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ADAA and Beyond OCD

Effective April 1, 2016, Beyond OCD joined forces with ADAA and transferred its resources to us. ADAA staff is working to incorporate the content of Beyond OCD and OCD Education Station websites. Until that is completed, please continue to visit Beyond OCD. 
Read more here.

About OCD

Children and adults with obsessive-compulsive disorder (OCD) suffer from unwanted and intrusive thoughts that they can’t seem to get out of their heads (obsessions), often compelling them to repeatedly perform ritualistic behaviors and routines (compulsions) to try and ease their anxiety.

Most people who have OCD are aware that their obsessions and compulsions are irrational, yet they feel powerless to stop them.

Some spend hours at a time performing complicated rituals involving hand-washing, counting, or checking to ward off persistent, unwelcome thoughts, feelings, or images. Learn more symptoms.

These can interfere with a person’s normal routine, schoolwork, job, family, or social activities. Several hours every day may be spent focusing on obsessive thoughts and performing seemingly senseless rituals. Trying to concentrate on daily activities may be difficult.

Left untreated, OCD can interfere with all aspects of life.

• Watch someone who lives with OCD and two recovering hoarders talk about their struggles. See what a psychologist says about the disorders.

Children suffer from OCD. Unlike adults, however, children with OCD may not realize that their obsessions and compulsions are excessive.

Request a free brochure and DVD.

Learn about related disorders: trichotillomania and Tourette Syndrome.

Use the Treat it, don’t repeat it. OCD mug. Purchase it through iGive.com, and ADAA will receive an 8 percent donation at no extra cost to you. Other items are available, too.

Dealing with Bipolar Disorder
If you have bipolar disorder, get treatment and stick with it. Here are some tips:

• Talk to your doctor about your treatment.
• Stay on your medication.
• Keep a routine for eating and sleeping.
• Get enough sleep.
• Learn to recognize your mood swings.
• Ask a friend or relative to help you stick with your treatment.
• Be patient. Improvement takes time.
• Chart your moods to help figure out what triggers episodes and how medications are working.

If you’re thinking about hurting yourself, call a doctor, 911 or go to the emergency room. You can also call a toll-free suicide hotline. The National Suicide Prevention Lifeline is 1-800-273-TALK (8255); the TTY number is 1-800-799-4TTY (4889). If you’re with someone in crisis, don’t leave them alone.

Most people feel happy and energized on some days and less so on others. But if these mood changes last for a week or more and are severe—making it hard for you to sleep, stay focused or go to work—it may be a sign of bipolar disorder. Not only can bipolar disorder damage relationships, affect your grades and make it hard to keep a job; it can also be dangerous.

People with bipolar disorder—also called manic-depressive illness—go through extreme changes in mood, energy and behavior. These “mood episodes” can continue for a week or 2, and sometimes longer, with symptoms lasting every day for most of the day.

Sometimes people with bipolar disorder become very sad and much less active. They have trouble concentrating, forget things and lose interest in fun activities. They may try to hurt or even kill themselves. This is called depression.

People with bipolar disorder also go through periods of feeling unusually happy. They become more energetic and active than usual. They become impulsive and take great risks. They might do things that make them lose their jobs, their spouse or all their money. This is called mania. “They don’t see the consequences of their behaviors,” explains Dr. Carlos A. Zarate of NIH’s National Institute of Mental Health (NIMH). “Or they do see it but they don’t care.”

Bipolar disorder is fairly common, but it’s difficult to tell exactly how widespread it is. “There are a variety of illnesses that are similar to bipolar disorder, but with less severe upswings,” says NIMH’s Dr. Francis J. McMahon. Researchers estimate that bipolar disorder affects nearly 6 million American adults in a given year.

Children and teens can also have bipolar disorder. NIMH’s Dr. Ellen Leibenluft, whose work focuses on children, explains that a recent upsurge in diagnoses has led to controversy about whether children with severe irritability, but without clear episodes of mania, are being misdiagnosed as having bipolar disorder. “There really isn’t debate about whether there is bipolar disorder in children,” Leibenluft says. “What’s debated is how common it is.” But the bottom line is that any child diagnosed with bipolar disorder needs help.

Researchers are gaining new insights into what goes awry in the brains of people with bipolar disorder. For example, people with the disorder seem to have different ways of perceiving emotions in others’ faces.

One area that seems to play a role in bipolar disorder is deep inside your brain: the amygdala. “The amygdala tells us what in our environment is emotionally important,” Leibenluft says. “It seems to be acting differently in bipolar disorder, in both adults and children. We see an increased activity in the amygdala in response to emotional triggers in the environment.”

Scientists have also been finding clues in genes. “We’ve known for at least 50 years that the majority of bipolar disorder is caused by genes,” McMahon says, “but those genes have been remarkably difficult to pin down.”

