There are many disorders diagnosed in emergency departments every day. However, there are many more that are generally too subtle and long term in nature to lend themselves to emergency evaluation, until they come to a crisis level.

Such was the case for a young lady I saw recently with a list of confusing complaints, including low abdominal pain and a numb upper lip. She had been evaluated for some of these complaints intermittently for a long time, but was not satisfied with the result.

With a general medical work up, I was able to allay most of her concerns. However, the thing I wanted most to do was to give her a diagnosis or two consistent with her complaints. That would allow her the opportunity to deal with the complaints in a consistent and effective manner.

In her case, the tests indicated an ovarian cyst had leaked the fluid from inside it, causing her abdominal pain. On the other hand, the numb lip was consistent with hyperventilation, proven by another test.

In discussing hyperventilation and her underlying anxiety, the patient provided another related diagnosis. She began to talk about Obsessive-Compulsive Disorder (OCD) and her need to recheck her purse repeatedly. Her husband also noted that she often asked the same question repeatedly in spite of getting the same answer repeatedly. They had many other examples consistent with OCD.

OCD is one of a group of anxiety disorders, which also includes panic disorder, post-traumatic stress disorder (PTSD), social phobia (or social anxiety disorder), specific phobias (like fear of heights), and generalized anxiety disorder. Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread.

People with OCD have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Some of the time, the rituals end up controlling them as you have seen if you have ever watched the TV series, "Monk," which depicts a brilliant detective with OCD.

If people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror, possibly to the point they get "caught" in the mirror and can't move away from it.

Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.

Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.

OCD affects about 2.2 million American adults and as many as one million children. It can be accompanied by eating disorders, other anxiety disorders, or depression. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families.

Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.

OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them. There is also research into new treatment approaches for people who do not respond well to the usual therapies. These approaches include combination treatments, as well as modern techniques such as deep brain stimulation.

As for my patient in the ER, I hope I helped her by prescribing a medicine for her anxiety disorder as the initial step toward a long-term treatment of her OCD. At the very least, I was able to give her some insight into how OCD, which she already suspected, related to the complaints that brought her to the ER.

Source: FW Daily News