Images of Obsession

Abstract

E very day, a young woman shakes her clothes for a half hour and washes herself for up to six hours, haunted by the thought that germs might infect her with a deadly disease. A man cannot prevent himself from driving back to check every place on the road where he has hit a bump, because thoughts that he has run someone over torment him at every turn. Another man stops cooking for fear he will poison his wife and refuses to use electrical appliances because he worries about causing a fire. These people illustrate some of the symptoms of obsessive-compulsive disorder, a strange brew of recurrent ideas and impulses that are often experienced as repugnant (obsessions) mixed with ritualistic, seemingly senseless behaviors aimed at preventing harm and warding off anxiety (compulsions). An estimated 2 percent of the adult population in the United States suffers from obsessive-compulsive disorder at some time in their lives, and one-third of them develop the disorder during childhood. French physician and psychologist Pierre Janet described obsessive-compulsive disorder, using the term psychasthenia, in a classic 1903 publication. Not long afterward, Sigmund Freud conceived of obsessions and compulsions in his patients as complex psychological defenses used to deal with unconscious sexual and aggressive conflicts. In contrast with this long history of clinical observation, little is known about what parts of the brain help to produce the disorder's bizarre thoughts and acts. But that is beginning to change. In the March ARCHIVES OF GENERAL PSYCHIATRY, scientists at the University of California at Los Angeles School of Medicine suggest that there is an imbalance in the energy-conversion rates of two structures in the frontal lobes of obsessivecompulsives. The two brain regions normally work together to help channel and control incoming sensations and perceptions. While this metabolic mismatch accompanies obsessive-compulsive symptoms, says psychiatrist and project director Lewis R. Baxter Jr., it is not necessarily a cause of the disorder.