Getting Control of OCD

Jan. 29, 2003 -- Becky, a schoolteacher, is frightened of contamination from cleaning products.

Lee, a chiropractor, fears accidentally bumping into things, and can't walk past a mirror without turning back to look again.

Danielle, who is terrified of eating with plastic utensils, obsessively washes her hands.

Each has been diagnosed with obsessive compulsive disorder, or OCD, an illness that affects as many as 3.3 million adults and about 1 million children every year. It can ruin lives and even drive some people to thoughts of suicide.

It is also a disorder that is so embarrassing to sufferers that most never seek help. On average, people see three to four doctors and spend at least nine years seeking treatment before they get a correct diagnosis, and even then, it can take even more years to get the right treatment.

But Becky, Lee and Danielle — who all wanted their last names withheld — went to McLean Hospital in Belmont, Mass., where the OCD Institute is a last resort for people in the grip of compulsion.

"It's sort of the purest form of torture, because these are people that aren't crazy or insane, and yet they're unable to see that ... or unable to stop what they're doing," said Dr. Michael Jenike, who heads the institute. At the clinic, patients learn how to overcome their obsessions by confronting their fears head-on.

People Don’t Understand

It is unclear what causes OCD, but some speculate that it could be hereditary, while others say it may be the result of a chemical imbalance of serotonin, a neurotransmitter linked to mood and depression. But other brain chemicals are almost certainly involved, and stress can be a trigger for it as well.

Because of their odd behavior, people with obsessive compulsive disorder are misunderstood, and often miserable about their obsessions.

"I never had a normal childhood," said Danielle.

"I've been called, lazy, stupid, inconsiderate," Becky said. "Even people who know I have the disorder just don't understand."

"I used to scrub each and every finger," Danielle said.

Jenike started the OCD Institute six years ago. For patients, living at the institute means confronting their fears. Seven days a week, therapists push boundaries, immersing the patients in the things they fear the most.

Experts now believe that such "exposure therapy" may be the only way for some patients to overcome the disorder. Pushing anxiety to its limit while resisting the urge to give in to obsessive fears may control OCD.

Facing Fear of Germs

Juan, who has a fear of germs, faced his fear head on when his therapist had him put his hands on the outside of a garbage can. He followed that with an exercise that included lying down on the carpet.

"Think of all the garbage that's in there ... all the food ... who knows what else is in there?" the therapist said, as Juan practiced deep breathing. "What's on the floor?"

"Dirt, germs, everything," Juan said, with his hands spread out on the carpet.

"That's right. Put your hands on your face," the therapist said.

"This is hard," Juan said.

"Go ahead, you can do it," the therapist said. "Think of all the germs that are now on your face."

"That's gross," Juan said.

"I know it's gross," the therapist said. "Keep 'em there. Where's your anxiety level?"

"Nine," Juan said.

"OK. Keep 'em there," the therapist said.

Throughout their therapy, patients must rate their anxiety on a scale of one to 10. Often, in one sitting, that anxiety can go down dramatically.

"Their brain will, what do we call habituate, and get used to the anxiety," Jenike said. "And then they'll realize that they won't die, and nothing terrible will happen."

Losing Fear, Finding Hope

A therapist named Denise worked with Danielle on eating with a plastic fork.

"I can't," Danielle said.

"Yes you can, just try," the therapist urged.

"Oh God," Danielle said. "I don't feel like Danielle any more. I feel like OCD Danielle. This is hard."

Becky, who fears contamination from cleaning products, said that she hopes that she will be able to face her fears after she leaves the clinic to go home.

"What I do here is very important, but the most important part is when I go home," Becky said. "It's very scary."

Treating OCD

Eventually, everyone goes home from the OCD institute, where they learned how to live a life free of OCD and free of fear. While experts say it won't work for everyone, it does offer one thing many needed when they arrived here: hope

"I just feel so relieved to be a typical person for once," Danielle said.

In treating OCD, cognitive behavior therapy should be the first line of action, and it can be combined with anti-depression medications, which increase serotonin, ABCNEWS' Dr. Tim Johnson said. But a third of patients are resistant to the usual treatment, a mix of behavioral therapy and antidepressants, Johnson said.

Other treatments are also being researched. This fall, some French researchers completely cured some patients of the disorder, using electrical stimulation of the brain — a treatment that is also used for patients with Parkinson's disease.