Recently, some patients have been asking questions about whether OCD is a disease that can be “cured,” and I am reproducing Dr. Wang Zhen’s discussion of this point of view. I hope that this article will be of some help to patients who are confused about the question of whether OCD is curable. In clinical practice, we often hear the view that “OCD cannot be cured” and “OCD has to be treated for the rest of one’s life”, and even many doctors have argued that
“Many physicians are even reluctant to treat OCD because they feel that it is unlikely to be completely cured, and that treating OCD brings a strong sense of frustration to the physician. “This disease cannot be cured”. All of this has led to the widespread expression “OCD is a ‘mental cancer'” on the Internet. Is this really true? OCD is indeed an incurable psychological disorder and is considered one of the top ten most disabling diseases in the world, causing huge economic losses and mental suffering to patients and families. Without any treatment, OCD usually has a chronic course, with symptoms that come and go, with only about 5-10% of patients resolving on their own, while another 5-10% have symptoms that continue to worsen, and a small number of children and adolescents exhibit episodic courses. Although the pathogenesis of OCD has not been fully elucidated to date, available treatments have been able to alleviate the symptoms of OCD to a large extent. Commonly used treatments include medication, psychotherapy, or a combination of both, and a small but immature number of researchers have also attempted treatments such as transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS). Data reported by clinical studies in various countries show that the overall effectiveness of treatment for OCD is about 40-60%, in other words about half of the patients lack efficacy. It should be noted, however, that most of these data come from randomized, double-blind controlled studies that use “standardized” treatment protocols to treat “standard” patients, which are often monolithic and do not individualize the protocols according to the patient’s symptom profile. These treatment regimens are often single-issue and are not individualized and adjusted according to the patient’s symptom profile, and therefore may differ significantly from the true treatment efficiency. To date, I have not seen similar studies of STAR*D for OCD, but a small number of open observational studies that are closer to the real clinical setting have shown that the actual cumulative treatment effectiveness of OCD exceeds 80% when appropriate treatment regimens are selected according to treatment guidelines and combined with the patient’s clinical symptom profile, and when treatment regimens are adjusted or changed in a timely manner according to the patient’s response to treatment. The actual cumulative treatment efficiency of OCD was over 80%. However, most of these open studies also did not include patients’ preferences for treatment methods, e.g., some patients wanted psychotherapy but actually received only medication. Our investigation showed that the consistency between treatment preferences and actual treatment regimens for patients with OCD has a very strong impact on outcome. Therefore, there is room for further improvement in the treatment efficiency of OCD if the selection and development of treatment plans are based on individualized factors of OCD patients, including treatment preferences. In this sense, OCD is a treatable disorder that is far from being a “mental cancer. If this is the case, what are the reasons why OCD is “difficult to treat” in clinical practice? The author believes that, in addition to the disease characteristics of OCD itself and the limitations of existing treatments, there are at least the following reasons: 1. The general public has very limited knowledge of this disorder. Many people know that they or a friend or relative has a “cleanliness problem,” or that someone can’t help but “double-check the locks” when they leave the house, or that a co-worker has repeatedly gone to the hospital to check for HIV infection because of “Islamophobia. Or, you may find that your friends always ask a meaningless question over and over again; however, most people never think of it as a mental illness, but often consider it as a personality or habit problem. 2. Low consultation rate of OCD: Many patients do not seek help from professional institutions in time after they learn that they may suffer from OCD. Some of them are reluctant to accept the fact that they suffer from OCD, thinking that they will be fine as long as they make an effort; some want to go to the clinic, but are worried about being considered “mentally ill”, that is, “sickness stigma “Some people are prevented by their families from seeing a doctor because they think that “obsessive-compulsive” is a sign of weak willpower and there is no need to see a doctor. 3, OCD recognition rate is low: Although OCD is a common psychiatric disorder, compared to the popularity of knowledge of schizophrenia and other serious psychiatric disorders, even psychiatrists, the recognition rate of the disease is also worrying. Psychiatrists generally do not misdiagnose typical OCD manifestations, such as repeated washing and repeated examinations, but the manifestations of OCD are complex and variable, and many patients will not be as typical as described in textbooks, plus the complaints at the initial consultation are not necessarily obsessive-compulsive symptoms, but may be emotional symptoms such as anxiety or fear, or bizarre behaviors described by family members, and many patients or family members even use a bit of incorrect medical Many patients or family members may mislead the physician with the wrong medical “terminology”, thus failing to correctly identify OCD. Considering the reality that many patients do not visit a psychiatrist for the first time, it is easy to understand the low recognition rate of OCD. 4. Inadequate availability of OCD treatment: The severe shortage of psychiatrists and qualified psychotherapists in China has led to a large number of OCD patients having difficulty obtaining professional help even when they have a clear diagnosis and are eager to get treatment. While it is easy for OCD patients to find the right doctor at the right hospital in large cities such as Shanghai and Beijing, the road to medical treatment can be extremely difficult for many patients in small and medium-sized cities or rural areas. This lack of treatment resources has led to the emergence of various false propaganda on the Internet, with “three-month cure for OCD” and other seductive advertising words, so that patients who are anxious to seek treatment are deeply affected by the waste of money, not to mention the damage caused to patients by the delay in treatment is huge. As a direct result of the four aforementioned points, the time between the onset of symptoms and effective treatment for OCD patients is greatly extended, and studies have shown that the longer this time is, the worse the prognosis for patients. Treatment is not standardized: The treatment of any disease cannot be achieved without a standardized treatment plan, and the current treatment of OCD in China is still not standardized. On the one hand, this irregularity is related to the clinicians’ unfamiliarity with OCD treatment, such as: inappropriate selection of drugs, or treatment drugs stay at low doses (OCD treatment usually requires high doses of drugs); on the other hand, many patients are unwilling to cooperate with the continuation of longer maintenance treatment after the symptoms are relieved or alleviated, leading to premature discontinuation of drugs or termination of psychotherapy, resulting in relapse of the disease (studies On the other hand, many patients are reluctant to continue maintenance treatment for a longer period of time, resulting in early discontinuation or discontinuation of psychotherapy, resulting in relapse (studies have shown that the relapse rate of OCD decreases significantly with longer maintenance treatment). In summary, OCD is not a “mental cancer”, it is a treatable psychological disorder, and early diagnosis and treatment will greatly improve the symptoms and quality of life of patients.