Scientists know that bipolar disorder is largely genetic because of twin studies. When an identical twin has bipolar disorder, their twin, who has the same inherited DNA, also has bipolar disorder 60-80% of the time. Non-identical twins, who share only about half their DNA, tend to share bipolar disorder only about 20% of the time. “That tells us that about two-thirds of the risk for bipolar disorder can be explained by genes,” McMahon says.

McMahon and his colleagues have been comparing the genomes of people with and without bipolar disorder, searching for genetic variations—small genetic differences—that appear more often in people with the disorder.

“We’ve found 3 or 4 genes that are consistently associated with bipolar disorder,” McMahon says. But the genes that researchers have found thus far collectively increase the risk of bipolar disorder by only about 10-20%. McMahon says that many other genes must be involved as well.

If scientists could identify the genetic changes that lead to bipolar disorder, they might eventually be able to design a more accurate test or better treatments for the disorder.

Research may also uncover ways to lower your risk for bipolar disorder. “Even in identical twins, who have identical genes,” McMahon says, “a third escape the illness for reasons we don’t understand. Life experiences or other non-genetic factors may be involved. But we have a poor understanding of what those might be.”

While there’s no cure for bipolar disorder, treatment can help prevent episodes and control their symptoms. Different types of medication can help. So can talk therapy.

If you think you or a family member has bipolar disorder, call your doctor to get assessed. “Getting help sooner rather than later is really important,” McMahon says. “You don’t have to go first to a psychiatrist. Your primary care doctor can get you started.”

If you’re diagnosed with bipolar disorder, Zarate says, learn as much as you can about it. “You as the patient can take responsibility for your own illness and should do everything in your power to stay well,” he says. He suggests mood charting—tracking what brings about episodes and how well the medications are working. Mood charts can help you and your doctor design a more effective treatment plan.

“It’s important to have a good support system of friends and family,” Zarate adds. They can help by learning to spot the signs of an episode and what to do when they see the warning signs.

Be patient. “People sometimes get frustrated,” Zarate says. “These kinds of medications don’t work overnight.” It can take several weeks to control your symptoms—and several months to really stabilize the disorder. So stick to your plan and keep in touch with your doctor.

Don’t be shy about getting help. With treatment, you can lead a successful life.

An at-home bipolar test, launched in February 2008 and sold over the Internet, is meant to be used with a doctor’s evaluation to make a correct diagnosis of bipolar disorder more quickly.

“Sales continue to be brisk,” says Kurt May, CEO and founder of Psynomics Inc., the San Diego-based company producing the $399 at-home test for bipolar disorder, the latest in an array of tests marketed to consumers who want to know their risk for various diseases.

But some mental health experts are skeptical about the test, saying that while its premise shows promise, more research about the genetic links to bipolar disorder is needed to back up the credibility of such tests.

On one point proponents and critics alike agree: The bipolar test doesn’t tell users if they do or don’t have the mental illness. Rather, it reveals whether their genetic makeup may put them at higher risk of having it — or getting it.

(Do you think such a test would be helpful in diagnosing bipolar disorder? Discuss it with others on WebMD’s Bipolar Disorders: Support Group board.)
The Bipolar Test: How It Works
The bipolar test, called Psynome, looks for two mutations in a gene, GRK3, associated with bipolar disorder. The test is based on the long-term work of John Kelsoe, MD, a board-certified psychiatrist and professor of psychiatry at the University of California San Diego, who is co-founder of the company and serves as executive vice president.

People who have either of the two gene mutations, are white, are of Northern European ancestry, and have a family history of bipolar disorder are three times more likely to have bipolar disorder themselves, according to the company web site. Research has not shown such an association for other ethnic groups, according to Psynomics.

“This test is different than others that are truly home tests,” says Martin Schalling, MD, PhD, a professor of medical genetics at the Karolinska Institutet in Stockholm, Sweden, and a member of the scientific advisory board for Psynomics. “The results go to the treating physician.”

Purchasers are mailed a “spit kit” and are instructed to deposit saliva into the kit’s resealable container, then mail the saliva sample back to Psynomics.

The Bipolar Test: How It Works continued…
A second genetic test is also available. It predicts a patient’s likely response to serotonin-based drugs, the most widely prescribed class of psychiatric drug therapy today, according to the Psynomic web site. It also costs $399. If both tests are ordered together, the cost is $750.

Tests are analyzed at a lab regulated by the state and by federal standards under the Clinical Laboratory Improvement Amendments of 1988.

The saliva is tested for GRK3 mutations linked to bipolar disorder. The results are sent to the patient’s doctor, who discusses them with the patient.

Home Bipolar Disorder Test: How Accurate?
Schalling says the bipolar test is very accurate in detecting the genetic variant. “This test can tell you almost 100% if you have the risk variant,” he says.
But it isn’t meant to be used in isolation. “The test is really no good on its own,” Schalling says. “The test must be used in combination with family history and the clinical picture.”

