Obsessive Compulsive Disorder (OCD)

The obsessive-compulsive disorder is a common and often severe disorder the symptoms of which cause significant impairment in psychosocial functioning. Some patients commit suicide. Yet these distressing and impairing disorders often go undetected in clinical settings. Patients often suffer in silence and without receiving adequate care. Many are ashamed of their symptoms and reluctant to reveal them to a clinician

OCD is a psychological disorder in which a patient has intrusive repetitive thoughts (Obsessions) which are not pleasurable and cause significant anxiety or distress. Individuals attempt to ignore or suppress these obsessions (e.g., using thought suppression) or to neutralize them with another thought or action (e.g., performing a compulsion). Compulsions (or rituals) are repetitive behaviours (e.g., washing, checking) or mental acts (e.g., counting) aimed at reducing the distress triggered by obsessions, according to rules that must be applied rigidly, or preventing a feared event (e.g., contracting an illness). Compulsions are not pleasurable, although some individuals experience relief from anxiety or distress. Compulsions are not connected in a realistic way to the feared event (e.g., arranging items symmetrically to prevent harm to a loved one) or are clearly excessive.

Greater psychosocial impairment is associated with greater OCD symptom severity and the presence of comorbid conditions, particularly major depression. Studies suggest that the incidence of suicide attempts is higher in individuals with OCD compared with the general population.

Age of onset

Obsessional disorder usually reveals itself between the ages of 20 and 30 years, though obsessional patients often report a variety of neurotic symptoms (or ‘over-sensitivity’) in childhood. Adult obsessional patients often experience phobias (exaggerated fears of particular things such as heights or spiders) and mild compulsions in childhood. Obsessional traits are also common before the full-blown disorder emerges, although this is by no means always so.

Symptoms:

Symptoms of OCD include obsession of a need for symmetry or exactness, repeating/checking rituals, counting compulsions, ordering/arranging compulsions, contamination obsessions, and cleanliness/washing compulsions.

Many patients with OCD see their symptoms as stigmatizing and potentially shameful. These difficulties may be compounded and limit the consultation to more comfortable physical symptoms such as skin problems resulting from repeated hand washing thus reducing the chances of disclosure of specific psychological symptoms which causes delay in accurate diagnosis.

Causes:

Although it is not clear what causes OCD, on the basis of the studies, some known factors are:

Genetic Factors: Twin and family studies have shown that there is genetic susceptibility to OCD. Serotonin (5-HT) and glutamate genes are the most consistently found in OCD.

Biological/Neurological: There are different findings of the studies on subjects with OCD compared with healthy control subjects. Major findings reported structural abnormalities in OCD involve the basal ganglia orbitofrontal cortex, anterior cingulate cortex, and striatum. While some research suggests a chemical imbalance of serotonin in the brain in the development of OCD.
Life changes: Sometimes major life changes like loss of job or loved one, moving to new place, birth of a child impose some new responsibilities on a person which in turn causes anxiety and triggers OCD.
Behavioural factors: People who are extremely organized, neat and particular sometimes have the risk of developing OCD.
Personal Experiences: It is studied when a person experience a severe trauma, he is likely to develop OCD. For example during the pandemic of COVID, people unknowingly develop the compulsion of hand-washing.

Treatment:

Treatment of OCD differs from variety of medications to therapies depending on the severity of OCD.

Behaviour therapy: Behaviour Therapy is an effective treatment for OCD where overt behaviour is involved. One such technique is Response Prevention in which the therapist might sit with the patient encouraging her or him not to make the response, such as hand-washing. Where a fear of some future consequence is involved, the technique of behavioural modelling has proved useful. For example entering into a shop might be followed by contaminated feeling and extensive washing rituals. In such a case, the patient might be encouraged to visit a shop with the therapist, who would thereby demonstrate that no harm comes to people who visit shops.
Cognitive therapy: Cognitive therapy – logical restructuring of thought – works by the therapist questioning critically the assumptions on which the patient seems to be operating. Logic from which the disturbed mental state could derive support is unearthed and then challenged. CBT help to think, act and react to your unhealthy/illogical thoughts and habits aiming at replacing negative thoughts with productive ones.
Drugs Therapy: A number of antidepressants have a beneficial effect on obsessional illness in both adults and children. The first of these to be developed was clomipramine (Anafranil). Subsequently, the drugs fluoxetine (Prozac), fluvoxamine (Faverin), citalopram (Cipramil), sertraline (Lustral) and paroxetine (Seroxat) have proved to be of help in treating the condition, and one of these is now more often the first choice for OCD.