Bruce Fountain - Licensed Marriage and Family Therapist  

Bruce A. Fountain
101 Redlands Blvd
Suite 200
Redlands, CA 92373
(909) 792-9797

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Obsessive-Compulsive Disorder is Based in Brain Disorder


Obsessive-Compulsive Disorder(OCD) as the name implies, involves excessive and irrational worrying combined with ritualistic behaviors that are intended to prevent a perceived danger. Someone who suffers from OCD knows that their worry and behavior is irrational but still engages in them. Many of us have experienced it in a mild form periodically. The difference is that it consumes a large amount of an affected person's time and interferes with their daily functioning and relationships.

Recently, I was walking into a local store and noticed that to enter I would have to pass two ladders that were leaning against the outside of the building. A direct path to the entrance would take me under the ladders. For a split second I contemplated continuing under them, but instead I walked around them. I gave into the superstitious belief that walking under ladders will bring bad luck. I rationalized my decision by telling myself that it would be unsafe to walk under them. The truth was that it was purely superstitious.

The entire experience took less than 30 seconds and I went on my way without too much of a second thought. Someone with OCD may structure their entire day around ritual behavior. It is not the type of superstitious belief system that most of us realize is unrealistic and somewhat entertaining. They are unable to move from thought to behavior quickly once the worrying begins.

I knew a young man who had to go up and down a staircase twice and sometimes three or four times if he didn't do it correctly, in order to prevent his mother from dying. One woman spent up to an hour in her car because the seat belt didn't fall across her chest in just the right way. She would buckle and unbuckle her belt until she got it right. She was sure that if she didn't she would get into an accident and be killed. Many of us have heard of people who compulsively check and recheck oven controls and locks. Others wash excessively to avoid contamination and some will not purchase property or use phone numbers that contain certain "bad luck" numbers.

OCD can be a debilitating condition and currently we have no cure. However, treatment can greatly reduce the negative impact it has on someone's life.

From work done with brain scans we can see that the origin of the condition is physiological. The caudate nucleus works like the automatic transmission for the thinking part of the brain. In coordination with the putamen which is the automatic transmission for the part of the brain that controls body movement, the caudate nucleus coordinates thoughts and movement during daily activities. With OCD, messages get stuck in the thinking part of the brain in a looping pattern. Thoughts like, "You'd better check the oven" may occur over and over even though you know you have already checked it. Some medications appear to act in an "anti-obsessive" manner and lubricate the thought process. This allows the brain's transmission system to shift from one thought to another and from task to task instead of getting stuck.

Cognitive-behavioral therapy aims to correct irrational behaviors and distorted perceptions. One strategy involves identifying the perceived danger, making a plan to address it and implementing that plan. If an individual is worried about having an automobile accident, the underlying fear might be leaving his or her children parentless. A rational plan might involve seeing a doctor regularly, maintaining a good diet and exercise plan, making a will and getting life insurance. After implementing the plan, obsessive worry and compulsive behavior is avoided.

Another strategy involves developing a list of the feared images or behaviors. Each one is dealt with in the therapy session through imagery or actual triggers and the magical compulsive behavior is avoided for as long as possible until the feared image is detoxified.

A combination of medication and therapy seems to be the best approach to treatment. People frequently spend a lot of time and money in therapy that is focused on early childhood conflicts and parent blaming. This is usually misguided because OCD is a brain condition. Treatment should be directive and present focused. It is helpful to investigate the anxiety that is being managed by the OCD, but almost always it is something in the present.

OCD affects approximately 1 to 3 percent of the population. It is not rare. Treatment has come a long way in the past 20 years and can be very effective in helping people break free from compulsive behavior. "Brain Lock", by Jeffrey Schwartz is an excellent book that describes and teaches a very effective intervention for obsessive-compulsive behavior.

Bruce A. Fountain, MS is a licensed marriage and family therapist. He has a practice in Redlands, CA and can be reached at (909) 792-9797 or via e-mail at © 2006-2010