According to Psynomics, bipolar disorder is largely hereditary, with inherited factors perhaps explaining as much as 70% of the cases.

Although the results are accurate, a definite prediction of bipolar disorder remains elusive. “This is a test that works, but it does not provide a huge amount of power, a huge amount of certainty,” Schalling says. As more discoveries are made about other genes that are important in predicting bipolar disorder, that power is expected to increase.

Diagnosing Bipolar Disorder
Bipolar disorder, also known as manic depression, is marked by mood shifts, and these shifts can be subtle or dramatic, making it difficult to diagnose the disorder. Generally, it is lifelong, with recurring episodes of mania and depression that can last from days to months, according to the National Institute of Mental Health.

Symptoms of mania can include:

Increased activity or energy
Severe irritability
An overly good, very euphoric mood
Inability to concentrate
Lack of good judgment
Need for very little sleep
Inability to stay “on topic”
Lavish spending
Boost in sex drive
Drinking too much alcohol or abusing drugs or sleep medications
Aggressive or provocative behavior

Diagnosing Bipolar Disorder continued…
Depression, the other “pole,” can be marked by such symptoms as:

Feelings of pessimism, sadness, anxiety, or emptiness
Lack of interest in any activities that used to bring pleasure, including sex
Fatigue or diminished energy
Feelings of irritability or restlessness
Sleep problems — too much or too little
Weight gain or loss (without trying to) and unusual appetite changes
Suicidal thoughts or attempts
A diagnosis of mania or depression is made based on how many symptoms occur, how frequently, and for how long. Sometimes, the diagnosis is missed altogether; other times, it’s mislabeled as simply clinical depression.

Typically, a doctor takes a careful history, noting the symptoms, and asks about family history.

Estimates of how many people have bipolar disorder vary widely. The National Institute of Mental Health estimates about 5.7 million Americans over age 18 are affected.
The Bipolar Test: Second Opinions
Mental health experts consulted about the new bipolar disorder tests say the science is not yet there.

“Based on everything we know, this science [behind the bipolar test] is not ready for prime time,” says Tom Insel, MD, director of the National Institute of Mental Health. He doesn’t rule out the possibility that within a few years and with more discoveries about the genetic roots of mental illness, some ”practical information of value” might be gotten from these types of tests.

Of the genetic links, Insel says: “What has been found is an association with a common [genetic] variant that increases your risk of the illness. It confers a very slight increase in risk. But that is a long way from being able to use that single genetic association to make any practical clinical decision.”

“They simply haven’t proven an association,” says Douglas F. Levinson, MD, the Walter E. Nichols, MD, Professor of Psychiatry at Stanford University School of Medicine. “These tests are based on data which are not considered statistically significant in the field of genetics as a whole,” he says, adding that a person’s best resource for diagnosing bipolar disorder is still a mental health professional.

Medical ethicist Arthur Caplan, PhD, agrees that the science isn’t there yet. “I think we have companies rushing to take advantage of hype that genomics is ready to go and predict a wide variety of diseases,” says Caplan, the Emanuel and Robert Hart Professor of Bioethics at the University of Pennsylvania, Philadelphia. “It’s coming, but [it’s] not there yet.”

The Bipolar Test: Second Opinions continued…
A more powerful predictor would be to ask a doctor to look at your family history in more detail, says Ken Duckworth, MD, medical director of the National Alliance on Mental Illness and assistant professor at Harvard Medical School. “I would pay that $399 for the best mood disorders consultant in your city. Ask me in five years and perhaps I would have a different take on this.

“We don’t actually know enough about the brain to consider genetic testing to be definitive at this point for any mental illness,” he says.

The test could have potential harm, says Clarence H. Braddock III, MD, MPH, associate professor of medicine and director of clinical ethics for the Stanford Center for Biomedical Ethics. For instance, a doctor might erroneously diagnose someone as bipolar based on the genetic test results. “There are a lot of consequences [associated with an incorrect diagnosis],” he says, such as medication costs and side effects and the social stigma associated with mental illness.

In a general statement addressing all at-home genetic tests, the Federal Trade Commission notes that “a healthy dose of skepticism may be the best prescription.”
A Patient’s Perspective
The home test wasn’t available when Ross Szabo, now 29, was diagnosed with bipolar disorder at age 16. He probably wouldn’t have taken advantage of the test, he tells WebMD, because his diagnosis, based on symptoms, was “pretty clear.”

Whether consumers use the test or not, says Szabo, who works as director of youth outreach for the National Mental Health Awareness Campaign, “you can’t look at the diagnosis as the end of the problem. It’s really only the beginning. Finding the right diagnosis is important. Accepting that diagnosis is more important.”