What we don’t know about OCD

Eleanor Cummins in Vox:

At 13, Arnie got a paper route. The work troubled him, however — and not in the usual way a kid might worry about their first adult responsibility. He could never be sure the papers had actually been delivered. “After Arnie had finished a block, he had to go back to be sure that there was a paper on each and every doorstop,” Judith L. Rapoport wrote in The Boy Who Couldn’t Stop Washing, her 1989 bestseller about treating people with obsessive compulsive disorder, or OCD. “As soon as he had checked it, and turned to face the new work, the feeling came over him: ‘I had better make sure.’” Around and around he’d go, unable to break the cycle.

Arnie’s case was one of dozens of stories that Rapoport, a child psychiatrist, recounted in her book, one of the first accessible accounts of the disorder written from a doctor’s perspective. As Arnie grew older, his preoccupations began to morph. He never felt as though he could shower or dress “right.” His days were disrupted by violent thoughts about hurting his family members. In his 20s, he got a job in a shoe store but felt compelled, when sorting shoes by size and style, to never repeat any action six or 13 times. On some level, Arnie probably knew the papers had been delivered successfully, that he wasn’t going to kill his family, and that the storeroom was sufficiently ordered. But, on another level, Rapoport wrote, he just couldn’t be sure.

For most of the 20th century, OCD — defined by obsessive thoughts, compulsive rituals, or a combination of the two — was considered a rare and incurable illness. But starting in the 1980s, researchers like Rapoport began to find that the “doubting disease,” as some patients called it, was much more common and more responsive to treatment than previously imagined. Today, studies indicate about 2.3 percent of American adults have had or currently have OCD. For many, the disorder can severely affect quality of life: About half of those with OCD experience serious impairment as obsessions and compulsions take time away from work, relationships, and even more basic functions like dressing and eating.

More here.