Mental or Physical Illness?

Today, OCD is understood as a physical illness (although some experts in the field say that it also has a psychological component). However, it is still often described as a mental illness — a holdover, perhaps, from times past, when there was no way for doctors to “see” OCD.

If you look on any mental health organization's Web site — for instance, the sites of the National Alliance for the Mentally Ill (NAMI), the National Institute of Mental Health (NIMH), and others — you will see OCD listed and discussed there. (Of course, taken logically, many illnesses currently understood as mental, including such “dramatic” ones as schizophrenia and bipolar disorder, are also believed to originate in the brain and have little, if anything, to do with their victims' upbringing and experiences.) Perhaps someday very soon, nearly all of the conditions we now understand as mental illnesses will be reclassified as physical ones.

Physical illness generally can be observed. A broken bone, for instance, will of course be obvious once an X-ray is taken. Not so a “broken heart.” Or OCD…until recently. However, in the late 1990s, Dr. Susan Swedo, Dr. Judith Rapoport, and others at the NIMH were finally able to see evidence of OCD in children who developed symptoms after having had rheumatic fever (which results from an acute complication of untreated “strep throat”).

Is brain surgery an option for OCD patients?

Some researchers have experimented with implanting “a pacemaker for the brain” (actually a surgically implanted chip) to reduce symptoms in people whose OCD has not responded to more conventional treatments. The device has also been used to treat patients who have Parkinson's disease, and may be used for other conditions, as well.

These children may develop a disease called Sydenham's chorea, an illness marked by strange movements, such as tics, as well as obsessions, compulsions, and other unusual behaviors. It is estimated that about 70 percent of Sydenham's chorea patients have OCD symptoms. A diagnostic category was created to identify such children; it is known by the acronym PANDAS, for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.

The researchers discovered a protein in the blood of these patients that was missing from other patients. They compared those samples with blood samples from children whose OCD or Tourette's syndrome had worsened or become apparent after strep infections and discovered that a high percentage of the children with OCD and Tourette's also had this protein in their blood. Other illnesses may also cause OCD to develop or worsen.

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