Dr. Jenike Joins 48 Hours Chat

Explains Treatment Options For Obsessive-Compulsive Disorder

This week's edition of 48 Hours provided unique insight into the world of obsessive-compulsive disorders. Exposure therapy, according to Dr. Michael Jenike, who started the first in-patient OCD facility outside Boston, Mass., works best for the most severe cases.

At his clinic, participants face their fears head on to get a handle on the disorder. While there is no cure for OCD, and no consensus from the medical community about what causes it, the small victories that some patients have accomplished keep hope alive for others.

Tonight Dr. Jenike joins us to share his insights from dealing with all sorts of patients at his pioneering, groundbreaking clinic in Massachusetts. Please welcome Dr. Jenike.

Dr. Jenike: Thank you. It is good to be here.

spongebob: Can you describe the nature of OCD and its main effects and behaviors?

Dr. Jenike: The symptoms of OCD can be varied. Some of the common symptoms include excessive washing or checking. Some patients repeat behaviors over and over. Many patients do rituals to prevent anxiety while others just do rituals to obtain a feeling of completeness.

NYCMike: How can you tell obsessive compulsive disorder from someone suffering from ordinary stress and worry?

Dr. Jenike: OCD can sometimes get worse under times of stress. But if someone does not have OCD, the symptoms will not develop just because of stress. To make the diagnosis, the doctor will look for positive signs of the illness such as the presence of obsessive thoughts or compulsive rituals.

CBS Host: Tonight, we saw a lot of the more extreme cases of the disease. Can you describe some of the more "common" cases of OCD for the chat viewers?

Dr. Jenike: I would like to emphasize that the 48 Hours program illustrated some of the more extreme forms of OCD. Most patients with OCD are not this sick and do very well with outpatient treatment that generally consists of behavior therapy and specific medications.

GloriaG: What's the most difficult case you have dealt with?

Dr. Jenike: I think David and Ed who were discussed on the program tonight are probably two of the toughest cases I have seen. As I focus more on the severe patients, I tend to see more severe patients like them.

ljtg: Can you talk about obsessions vs. compulsions? Also is there different treatment for persons who have checking/contimation fears vs. intrusive thoughts?

Dr. Jenike: Yes, the treatments need to be tailored to a patient's specific symptoms. The treatment for washing and checking and other rituals involves behavior therapy techniques that are called exposure and response prevention. The treatment of obsessive thoughts is more difficult. But as we learn more and more, we realize that there are behavioral techniques that help these also.

In addition, medications can be a major help for intrusive osessive thoughts and can also help checking and washing. I feel that the behavior therapy approach is actually the most helpful one for OCD. In my opinion, medications are secondary treatments; especially for the sicker patients.

patty: I have suffered from extreme OCD for three years now. I am currently taking medication. Is behavior therapy necessary? The thought of it terrifies me.

Dr. Jenike: Yes, behavior therapy is crucial. A good behavior therapist will respect your terror and move you very gradually through you fears. It is exceedingly common to be afraid of doing behavior therapy. To do it, you must really trust your behavior therapist.

CBSHost: Dr. Jenike, can you tell us a little bit about the different medications for OCD, and how these different medications affect the patients?

Dr. Jenike: To get a lot of information on medications for OCD, go to the OC Foundation's web site at www.ocfoundation.org. There are many links to other sites as well.

The medications that help OCD are called SRIs or serotonin reuptake inhibitors. There are about six drugs that have been used successfully to partially treat OCD. These include Luvox, Celexa, Prozac, Anafranil, Paxil and Effexor.

Dr. Jenike: It often takes up to three months for the drugs to have a full anti-obsessional effect. These drugs are all anti-depressants as well, and depression often goes along with OCD.

When they work, they can dramatically lessen obsessive thoughts or the need to do rituals. They often help anxiety as well. In patients who do not improve with one of these drugs, we try the others.

In some patients we combine these medications with other ones to try and lessen the OCD. Again, it is very important to be getting competent behavior therapy while taking medication.

JenniferH: Do the medications recommended for treatment pose any risk?

