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Personal Health Jane Brody on health and aging.

In the 1997 film “As Good As It Gets,” Jack Nicholson portrays Melvin Udall, a middle-aged man with obsessive-compulsive disorder who avoids stepping on cracks, locks doors and flips light switches exactly five times, and washes his hands repeatedly, each time tossing out the new bar of soap he used. He brings wrapped plastic utensils to the diner where he eats breakfast at the same table every day.

Though the film is billed as a romantic comedy, Melvin’s disorder is nothing to laugh about. O.C.D. is often socially, emotionally and vocationally crippling.

It can even be fatal.

Four years ago, John C. Kelly, 24, killed himself in Irvington, N.Y., after a long battle with a severe form of obsessive-compulsive disorder. Mr. Kelly was a devoted baseball player, and now friends hold an annual softball tournament to raise money for the foundation established in his honor to increase awareness of the disorder.

Obsessive thoughts and compulsive behaviors occur in almost every life from time to time. I have a fair share of compulsive patterns: seasonings arranged in strict alphabetical order; kitchen equipment always put back the same way in the same place; two large freezers packed with foods just in case I need them.

I hold onto a huge collection of plastic containers, neatly stacked with their covers, and my closets bulge with clothes and shoes I haven’t worn in years, and probably never will again — yet cannot bring myself to give away.

But these common habits fall far short of the distressing obsessions and compulsions that are the hallmarks of O.C.D.: intrusive, disturbing thoughts or fears that cannot be ignored and compel the sufferer to engage in ritualistic, irrational behaviors to relieve the resulting anxiety.

An excessive fear of germs may prompt repetitive hand-washing or a refusal to touch doorknobs or use objects handled by another person. But the rituals may be unrelated to the anxieties that trigger them: opening and closing doors an exact number of times, for example, or stepping over every crack or line, or counting to a certain number before performing an activity.

People with O.C.D. know that their thoughts and actions are not realistic, but they cannot stop themselves from behaving as if they were grounded in fact. Performing compulsive rituals does not give them pleasure and only temporarily relieves their anxiety, resulting in a need to re-enact them again and again.

Both the obsessive thoughts and resulting compulsions can take up an inordinate amount of time, making it impossible to meet the demands of a normal life. Mr. Kelly’s daily struggles with his illness, as revealed in his journal, did not fully come to light until after his untimely death.

In a recent article in The New England Journal of Medicine intended to better inform doctors about the disorder, Dr. Jon E. Grant, a psychiatrist at the University of Chicago’s Pritzker School of Medicine, described a 19-year-old man who “washes his hands a hundred times a day, will not touch anything that has been touched by someone else without scrubbing it first, and has a fear of germs that has left him isolated in his bedroom, unable to eat, and wishing he were dead.”

Over just two years, the man’s disorder had “gradually become completely disabling,” the man’s father reported.

Between 1 percent and 3 percent of people will develop O.C.D., starting in childhood or young adulthood. Often the condition is hereditary, though its severity can vary greatly within a family.

Although what causes O.C.D. is still poorly understood, Dr. Grant noted that abnormalities in several brain structures and functions seem to be involved, including deficits in certain cognitive abilities, like being able to change behavior based on new information.

Without proper treatment, the condition is unlikely to resolve on its own. The earlier it is diagnosed and treated, the better the results.

“Only approximately one third of patients with O.C.D. receive appropriate pharmacotherapy, and fewer than 10 percent receive evidence-based psychotherapy,” Dr. Grant wrote. Effective therapy is often stymied by a misdiagnosis of depression or anxiety; symptoms of both may accompany O.C.D.

In an earlier report in the same journal, Dr. Michael A. Jenike, a psychiatrist at Massachusetts General Hospital, suggested three screening questions that can help identify patients with the disorder:

■ “Do you have repetitive thoughts that make you anxious and that you cannot get rid of, regardless of how hard you try?”

■ “Do you keep things extremely clean or wash your hands frequently?”

■ “Do you check things to excess?”

Affected individuals and their families should know that treatment works, even if therapy is done by telephone or over the Internet. When properly treated, 60 percent to 85 percent of patients improve significantly and remain better for years, although booster sessions often are needed to maintain improvement.

The techniques of cognitive behavioral therapy have proved most effective. The preferred method, called exposure and response prevention, is done once or twice a week for up to 30 hours total.

The patient is exposed to anxiety-provoking stimuli, starting with the least provocative. The patient is taught to avoid the usual responses, until even the most feared stimulus causes little or no reaction.

Another approach, called cognitive therapy, helps patients identify automatic unrealistic thoughts and then change how these thoughts are interpreted.

For example, someone with a fear of germs might be asked to touch a range of dirty objects without washing his hands and to keep a log of how often illness follows this action. Eventually it becomes clear that the objects are not making him sick.

Medications like the antidepressants clomipramine (Anafranil) or a selective serotonin reuptake inhibitor (like Zoloft or Paxil) are also helpful, although cognitive behavioral therapy remains the treatment of choice.