm someone they love that their hands were dirty no matter How much they Are washed or that relatives May have been Hurt or killed. In trying to detect compulsions the interviewers asked if the people Felt they had to do something Over and Over again even if they considered it foolish or tried to resist it. The examples Given were also for the most common symptoms repeated hand washing or checking to see if doors Are locked or the stove turned off. In other questions meant to detect compulsions respondents were asked whether they Felt they had to do something in a particular order like dressing and whether they Felt they had to repeat the entire sequence from the beginning if something was done improperly. Some people with the disorder suffer mainly from obsession others from compulsions and still others from a combination. While the vast majority of those people who come for treatment often suffer from both problems Only 9 percent of those surveyed had both obsessions and compulsions. To qualify As a symptom for the Survey the obsessions or compulsions must have been present for at least three weeks have persisted despite All attempts to get rid of them and have interfered to some extent with aspects of the person s life. In the Survey 468 people were identified As qualifying for the diagnosis. Although the National average was 2.5 percent it varied from 1.9 percent to 3.3 percent among the five areas. The Survey results were reported by Marvin Karno a psychiatrist at the University of California at los Angeles and colleagues at other institutions. It is not necessarily abnormal for children to develop an obsession or compulsion such As counting cars that pass by. But when these become such Strong forces in their lives that they interfere with Normal play or school they Are considered symptoms that should be treated. All the medications for obsessive compulsive disorder Are still under experimental investigation psychiatrists who want to prescribe them can obtain them Only from the manufacturers. While the drugs seem to be effective in reducing symptoms in 70 percent of patients their Side effects such As difficulty with ejaculation in males Lead some patients to Stop them. On the other hand the behaviour therapy techniques that work Best with obsessive compulsive patients Are so demanding that about a Quarter of those who seek help decline to go through the process according to a report by Gail Steketee a clinical social worker and Edna Foa a psychologist at the Eastern Pennsylvania psychiatric Institute in Philadelphia. We recommend that patients try behaviour therapy first and then if that does not work for them try medications Rapaport said. Some people respond Best to drugs some to behaviour therapy. If people Are motivated enough to stick with the treatments the Odds Are excellent that they can be helped tuesday january 10, 1989 the stars and stripes Page 17