Obsessive Compulsive Disorder

Overview

Obsessive-compulsive disorder (OCD) is a mental condition characterized by recurrent ideas, unwanted thoughts and sensations (obsessions). As such, people with OCD engage in repetitive behavioural patterns (compulsions) to deal with their obsessions.

A typical example in this case is a patient's obsession with hygiene and cleanliness. To eliminate the anxiety associated with their obsession, the individual may resort to washing their hands in a specific manner and for a prolonged period.

OCD patients have thought and behavioural patterns that are significantly more rigid and persistent. For instance, not carrying out a specific compulsion may result in profound anxiety and distress for a patient. Someone with OCD can have only symptoms related to obsession or compulsion.

The condition typically manifests during the early teenage years or young adulthood. Regardless of the specifics of individual cases, most OCD patients experience varying symptoms as they age. The condition can sometimes become severely disabling if not managed or treated accordingly.

Obsessions:

Obsessions are recurring and persistent thoughts, impulses, or images that elicit negative emotions like anxiety, fear, or disgust. Many people with OCD recognize that their thoughts are excessive or unreasonable. However, the distress caused by these intrusive thoughts cannot be alleviated through logic or reasoning. Most people with OCD use compulsions to alleviate the distress caused by obsessive thinking or to eliminate perceived threats. They may also attempt to ignore or suppress their obsessions or distract themselves with other activities.

Examples of common obsessive thoughts:
 

Fear of contamination from people or the environment;

Disturbing sexual ideas or images;

Religious, frequently blasphemous thoughts or fears;

Fear of committing violence or being harmed by self or loved ones;

Extreme worry that something is incomplete;

Extreme concern for order, symmetry, or precision;

Fear of losing or discarding something valuable;

It can also include seemingly meaningless thoughts, images, sounds, words, or music.
 

Compulsions:

Compulsions are repetitive behaviours or mental acts that an individual feels compelled to perform in response to an obsession. The behaviours typically prevent or reduce a person's distress caused by an obsession temporarily, and they are more likely to do so again in the future. Compulsions can be excessive responses that are directly related to an obsession (for example, excessive hand washing due to fear of contamination) or completely unrelated actions. In the most severe cases, a constant repetition of rituals may take up the entire day, making a normal routine impossible.
Examples of compulsions include:

Excessive or ritualistic hand washing, showering, tooth brushing, or toileting;

Consistent cleaning of household objects;

Ordering or arranging things in a specific manner;

Check locks, switches, appliances, and doors on a regular basis;

Frequently seeking approval or reassurance;

Number-related rituals, such as counting, repeating, excessively preferencing, or avoiding particular numbers;

OCD sufferers may also avoid people, places, or situations that cause them distress and trigger obsessions and/or compulsions. Avoiding these things may impair their ability to function in life and harm other aspects of their mental or physical health.

Difference between OCD and OCPD:

Although they may sound similar, obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are distinct conditions.

OCPD is a personality disorder characterized by an excessive preoccupation with perfectionism, organization, and control.

People with OCD are usually aware that their obsessions and compulsions are problematic and recognize that they require professional assistance to treat the condition. People with OCPD typically believe that their behaviour and beliefs are normal.
 

Symptoms of OCD:

Obsessive-compulsive disorder is characterized by both obsessions and compulsions. It is possible, however, to have only obsession or compulsion symptoms. You may or may not realize that your obsessions and compulsions are unreasonable. However, they consume a significant amount of your time, lower your quality of life, and interfere with your daily routines and responsibilities.

Causes:

Researchers do not know exactly what causes OCD. However, they believe several factors contribute to its growth, including:

Genetics: Research indicates that people who have a first-degree relative (biological parent or sibling) with OCD are more likely to develop the condition. The risk increases if the relative develops OCD as a child or adolescent.
Brain changes: Imaging studies have revealed differences in the frontal cortex and subcortical structures of people with OCD. OCD is also linked to other neurological conditions that affect the same areas of the brain, such as Parkinson's disease, Tourette's syndrome, and epilepsy.

PANDAS syndrome: It is abbreviated as "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections." It refers to a group of conditions that can occur in children who have had strep infections, including strep throat and scarlet fever. OCD is one of these conditions.
Childhood trauma: Some studies have linked childhood trauma, such as abuse or neglect, to the development of OCD.
 

Risk Factors:

The following factors may increase the risk of developing obsessive-compulsive disorder:
Family history: Having parents or other family members with the disorder can increase your chances of developing OCD.
Stressful life events: If you have experienced traumatic or stressful events, your risk may increase. This reaction may result in intrusive thoughts, rituals, and emotional distress associated with OCD.
Other mental health disorders: OCD may be associated with other mental health disorders, such as anxiety, depression, substance abuse, or tic disorders.
 

Complications:

Obsessive-compulsive disorder can lead to excessive ritualistic behaviour, as well as health issues like contact dermatitis from frequent hand-washing;
Having a difficult time going to work, school, or participating in social activities;
Troubled relationships;
Poor quality of life;
Suicidal thoughts and behaviours.
 

Prevention:

There is no sure way to prevent obsessive-compulsive disorder. However, seeking treatment as soon as possible may help prevent OCD from worsening and disrupting activities and daily routines.
 

