Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive compulsive disorder (OCD) is a type of anxiety disorder characterized by intrusive and frequent obsessions and repetitive and ritualistic behaviors.

Individuals with obsessive compulsive disorder can describe feeling driven to do things with an irresistible urge in order to relieve stress and feel better. For those with this condition, ignoring these urges is not easy, and if they can manage, the urge will come back again later. For those with a fear of being infected by germs, it can be common to adopt a handwashing ritual that results in chapped or sore skin, and the condition is often accompanied by shame or other feelings of embarrassment related to the symptoms of the condition.

Prevalence

OCD affects males and females equally, and affects approximately 2% of people at some point during their lives.

People can confuse being a perfectionist with having OCD, but OCD can be a debilitating condition that can impact work, relationships, or school and is very different to a quest for flawless results in a task.

Symptoms of Obsessive-Compulsive Disorder:

OCD is experienced in obsessions and compulsions.

Obsessions – An obsession is a persistent and unwanted thought, image, or urge that enters the mind and triggers distress.

Common obsessions in OCD include:

  • Fear of contamination – not engaging in normal activities like shaking hands for fear of contamination
  • Fear of dirt
  • Fear of harm occurring – being plagued with fear about forgetting to turn off a stove or lock a door before leaving home
  • Excessive concern with exactness – objects not facing a particular direction nor set in an orderly or symmetrical fashion
  • Beyond normal focus on the need for orderliness
  • Anxiety related to unwelcome thoughts including anger, or sexual or religious content
  • Anxiety related to unwelcome thoughts of hurting others or oneself
  • Anxiety related to unwelcome thoughts about cursing in public or other inappropriate behavior

Compulsions – A compulsion is recurrent behavior or mental act(s) carried out to provide relief brought on by the distress of obsessions.

Common compulsions include:

  • Cleaning
  • Repeatedly checking stoves, windows, or doors
  • Washing
  • Repeating acts
  • Repeating words, prayers, or phrases
  • Mental rituals
  • Ordering or arranging things

Evidence of OCD can typically begin to be seen in teenage or early adult years. Generally, symptoms have a gradual progression in their severity and can be more extreme in stressful times. The disorder is thought of as a lifelong condition and will either be mild, moderate, or severe.

Diagnosing Obsessive-Compulsive Disorder:

A diagnosis of OCD is based on symptoms and is made after making sure nothing else is going on that might be causing it.

Tools like the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) and other criteria in the DSM-5 can be used to assess and rate the severity of the condition.

The following steps may be included to make a diagnosis, 

  • Elimination of other problems that could contribute to symptoms, with a physical exam
  • Bloodwork and urine lab work to assess thyroid function, and to determine if alcohol or drug use is a factor
  • A psychological interview to evaluate the individual’s feelings, behaviors, symptoms, and thoughts

Obsessive-Compulsive Disorder Complications:

OCD often interferes with day-to-day life and can cause considerable distress. The World Health Organization (WHO) has listed OCD in the top ten most disabling illnesses in the world. OCD can:

  • Prevent one from going to school or work and from socializing
  • Place a tremendous amount of stress and strain on close relationships
  • Cause health complications such as contact dermatitis from compulsive handwashing (out of fears of contamination)
  • Lead to suicidal thoughts or behavior

Causes of Obsessive-Compulsive Disorder:

The cause of OCD remains unknown.

It is thought that OCD results from a combination of the following factors:

  • Biological — such as a change in the chemistry of a person’s brain
  • Psychosocial — adverse childhood or adult experiences such as sexual abuse
  • Environment — such as infections

People who have a family history of OCD are at increased risk of developing this condition themselves.

Situations which can contribute to the likelihood of triggering or developing OCD include:

  • The presence of other mental health conditions or substance abuse
  • Other close family members with OCD
  • Traumatic or stressful situations

Treatment for Obsessive-Compulsive Disorder:

With OCD being considered a lifelong condition, a cure may not be the result of treatment but of the individual coming to a place where their life is not ruled by the condition and the symptoms are under control.

  • Therapy can take place in group settings, with family, or one-on-one.

    • Cognitive-behavioral therapy (CBT) – is an effective form of treatment for many people with OCD.
    • Exposure and response prevention (ERP) – a component of CBT, this involves gradually exposing the patient to a feared object or obsession and teaching strategies and techniques to cope with the elicited anxiety in a healthy and adaptive way.
    • Other therapies including deep brain stimulation – for people who have had symptoms for about five years and are not responding well to other treatments.
  • MEDICATIONS – Certain FDA-approved psychiatric medicines such as antidepressants and antipsychotics can help reduce the symptoms and distress of OCD.

    For many people, finding the right medication can take quite some time since the doctor may want to try a variety before deciding which works best, and it can take weeks or months before actionable results are seen.

    There are suicide risks with antidepressants, especially for individuals under 25, even though the medications are deemed safe by the FDA and prescribed by doctors.

    While not considered addictive, individuals can develop physical dependence on antidepressants, and any changes or cessation of a prescribed treatment dosage can trigger a response, like withdrawal.

