
Dr. Dorothy Grice, professor of psychiatry at Mount Sinai, says, “OCD can be extremely disabling, especially when the compulsions become time-consuming and elaborate.”
THE SPECIALIST: Dr. Dorothy Grice
A professor of psychiatry at Mount Sinai, Dr. Dorothy Grice is a child psychiatrist who specializes in obsessive-compulsive disorder and tic disorders such as Tourette’s syndrome. Her program provides care to children, teens and adults who have OCD, tics or related disorders like compulsive hair pulling.
WHO’S AT RISK
According to the World Health Organization, obsessive-compulsive disorder, or OCD, is one of the 10 leading causes of disability in the developed world. “OCD is characterized by recurrent disturbing, distressing or intrusive thoughts called obsessions, or ritualized behaviors or mental acts, called compulsions,” says Grice. “Individuals with OCD usually try to actively dismiss or neutralize an obsession by performing a compulsion or avoiding situations that trigger these thoughts, but the compulsion is a short-term fix that ends up feeding the OCD cycle.”
More than 6 million Americans are living with OCD, many of them undiagnosed and untreated. “OCD is not a rare disorder — it affects more people than schizophrenia, panic disorder or bipolar disorder,” says Grice. “There’s a wide range of severity, but in the more severe cases, OCD can be extremely disabling, especially when the compulsions become time-consuming and elaborate — for instance when someone can’t get to work or school because they’re stuck washing their hands again and again, checking the locks and windows over and over, or performing actions until they feel just right or perfect.”
The underlying cause of OCD is not fully understood. “We know that the symptoms are rooted in the brain circuitry,” says Grice. “Serotonin is one of the brain’s chemical messengers that allow nerve cells to communicate, and we know that serotonin circuits are dysregulated in some of the individuals who have OCD.”
Research has shown that there is a genetic component to OCD, so people with a family history of OCD or tic disorders, such as Tourette’s, are at higher risk. “OCD and tic disorders often co-occur, so anyone who has one of these disorders has an elevated risk to develop the other,” says Grice. “Up to 30% of patients with OCD have a current or past history of tics, and up to 45% of patients with Tourette disorder also have OCD or OCD-related symptoms.” The best treatment will depend on correctly categorizing the symptom as a tic or a compulsion.
OCD affects people from all backgrounds, boys and girls and men and women. “The onset of OCD happens at two times during the lifespan — either during childhood or during the later teens and young adulthood,” says Grice. “OCD symptoms can come on gradually over time, but occasionally children experience an abrupt onset of OCD, which we think might be linked to an immunological response or infection.” More than half of all adults with OCD first developed symptoms as children.