What is obsessive-compulsive disorder (OCD) ? Types and symptoms of OCD, Risk factors of OCD, Causes of OCD, Treatment of OCD

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OCD [Obsessive Compulsive Disorder]

OCD is a mental disorder which consists of obsessions and compulsions. Obsessions such as repetitive unwanted thoughts, images, impulses and fears which is intrusive and persistent, and leads to repetitive behaviors[ compulsions] that are extensive, time consuming and distressful [ eg., cleaning, counting, or hoarding].

The obsessive-compulsive and related disorders differ from developmentally normative preoccupations and rituals by being excessive or persisting beyond developmentally appropriate periods. The distinction between the presence of subclinical symptoms and a clinical disorder requires assessment of a number of factors, including the individual’s level of distress and impairment in functioning.

OCD also reduce quality of life as well as social and occupational impairments . Impairment can be caused by the time spent obsessing and doing compulsions. Avoidance of situations that can trigger obsessions or compulsions can also severely restrict functioning.

A person with OCD have improper daily routine because of unwanted, repetitive thoughts and behaviors. Man and women are equally likely to suffer from OCD but in children's, girls suffer more as compared to boys. OCD is a chronic and severe condition that rarely remits without treatment. It usually begins between late adolescence and early adulthood.[Stein et al, 2010].

People with OCD knows  that their obsessions are the product of their own mind and not anyone else put this on their mind. Common obsessions include thought's about dirt and germs, aggression, failure to engage locks, bolts, and other safety devices, sex[ inappropriate sexual relationships] , and religion.

Obsessive thoughts can include:-

  • Suspicion that a partner is unfaithful, with  no reason to believe it
  • Fear of getting contaminated by people or the environment.
  • Extreme concern with order , symmetry, or precision
  • Fear of losing or discording something important
  • Worries about yourself or other people getting hurt
  • Constant awareness of blinking , breathing or other body sensations
  • Recurrent intrusive thoughts of sounds, images, words, or numbers
  • Disturbing sexual thoughts or images

Compulsive habits can include:-

  • Fear of touching doorknobs, using public toilets, or shaking hands
  • Repeated cleaning of household objects
  • Repeated counting to a certain number
  • Ordering or arranging things in a particular way
  • Doing tasks in a specific order every time or a certain "good" number of times
  • Repeatedly checking locks, switches, or appliances
  • Excessive or ritualized hand washing , showering, brushing teeth, or toileting
  • Constantly seeking approval or reassurance

Types of OCD and Symptoms:-

  • Checking- Door locks/ or windows, electrical appliances, house lights and candles, pregnancy, sexual arousal, gas or electrical stove knobs, schizophrenia, valuable items[ wallet, purse, phone], driving route and checking car.
  • Symmetry and ordering- The need to have things lined up in a certain way e.g., Neatness, books, cloths, pictures .
  • Contamination- A fear of things that might be dirty or a compulsion to clean. The common compulsions might be to wash or clean or avoid. e.g.,  money, sex, bathroom, toothbrush, places, door handles, public toilets, shaking hands, crowds etc.
  • Ruminations and intrusive thoughts- An obsession with a line of thoughts. Rumination person's include deeply preoccupied, very thoughtful, and detached. Intrusive thoughts- violent, religious, sexual, relationship intrusive thoughts etc. 

Risk factors of OCD:-

  • Depression, anxiety or tics
  • A history of physical or sexual abuse as a child
  • Stressful life events
  • Family history
  • Experience with trauma
  • Chemical imbalance in brain
  • Suicidal thoughts occur because of repetitive obsessions and compulsions

Causes of OCD:-

  •  Childhood experiences
  • Hereditary and genetic
  • Pregnancy or giving birth
  • Chemical, structural and functional abnormalities in the brain are the cause
  • Learning from watching family members or gradually learned over time

Treatment of OCD:-

Studies evaluating the effects of drugs on OCD are showing some promise[Steketee & Barlow, 2002; Stewart, Jenike, & Jenike, 2009]. The most effective seem to be those that specifically inhibit the  reuptake of serotonin, such as clomipramine or the SSRIs,  which benefit up to 60% of patients with OCD .

Medications:- The most commonly used medications for the OCD are SRIs{ Serotonin reuptake inhibitors}. SRIs were initially developed as antidepressants, but it is well established that they are effective in the treatment of OCD [Steketee and Barlow, 2004]. Most commonly prescribed SRIs for OCD is clomipramine [Anafranil ; Mc Donough and Kennedy, 2002]. In one multisite study, clomipramine led to an approximately 50% reduction in OCD symptons [Mundo, 2000], and it is helpful for youth as well as adults [ franklin and Foa, 2011] 

 Newer class of SRIs is "Selective" serotonin reuptake inhibitors [ SSRIs] which is also appear to be effective in the treatment of OCD [ Soomro, Altman, Rajagopal, et al, 2008] but it has fewer side effects.

Psychological treatment:- Patients with OCD belief that their compulsive behavior will prevent awful things from happening. In the response prevention component of ERP, people expose themselves to situations that elicit the compulsive act and then refrain from performing the compulsive rituals- for instance, the person touches a dirty dish and then refrains from washing his or her hands. The reasoning behind this approach goes like this-

1.   Not performing the ritual exposes the person to the full force of the anxiety provoked by the stimulus.

2. The exposure results in the extinction of the conditioned response[ the anxiety]

The first study of ERP as a treatment for OCD involved creating a controlled environment at Middlesex Hospital in London [ Meyer , 1966]

 ERP was highly effective in reducing obsessions and compulsions [ RosaAlcazar , Sanchez- Meca, Gomez- Conesa, et al, 2008]

 ERP appears to be more effective than clomipramine for the treatment of OCD [ Foa, Libowitz, Kozak, et al, 2005], and it is effective for children and adolescents as well as adults[ Franklin and Foa, 2011]

Cognitive approachs to OCD focus on challenging people's beliefs about what will happen if they do not engage in rituals [ Van, Oppen, 1995]. Eventually, to help test such beliefs, these approaches will use exposure. Several studies suggest that cognitive approaches perform as well as ERP [ Derubeis and Crits-Christoph, 1998].

Psychosurgery is one of the more radical treatments for OCD  " Psychosurgery"  is a misnomer that refers to neurosurgery for a psychological disorder.




Reference:-

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5

 

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