Written by Dr. Peggy Richter, head of the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook.
There’s a serious gap in the health-care system when it comes to treating patients with obsessive compulsive and related disorders. And limited knowledge is to blame.
Obsessive compulsive disorder (OCD) has always been somewhat of an “orphan disorder” when it comes to mental illness, misidentified as a rare disorder as recently as about 25 years ago (we now know this isn’t true, the disorder affects one in 40 adults).
Couple this with the fact that obsessive compulsive and related disorders, such as hair-pulling (trichotillomania) and body dysmorphic disorder were redefined, and skin-picking and hoarding disorder were only formally recognized in medical diagnostic manuals four years ago. With all this in mind, it’s clear that information about diagnosis and treatment of OCD and these related disorders is a new addition to the health-care scene.
What does this mean for patients? Most community doctors aren’t fully informed on the ways to diagnose and treat OCD and related disorders, and patients are often going undiagnosed for years. That’s a problem.
OCD: The “orphan” disorder
There have been a number of problematic consequences to the mislabeling of OCD as a rare disorder. For one, OCD education generally hasn’t been extensive due to the idea that OCD wasn’t a condition a doctor would likely see in his/her clinic.
Dr. Katherine Feleki is a general practitioner psychotherapist in Kingston, ON, and like many of us who have undergone medical training, has experienced this education gap first-hand.
“There are huge, huge gaps,” she says of OCD training in medical schools. “Other than acknowledging the disorder exists, maybe a couple of sentences on how it’s treated, there’s no specific training. Most of my training was on depression and anxiety in general.”
This education gap leaves now-practicing doctors with an unfamiliarity of OCD. And even if a doctor does recognize symptoms in a patient, it’s likely he/she may not know the right ways to proceed with treatment.
For Dr. Feleki, she recognizes the symptoms of OCD in patients, but doesn’t feel she has the competency to treat them.
To add to the equation, there are only two main publicly funded centres in the GTA where patients can receive specialized care for OCD and related disorders: the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook, and the Centre for Addiction and Mental Health.
These institutions are great resources for patients who are seeking help for OCD or a related disorder, but these centres do not have the capacity to provide care to each and every patient, making access to publicly funded, specialized care quite limited.
Improving access to OCD treatment
To try and combat this issue, my team at the Thompson Centre developed a unique training program for practicing doctors to help them identify, diagnose and treat obsessive compulsive and related disorders.
It’s from teaching at this training program that I met Dr. Feleki, who felt she “needed to learn the skills for treating OCD.”
The main goal of this program is simple: to expand access for patients. So when a patient who has an obsessive compulsive and related disorder sees one of these trained physicians, these doctors will be able to diagnose and treat it as comfortably as they do depression.
Our first cohort of doctors — including Dr. Feleki — are still in training, but so far the course seems to be a success. Dr. Feleki says the program has provided her with guidelines on how to treat OCD from start to finish.
“Most helpful is the ability to get direct feedback from clinicians who are used to treating patients with OCD. If I’m not sure of an issue, I can get confirmation that I’m on right track or other ideas for treatment approaches,” she says.
Once our first group of doctors graduate from the course, we plan to create a directory for patients and doctors, so they can easily seek out these physicians with specialized training for OCD and related disorders.
Knowledge is wealth, especially when it comes to mental health care and treatment. Looking forward, I hope to see obsessive compulsive and related disorders shed the “orphan disorder” identity, and become well understood in homes and clinics across the country.
Want to learn more about mental health resources? Attend Sunnybrook’s community open house May 3, 2017.
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Thinking that your actions or thoughts will cause harm to yourself or someone else.
Extreme need for a certain order of things.
Excessively thinking about germs and illness.
Going over and over the same things in your head.
Constantly needing to touch or rearrange objects.
Compulsive hand-washing or housecleaning.
Compulsively checking (up to hundreds of times a day) things like alarms, locked doors, and unplugged fixtures.
Inability to throw away items there is no reason to keep.