  • Deep Brain Stimulation – DBS has been seen to be an effective treatment in addressing severe tics that haven’t yet responded favorably to other treatment options. Through surgery, a battery-operated medical device is inserted in the brain, and it precisely delivers stimulation to specific areas in the brain that control functions like movement.

Symptoms of Obsessive-Compulsive Disorder:

OCD is experienced in obsessions and compulsions.

Obsessions – An obsession is a persistent and unwanted thought, image, or urge that enters the mind and triggers distress.

Common obsessions in OCD include:

  • Fear of contamination – not engaging in normal activities like shaking hands for fear of contamination
  • Fear of dirt
  • Fear of harm occurring – being plagued with fear about forgetting to turn off a stove or lock a door before leaving home
  • Excessive concern with exactness – objects not facing a particular direction nor set in an orderly or symmetrical fashion
  • Beyond normal focus on the need for orderliness
  • Anxiety related to unwelcome thoughts including anger, or sexual or religious content
  • Anxiety related to unwelcome thoughts of hurting others or oneself
  • Anxiety related to unwelcome thoughts about cursing in public or other inappropriate behavior

Compulsions – A compulsion is recurrent behavior or mental act(s) carried out to provide relief brought on by the distress of obsessions.

Common compulsions include:

  • Cleaning
  • Repeatedly checking stoves, windows, or doors
  • Washing
  • Repeating acts
  • Repeating words, prayers, or phrases
  • Mental rituals
  • Ordering or arranging things

Evidence of OCD can typically begin to be seen in teenage or early adult years. Generally, symptoms have a gradual progression in their severity and can be more extreme in stressful times. The disorder is thought of as a lifelong condition and will either be mild, moderate, or severe.

Diagnosing Obsessive-Compulsive Disorder:

A diagnosis of OCD is based on symptoms and is made after making sure nothing else is going on that might be causing it.

Tools like the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) and other criteria in the DSM-5 can be used to assess and rate the severity of the condition.

The following steps may be included to make a diagnosis, 

  • Elimination of other problems that could contribute to symptoms, with a physical exam
  • Bloodwork and urine lab work to assess thyroid function, and to determine if alcohol or drug use is a factor
  • A psychological interview to evaluate the individual’s feelings, behaviors, symptoms, and thoughts

Obsessive-Compulsive Disorder Complications:

OCD often interferes with day-to-day life and can cause considerable distress. The World Health Organization (WHO) has listed OCD in the top ten most disabling illnesses in the world. OCD can:

  • Prevent one from going to school or work and from socializing
  • Place a tremendous amount of stress and strain on close relationships
  • Cause health complications such as contact dermatitis from compulsive handwashing (out of fears of contamination)
  • Lead to suicidal thoughts or behavior

Causes of Obsessive-Compulsive Disorder:

The cause of OCD remains unknown.

It is thought that OCD results from a combination of the following factors:

  • Biological — such as a change in the chemistry of a person’s brain
  • Psychosocial — adverse childhood or adult experiences such as sexual abuse
  • Environment — such as infections

People who have a family history of OCD are at increased risk of developing this condition themselves.

Situations which can contribute to the likelihood of triggering or developing OCD include:

  • The presence of other mental health conditions or substance abuse
  • Other close family members with OCD
  • Traumatic or stressful situations

Treatment for Obsessive-Compulsive Disorder:

With OCD being considered a lifelong condition, a cure may not be the result of treatment but of the individual coming to a place where their life is not ruled by the condition and the symptoms are under control.

  • Therapy can take place in group settings, with family, or one-on-one.

    • Cognitive-behavioral therapy (CBT) – is an effective form of treatment for many people with OCD.
    • Exposure and response prevention (ERP) – a component of CBT, this involves gradually exposing the patient to a feared object or obsession and teaching strategies and techniques to cope with the elicited anxiety in a healthy and adaptive way.
    • Other therapies including deep brain stimulation – for people who have had symptoms for about five years and are not responding well to other treatments.
  • MEDICATIONS – Certain FDA-approved psychiatric medicines such as antidepressants and antipsychotics can help reduce the symptoms and distress of OCD.

    For many people, finding the right medication can take quite some time since the doctor may want to try a variety before deciding which works best, and it can take weeks or months before actionable results are seen.

    There are suicide risks with antidepressants, especially for individuals under 25, even though the medications are deemed safe by the FDA and prescribed by doctors.

    While not considered addictive, individuals can develop physical dependence on antidepressants, and any changes or cessation of a prescribed treatment dosage can trigger a response, like withdrawal.

  • Deep Brain Stimulation – DBS has been seen to be an effective treatment in addressing severe tics that haven’t yet responded favorably to other treatment options. Through surgery, a battery-operated medical device is inserted in the brain, and it precisely delivers stimulation to specific areas in the brain that control functions like movement.
Sources NIH – Deep Brain Stimulation | MEDTRONIC – Deep Brain Stimulation | MEDTRONIC – Obsessive Compulsive Disorder | OCDUK – OCD DSM Classification | PSYCHIATRY – What is OCD | MAYO CLINIC – Symptoms | HEALTHLINE – Risk Factors | PSYCHOLOGY TODAY – OCD Types