New Approach to OCD

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Mention OCD and you bring up strong feelings in any person or family member that suffers from it. Strange and frightening thoughts that intrude and don’t go away, meaningless gestures and actions that someone is compelled to perform, over and over, fully aware that these behaviors are at best silly and at their worst thieves of normal living. OCD causes estrangement among family members, even those who love each other dearly. It has ruined marriages. It has crippled lives. It has caused tremendous pain in untold families.

Its sufferers make comments ranging from “It’s really a bitch” to “I wouldn’t wish it on my worst enemy” to “It’s worse than cancer.”

Estimates of the incidence and prevalence of OCD keep changing as many of those who suffer it leave its secret closet and seek treatment. Estimates seem to vary between 2 and 4 percent of the population. There are different forms of OCD, involving checking, cleaning, symmetry, fears of contamination and catastrophes, vile and unbidden thoughts, and even strange thoughts about religion, a form of OCD called scrupulosity.

One of the first medications to offer hope was chlorimipramine (Anafranil). With just one more chlorine ion attached to the molecular structure of imipramine (Tofranil), this medicine had an anti-obsessive compulsive effect on many, but it had side effects ranging from heart problems to seizures and did not have FDA approval. Some sufferers, so desperate, went to Mexico or Canada to purchase this drug. When Prozac and other SSRIs were approved in the late 1980s and early 1990s, they became the first line of treatment, along with behavior therapy, for those with OCD.

Despite the effectiveness of these approaches, each helps only 50 to 70 percent of those with OCD. And it doesn’t “help” each person at the 80 or 90 percent level. Out of at least six-to-ten million sufferers in the United States, this means many receive minimal help or none at all.

For the past 20 years, the mantra for treatment and research into OCD has always been, behavior therapy and medicine, behavior therapy and medicine, behavior therapy and medicine, behavior therapy and medicine. Other approaches were discouraged. To some, the constant emphasis of only these two approaches seemed like just another variation of OCD itself, things done over and over and over again. Treatment of OCD became an ideology, not an empirical science with fresh hypotheses and a keen eye out for new ideas or serendipity.

Michael Jenike has written a beautiful book on how he went beyond the treatment mantra of “behavior therapy and medication” in his new book, featured in a recent story in the Boston Globe:

OCD book and story in Boston Globe

Dr. Jenike deserves high praise for having the courage to risk a new approach. He deserves our immeasurable gratitude for all he has done in the past for OCD sufferers in his role as a Harvard University psychiatrist, and for his countless contributions of free treatment to those who could not afford it, readiness to take questions from anyone, and his unstinting work with the Obsessive Compulsive Foundation. I think this new book may be his greatest masterpiece. Thank you, Dr. Jenike.

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