When to Consult A Doctor?

On Symptoms: The clinical markers for OCD are divided into obsessions and compulsions. No two patients demonstrate similar symptoms. Nonetheless, the condition manifests in specific themes.

A patient with OCD will have persistent anxiety over one thought, such as the fear of bacterial or viral contamination, difficulty dealing with spontaneous situations, and requiring things to be organized properly. 
Subsequently, compulsions will directly address the related obsession. For instance, if an individual wants things to be organized, he/she may have unusual demands for how it should be done (making objects face a particular direction or be positioned in a precise spot).

Family History of Mental Disorders: While there are no conclusive studies on the association between genetics and mental disorders, medical professionals have observed a correlation between the two. For example, clinical depression is commonly seen in people with immediate relatives suffering from the condition. Thus, it is critical to consult a clinical psychologist if the individual has a family history of OCD. While symptoms might not be present currently, identifying risk factors and potential signs might be advantageous if required.

Regular Counselling or General Therapy: In a few cases, a person with no history of OCD or any other related disorder may develop the condition as a response to daily stressors, anxiety and general mental trauma. Visiting a therapist or counsellor can help pinpoint such issues before the symptoms worsen. Regular counselling can also enable patients to manage the condition effectively.

Diagnosis:

Psychological Evaluation: There are no specific tests for rendering a clinical diagnosis for OCD. In most cases, mental health professionals will rely on a psychological evaluation of the patient. This process includes discussing the symptoms of obsessions and compulsions and how they impact the person's daily life. In some cases, a clinical psychologist, with the patient's permission, may also approach his/her friends and family to gain a deeper insight into the individual's issue.

Diagnosis Based on the DSM-5: According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a clinical diagnosis of OCD requires three specific conditions to be met. First, the individual in question must have obsessions/compulsions that are time-consuming (they last more than an hour a day). Second, the associated symptoms must cause significant distress to the person. Finally, the patient must have experienced some form of disruption in their professional or social life due to the condition.

Additional Physical Tests: In most cases, doctors and mental healthcare providers will recommend a patient to undergo supplementary physical examinations. This includes imaging tests like Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI). However, these assessments are not meant to diagnose OCD but rather rule out the possibility of the symptom being caused by other factors (chemical imbalances in the brain, neurological disorders, elevations in bodily fluids).

Treatment:

Cognitive-Behavioural Therapy (CBT): CBT is a form of psychotherapy that involves the discussion of the related mental condition with a counsellor or therapist. This treatment method is typically structured over several sessions where the medical professional helps the patient recognize and manage the symptoms of OCD. However, CBT works best when supplemented with other remedial options, including medications and exposure therapy.

SRIs & Tricyclic Antidepressants: Serotonin reuptake inhibitors (SRIs) and tricyclic antidepressants are commonly used for most OCD patients. These prescription drugs increase the production and levels of serotonin in the patient's body, thereby mitigating the anxiety associated with obsessions and compulsion. Some examples include Fluoxetine, Sertraline, Paroxetine and Fluvoxamine.

Exposure/Response Prevention (EX/RP) Therapy: Considered a more nuanced treatment method, EX/RP therapy involves introducing an individual to a stressor. In the case of OCD patients, a clinical psychologist may expose the patient to an object or bring up a thought pattern that causes recurrent anxiety. The idea here is to get a person acclimated to their obsessions just enough so they do not produce the subsequent response (compulsion).

Electroconvulsive Therapy (ECT):  In more severe cases, medications, CBT and EX/RP therapy may not be effective. In such instances, clinical psychologists could suggest ECT. The procedure involves applying a mild electrical current to a patient's scalp. That stimulates particular areas in the brain and causes a minor seizure. Subsequently, the patient experiences a significant reduction in the recurrence of the related symptoms.

Transcranial Magnetic Stimulation (TMS): Similar to ECT, TMS is a treatment method involving stimulating brain parts. A magnetic device is placed on the patient's head, following which the apparatus sends out electrical impulses. These signals temporarily improve an individual's mood while reducing the effects associated with OCD.

Deep Brain Stimulation (DBS): DBS only applies to patients over 18. The procedure involves the surgical implantation of electrodes in specific brain regions. These electrodes then produce electrical signals that help regulate the symptoms related to OCD.

Additional Information

• Causal Factors of OCD

Recent medical research has established that OCD occurs due to inconsistencies in communication signals within specific brain areas, including the anterior cingulate cortex, the striatum and the thalamus. As such, the neurotransmitters that deliver these electrical signals are biologically different in OCD patients.

However, there is no conclusive evidence on what causes this issue with cerebral communication and neurotransmitters. Medical experts now consider a combination of genetic, behavioural, neurobiological and environmental triggers when diagnosing the condition.

• Global Prevalence of OCD

Ethnicity, biological gender or racial background don’t increase the risk of a person developing OCD. As such, the condition is relatively rare in the global population, affecting approximately 1% of it.

Regardless, certain factors, like childhood abuse and physical or mental trauma, can cause an individual to develop persistent habits or fears. If left unaddressed, this can develop into OCD.