A dedicated obsessive-compulsive disorder clinic at Sunnybrook Health Sciences Centre is the first of its kind in Canada, offering compassionate care and giving sufferers "greater hope" through cutting-edge research
Dan's symptoms were classic: he was constantly washing and cleaning his hands, credit cards, jewellery and other personal effects. He would spend 20 minutes writing a simple e-mail. Such was his obsession with perfection.
"At the time, I didn't realize it was a problem," he recalls. "No one really knew, and it wasn't affecting my career or family life for a long time."
But things escalated and his wife began to notice; Dan (not his real name) was getting less and less sleep, and he felt burned out.
After refusing to let his young daughter embrace him – in case she dirtied his suit – the busy finance executive finally realized he had a serious problem. "That was the final straw," says Dan. "My daughter was crying because I wouldn't let her hug me when I came in from work."
Dan eventually got a referral to Dr. Peggy Richter at Sunnybrook Health Sciences Centre, who treated him for obsessive-compulsive disorder (OCD). That was four years ago, and he's been getting better ever since.
‘Referrals have tripled since we launched…. We are working to expand our capacity.’
Dr. Peggy Richter,
Dr. Richter heads up the Frederick W. Thompson Anxiety Disorders Centre, a clinic dedicated to anxiety disorders with a special focus on OCD and related disorders.
The anxiety disorders centre is part of Sunnybrook's Hurvitz Brain Sciences Program, which is taking an unprecedented approach to collaboration, linking experts in each field of brain sciences – psychiatry, neurology, imaging, pharmacology, neurosurgery, ophthalmology and geriatrics – in an effort to accelerate research and slow the progress of brain disorders.
Home to a team of researchers investigating the genetic and cognitive basis of OCD, the clinic is "huge in the Canadian landscape," Dr. Richter explains. "There is no other dedicated centre for OCD and related disorders in Canada. This is the first of its kind focused on research and clinical care around specific OCD-related illnesses."
The number of people seeking help has astonished the team. "Referrals have tripled since we launched," Dr. Richter reports. "We are working to expand our capacity."
The most common manifestations of OCD are the classic stereotypes – compulsive cleaning and washing – but there are many other kinds of related "spectrum" disorders such as hoarding, hair pulling (trichotillomania), skin picking (excoriation disorder) and being obsessed with perceived flaws in one's own physical appearance (body dysmorphic disorder). Now, all these "orphan disorders" are being treated under one roof at Sunnybrook.
Another significant leap forward for OCD sufferers is that the DSM-5, a U.S. manual that classifies mental health problems, has recognized hoarding and skin picking as medical conditions, and acknowledged OCD as a separate illness from anxiety. All of this gives "great hope" to people who often suffer in silence for long periods of their lives, says Dr. Richter.
Once diagnosed, patients undergo treatment paths that are relatively painless: cognitive behavioural therapy (CBT, a type of psychotherapy) and/or medication. "If people engage in CBT, the majority may not need medication," Dr. Richter contends.
On the research side, the Thompson Centre is conducting genetic tests to fully understand what genes are at play and why OCD develops, with the end result of shaping better treatments.
Pharmacogenetics, or personalized medicine – the study of how genetic makeup influences response to medications – is another important area of study for OCD sufferers.
As Dr. Richter points out, some people do not tolerate drug treatments as easily as others, due to decreased enzymes produced in the liver. Or conversely, some might break down drugs more quickly, meaning they need a higher dose than the normal population.
"This is information we would never know without genetic testing," Dr. Richter says. "The 'one dose fits all' theory does not work well, so we are individualizing treatments."
All this work leads back to one thing – breaking the cycle of OCD.
That's why education is vital. It encourages support and understanding, breaks down the stigma around OCD and encourages health care professionals to take an interest in the field, says Dr. Richter. "We are looking at becoming a focal point for education and to build our capacity by training the next generation of professionals."
The centre's third annual conference for mental health providers will be held in March 2015 and is expected to be even bigger than in previous years.
Today, Dan is part of this message of hope, by giving talks to others starting out on their journey. "I really believe CBT works in a group setting with people who have gone through the same thing," he says. "You train your brain to start thinking in a certain way and learn to sit with your anxiety…and realize it will go away.
"I want to tell people you can have a productive and fruitful life. I have a great family, kids. If you can apply what you are taught, you can get things under control."
This is the third in a six-part series on the future of brain sciences. Look for the next one on Thursday, February 19. Visit sunnybrook.ca/brain for more information.
This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.