Until recently, OCD was considered a rare ailment. Findings from a large survey suggest that 2 to 3 percent of the population (roughly five million Americans) may suffer from OCD at some point during their lifetimes. One reason OCD may have remained hidden for so long is that patients are often secretive about their obsessive-compulsive symptoms out of concern that they will be perceived as “crazy.” In fact, many of these people become masters at camouflaging their symptoms by either performing them in private, by avoiding situations likely to trigger them or, in the case of compulsions that must be performed in public, by inconspicuously integrating them with ordinary activities.
For example, for more than 21 years an OCD sufferer successfully concealed from her husband that she had to repeat most activities in multiples of three, ranging from lighting a cigarette to flushing a toilet. Greater professional and public awareness of OCD via emergence of patient advocacy groups such as the Obsessive-Compulsive Foundation of Milford, Conn., coupled with a more optimistic treatment outlook, may explain why more cases of OCD are now being brought to clinical attention.
Who is affected and when does it start?
The onset of OCD usually occurs in adolescence or early adulthood. Nearly one-half of all cases begin in childhood, and it is rare to see onset after age 35. In adults with OCD, men and women are almost equally affected. This contrasts with both depression and panic disorder, two disorders with a clear preponderance of women. In cases of childhood OCD, boys outnumber girls and the age of onset is earlier. Studies from the National Institute of Mental Health suggest that very early onset (before age seven) of OCD in boys may be related to Tourette’s Syndrome, a disorder involving multiple sudden, involuntary movements called tics.
OCD strikes people from all walks of life and all levels of education. Factors that predispose individuals to the development of OCD have not been identified. Strict religious training is thought to shape the content of one’s obsessions (i.e., increased concerns with scruples and sacrilege), but has not been shown to increase the likelihood of developing OCD.
Few modifications are needed for making the diagnosis of OCD in children. The clinical presentation in children and in adults is remarkably similar. While most children recognize that the symptoms are unwanted, it may be more difficult to evaluate insight in younger children with OCD. Not all rituals in childhood should be considered pathological. A need for sameness and consistency may promote a sense of security at times of transition. For example, many normal children engage in bedtime rituals such as arranging their bedding in a particular way, ensuring that their toes are covered or checking for “monsters” under the bed. Childhood rituals should be suspected as signs of OCD when they become maladaptive (i.e., time-consuming or distressing) and persistent.
How does OCD affect society?
According to a recent study by the World Health Organization, mental disorders account for four of the 10 leading causes of disability in established market economies worldwide. These disorders are major depression, manic-depressive illness, schizophrenia and obsessive-compulsive disorder. While many patients lead apparently normal lives despite OCD, it often takes a toll on the individual and on the family. In many cases, OCD significantly encroaches upon ability to function productively in social, family, work and school settings. The financial cost of OCD to the U.S. economy is estimated in excess of $8 billion per year.