Dr. Jenike: The anti-obsessional medications listed above are very safe. That is not to say they do not have side effects; they all do. When these medications are stopped, the side effects go away.

There are medications called neuroleptics that are sometimes added to the SSRIs that can produce neurological problems.

Doop: I am a 31-year-old female (who) has been suffering with OCD since I was 3. I have been on Luvox for two years now, and I would like to know if I can continue with Luvox during pregnancy?

Dr. Jenike: There is now a lot of data on using the SRI medications during pregnancy, and they all seem safe. However, if it were me, I would try to get off the medications during pregnancy.

Not everything is known about these drugs effects on a fetus. I only recommend these drugs during pregnancy if the patient has very severe OCD, and it cannot be controlled by behavior therapy during pregnancy.

There is a chapter in an OCD textbook that m colleagues and I have written (Incompulsively) that reviews the use of medications in pregnancy.

I can email it to you. If you want it, contact me at jenike@mediaone.net.

Also send large amounts of money because I need a new car.

Moderator: Please continue to send in your questions. We will try to get to as many as possible, but we have so many good questions, we may not be able to get to yours.

GoMets: Is OCD an inherited condition?

Dr. Jenike: Dr. David Pauls at Yale has done a lot of work in this area.

It seems that maybe a quarter of OCD patients have OCD in the family so we can probably say that it may be inherited in some people. For most people, we do not know how or why they get it. Again, I can email a chapter on this to interested people.

jane: Does all OCD begin in childhood or present in childhood?

OCPreschooler: Hello, Dr. Jenike. We have a 3.5-year-old daughter who has been diagnosed with OCD. How would you proceed with treatment?

redskins: What treatment is available for children??

Dr. Jenike: The average age on onset of OCD is around age 18 to 22. The earliest age of onset I have seen is about age 2. In young children with OCD, behavior therapy can be done.

Unfortunately, it is exceedingly difficult to find behavior therapists who work with young children, but the results are often great. Medications are used in children and often help a lot. The same medications used in adults are used in lower dosages (than) in kids.

Dr. Jenike: These drugs have been studied in children. I should mention that if a young child develops OCD suddenly after a strep infection that special treatment is needed. It appears that antibodies against strep can not only attack the strep bacteria but also can attack part of the brain (in) susceptible children.

The treatment for this would be high doses (of) antibiotics along with behavior therapy.

Dr. Jenike: If someone has a young child with OCD and is having a hard time finding someone to help, contact the OC Foundation or our center, and we will try to help find someone near you.

doubie: Dr. Jenike, I'm 14 years please, and I have OCD, and I don't know what to do?

Dr. Jenike: Email me and I will send you information. This information is also available for the most part at the OC Foundation Web site I mentioned earlier.

Read Getting Control (2000 edition) by Dr. Lee Baer for information and advice that will help you. You need to see an OCD expert as soon as possible. I think that it is best to get competent treatment for OCD as early as you can.

Dodger4: What do you recommend for the loved ones coping with living with someone with OCD?

brotherofocder: Is there any risk of pushing someone too much who has OCD? I don't want my bro to hurt himself.

Dr. Jenike: Dr. Heb Gravitz has a good book for family members of OCD patients. I am old and cannot remember the name. Maybe I need to be a little more compulsive. How hard to push someone is always an issue. I recommend that you not make any major changes in how you are handling a loved one until you get consultation.

The behavior therapist will work with the family and come up with a plan that should guide family involvement and intervention.

Rose: LOL

sugar: I love a sense of humor. Laughing is my only salvation!!!

Madison: Ah, how I wish I could speak with him....Please tell him I love his humor, a doctor with a sense of humor!

Dexter: Is OCD a relatively new diagnosis? If it's so new, what did people afflicted with OCD do before the acceptance of the diagnosis? OCD is not really a new diagnosis. Shakespeare knew about it with Lady Macbeth. Those damn spots are everywhere.

Still toady, probably most people in the world who have OCD don't know what is wrong.
They just suffer in silence and think they are crazy.

Loved ones may shun them or worse, they may be accused of being possessed by devils or psychiatrists. I get many emails from around the world.

In many countries, you are not considered human or worthy of helping if you have a mental illness, including OCD. It is so incredibly sad. I think we don't realize how lucky we are in this country. I have had requests for me to list my email address again. I just hope this is not an OCD thing.

I will only list it 14.233 times tonight. Here it is: jenike@mediaone

Moderator: Thanks for sending that again! A followup to the remark about devils and psychiatrists.

Spath: Can traditional psychotherapy aggravate rather than help the situation?

Dr. Jenike: Yes, traditional psychotherapy can be a disaster.

If the therapists does not realize what OCD is, they can interpret every symptom. For example, if a loving mother has harmful obsessional thoughts towards her child. I have seen therapists tell family members to have the mother move out of the house because she has underlying unconscious murderous tendencies and may kill the baby.

This sounds like I am not serious, but this happens often.

I started out 25 years ago, trying to make sense of OCD symptoms and to do therapy with them. This did not work. Trying to use logic around an OCD symptoms is a hopeless tunnel. People with OCD are the first to admit that they are not logical when it comes to their symptoms.

NancyEEE: Can a person return to work and normal life with OCD?

Concernedmom: Does OCD ever just go away?

timmyisnice: Can someone be cured of OCD?

Dr. Jenike: The vast majority of outpatients with OCD that I see work and have good relationships.

Rarely is it some debilitating that someone could not work. The natural history of OCD symptoms is hat it fluctuates. With treatment, there are still likely to be some symptoms, and the patient will need to use some energy to control symptoms, but they can lead normal lives.

Even though we don't know exactly what causes it, we are really quite advanced in terms of treating most patients. For patients who are not currently getting better, we and others are doing a lot of research.

tallskinnyblackguy: Can OCD be fatal?

Dr. Jenike: OCD itself is not a fatal illness, but obviously resulting depression can lead to suicide. There is a new book out about Howard Hughes, and one could argue that OCD led to a series of events that cost him his life.

machinery: Is OCD at all allied to other disorders - anorexia, for example?

catb: Can you explain Trichotillomania and its relation to OCD?

BABYBEANS: How common is it to have both OCD and biolar disorder?

Dr. Jenike: Having OCD does not exclude anyone from having another disorder.

KwZz15: I have OCD and I, too, at one point cut like David (and burned) my arm....Why is it that OCD sufferers turn to mutilation?

Dr. Jenike: Many OCD patients just have OCD. About two-thirds of OCD patients develop a major depression sometime during the course of of their life.

When patients come to see me initially, about one-third are also depressed. OCD and bipolar disorder overlap occasionally. Trichotillomania is not technically classified at OCD, but there are clearly similarities.

For example, the same medications are used for trich. A behavioral techniques called habit reversal is sometimes helpful for trich. It is very uncommon for people with OCD to cut or burn themselves. Hurting oneself serves many purposes. Many people say that it allows the person to substitute physical pain for the more intolerable mental pain.

There are some good books on cutting and self harm. One is The Bright Red Scream.

Concerning trichotillomania, there is a good organization called the Trichotillomania Learning Center. People can again email me for address, and there is also a link on the OC Foundation Web site.

CBS Host: Dr. Jenike, how did you get interested in OCD, and why did you choose OCD as a specialty?

Dr. Jenike: Because I am a very sick individual! In the early days of my life, I mainly did geriatrics. I saw a few OCD patients and got interested.

I agreed to go with a patient on Larry King Live and then got literally hundreds of calls. I then did not have time for anything else.

I realized that almost nothing was known and that so many people were suffering and that as a profession, we were not helpful. I liked the patients. I went to medical school because I had seen a lot of suffering in the world and thought I could help cut it down.

So here was a disorder that had really nice and normal people just doing plain torturous suffering. So I was hooked. I tolyou I was ill!

twinb: Hello. How severe do you have to have OCD to come to your clinic?

Dr. Jenike: There is really no set level of severity. We take some highly motivated patients who want to really get better quickly. They are often in and out fairly quickly.

We try to limit the length of stay to three months for more severe patients. We do our best to make sure people have good followup care, which is crucial.

Eric: Dr. Jenike, how is David (a subject of the 48 Hours segment) doing now?

Dr. Jenike: The 48 Hour show is really up to date.

David comes out a lot and goes places. His wonderful mother, Jackie, emailed me a couple of days ago that she is optimistic. I really hope we can get him to the OCD Institute, and I think David wants to come. I am sure he thinks my jokes are bad and is a little afraid of having to listen to me too long. I remain very optimistic!

Moderator: Dr. Jenike, thank you for this excellent and informative (even at times, funny!) chat. Would you like to make any final comments? And would you remind people once again how to get in touch with you and find more information about OCD and its treatment.

Dr. Jenike: Thank you; it has been fun being here. I should say that I have been completely serious at all times. To reach me, email is best.

For more information, go to www.ocfoundation.org.

I know how you suffer, both patients and family members, and as we start this new year,
I wish you all the best and hope the year brings you relief and joy.

These guys checking my stuff are really compulsive. They said I misspelled my email address....Thanks for checkers! Here is correct version that has been checked four times: jenike@mediaone.net

Moderator: Thank you all for your excellent questions! I'm sorry we couldn't get to all of them....We had so many excellent ones!...Thanks again and goodnight!

wagvola: Thanks, Doc, and keep up the good work. You've given me (a caregiving dad) a ray of hope in what has been a real rough road for my family.

staceyh: Thank you.

kate: Thank you and you're welcome, too.

MzPeanut: Thanks for your insight, Dr. Jenike.

jane: Thanks, Dr. Jenike. You're great!

luckyroxie: Thank you, thank you, thank you!

Annette: Thank you, Dr. Jenike.

luckyroxie: Thank you, Dr. Jenike, and thank you, CBS!

absolutxin: Thank you.

jorge: Thanks.

lilia: Good luck, everyone.

Ryan: Thank you.

Debrah81: Thank you.

Concernedmom: Thank you! Good night.

seedee: Good night!

Crazyandlovinit: Thanky, thanky.

tallskinnyblackguy: Thanks.

trial: Thanks for your time!

rolie: Thank you, Dr. enike!

Foofy: Thank you for your humorous, caring help!

redskins: This was very hopeful. Keep up the great work.

staceyh: You really are great. This has been a great experience.

Ochead: Peace of mind to all, and thank you, Dr!!!!!!!

LindaMay: Thanks for your guidance & hope.

KimW: Thanks, Dr. Jenike, for your time, and the story was (an) incentive for those of us who have OCD.

Brushes: Thank you....It was very informative.

lilly: Thanks so much!!!

wendy: Thank you, Dr. Jenike.

d887: Thanks for taking time with us.

JeremyRKS: Good job, Doc and CBS.

smeil56: Thanks, Dr. Jenike.

helad: Helad says thank you, and we appreciate talking as we live with it in our son every day!

nuklhed: Thanx for the show, CBS.

jm555: God bless you tonight and every night.

Bird: Thank you and good luck in the coming year.

perfect: Thank you and God be with you on your road to a new life for us OCD sufferers. We need more docs out there like you!!

Katiestwin: Thank you, Dr. Jenike. You're really a great doctor and a great person. : )

mmmm: Thanks

luckyroxie: Best wishes to you fellow OCD'ers out there! : -)

Shopgirl: You sound like a great doctor!

Loudflower: Thank you, Dr. Jenike, for your extreme success in treating sufferers~

violet: Thank you, and, David, I hope you see the help you inspired !!!

tallskinnyblackguy: CBS is really great for putting this on.

tucksys: Thanks for your advice and resources.

Magdalena: Thanks for your help, Dr. Jenike. God bless you!!

tori: Thanks for the info and laughs, Doc!

mkab: Thanks, this may be the start that we need.

staceyh: Dr. Jenike, thank you for reminding me how much I love psych and helping people.

smeil56: I thought the show was an excellent issue to be addressed.

jonny: Answered a lot of questions. CBS, thank you

Moderator: Thanks again to all of you who logged in tonight....Goodnight!