Obsessive Compulsive Disorder (OCD)

For people with obsessive compulsive disorder, their obsessions are relentless. They can’t just be shrugged off. Typically, if someone tries to make their obsessions stop, the obsessions will grow to be even stronger and more distressing. The troubling thoughts drive people with OCD to engage in their compulsions to try to reduce the anxiety and distress that they are feeling. Even if the compulsions are carried out, the obsessions will not go away. Obsessions and compulsions are perpetuated in this way. Usually, someone’s OCD will pertain to a specific theme, and the obsessions will mainly relate to that category.

In some cases, people with obsessive compulsive disorder are aware that their obsessions are irrational. Invading thoughts and urges continue to plague them, and they continue to act out of habit as a result. Sometimes, people don’t think they’re being irrational when they have obsessions. However severe the case may be, dealing with obsessive-compulsive disorder can have a negative impact on one’s overall well-being.

Obsessive-compulsive disorder (OCD) affects an estimated 1.2 percent of American adults 18 and older. Females are more likely to have OCD than males are, with the prevalence being 1.8 percent for females and 0.5 percent for males. The impact that OCD has on someone’s life can vary. In a sample of people who had OCD in the previous year, 50.6% reported severe impairment, 34.8% moderate impairment, and 14.6% only mild impairment, according to the results of the study.

Someone can develop obsessive compulsive disorder at any point in their life. Typically, it is found in children between the ages of eight and twelve, or in late adolescence and the early years of adulthood. Additionally, some people may live with OCD for many years before seeking treatment and receiving a diagnosis.

The Signs and Symptoms of Obsessive-Compulsive Disorder

While obsessive compulsive disorder is typically characterised by the presence of both obsessions and compulsions, in some cases OCD may present with only obsessions or only compulsions. OCD symptoms usually take up a lot of time, getting in the way of daily activities.

Obsessions

An obsession is a persistent pattern of unwanted and distressing thoughts, images, or urges.

Obsessional themes include, but are not limited to:

• Harming (having obsessive fears about harming yourself or others) (having obsessive fears about harming yourself or others)
• Contamination (having obsessive fears about germs or sickness) (having obsessive fears about germs or sickness)
• Unacceptable thoughts (having taboo sexual, religious, or aggressive intrusive thoughts) (having taboo sexual, religious, or aggressive intrusive thoughts)
• The concept of balance and harmony (having the need to keep things in order and symmetrical)

Some ways that these obsessions might present themselves are:

• Intrusive thoughts about losing control and violently hurting somebody
• Not knowing for sure whether or not you’ve turned off the oven to a distressing degree
• Fearing getting sick from shaking hands with someone or touching surfaces
• Experiencing unwanted taboo sexual images that don’t align with one’s own morals
• Feeling extremely uneasy when things aren’t symmetrical

This is by no means an exhaustive list of how obsessions may present themselves. The types of obsessive thoughts that people experience are numerous, and they differ from one person to the next.

Compulsions

Compulsions are the behaviours or rituals that people with obsessive-compulsive disorder carry out in an attempt to reduce anxiety and distress. Sometimes, people feel like they must engage in their compulsive behaviours in order to stop something bad from happening. Compulsions aren’t always physical actions. They have the capacity to think as well. Compulsions may be a very temporary fix for coping with the worry and fears attached to obsessions, but the obsessions come back, and the cycle repeats.

Compulsions can include any of the following:

• Repeated avoidance of checking, cleaning, and counting
• Putting things in order\s Seeking reassurance

Obsessive behaviours include the following:

• Checking the oven multiple times to ensure that it’s off
• Excessive sanitising of the hands
• Repeating a certain behaviour a specific number of times
• The process of rearranging objects in a way that promotes harmony and balance
• Asking friends or family for reassurance that you won’t lose control and carry out a violent action

Again, this is not an exhaustive list of all of the compulsive behaviours out there. There is a huge range of compulsions, and they vary depending on the individual.

Obsessive Compulsive Disorder (OCD) Causes & Risk Factors

OCD cannot be attributed to a single factor, and scientists aren’t sure what causes it. Obsessive-compulsive disorder has been linked to a number of theories and risk factors. These include:

• Obsessive compulsive disorder in the family: OCD has a genetic component. Someone with a family history of OCD is more likely to also have OCD, such as if someone’s parent has OCD. According to studies, 20-40% of first-degree relatives (such as parents or siblings) have obsessive traits when it comes to OCD.
• The presence of other mental health issues, such as depression or anxiety, may increase one’s risk of developing OCD.
• Trauma in the past: Trauma or high stress situations may trigger obsessive compulsive disorder.
• History of abuse: A history of abuse (physical abuse or sexual abuse) particularly during childhood can make someone more likely to have obsessive compulsive disorder.
• Differences in parts of the brain: Through imaging studies, research has found evidence of abnormalities in certain parts of the brain (including the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and caudate nucleus in people who have obsessive compulsive disorder.

Individuals who meet the criteria for more than one risk factor are at an even greater risk of developing OCD.

Obsessive-compulsive Related Disorders

The DSM-5 notes the presence of disorders that are related to obsessive compulsive disorder. Similarly to obsessive compulsive disorder, obsessive-compulsive related disorders are characterised by someone having obsessions and compulsions that cause distress and impact their life. However the difference is that these disorders each have unique distinguishing factors that set them apart and create enough criteria for them to be their own subtypes.

These obsessive-compulsive related disorders include:

• Skin-picking disorder: Patients with skin-picking disorders are unable to resist the overwhelming urge to pick at their skin. They end up obsessively picking at their skin, sometimes for hours throughout the day. Before they pick, people with skin picking disorder may feel anxious or tense, but once they start picking, they get a rush of pleasure and are relieved of their anxieties. Sometimes, the picking is severe enough that it can cause scarring or tissue damage, which may even require medical attention and antibiotics. Skin picking disorder is frequently preceded by a dermatological condition such as acne. Anxiety and depression are frequently seen alongside it.
• Trichotillomania (hair-pulling disorder): The behaviour associated with trichotillomania is pulling hair out, whether it be from their head, eyebrows, eyelashes, or elsewhere. Hair-pulling has been classified as either focused or automatic in patients with this condition. Focused hair pulling is closer to an OCD compulsion, and the person is very aware that they’re doing it. On the other hand, automatic hair pulling is done more automatically or subconsciously without the person being fully aware that they’re doing it. Hair loss can occur as a result of trichotillomania, which usually begins in childhood or adolescence.
• Body dysmorphic disorder (BDD) is characterised by a person’s obsession with what they perceive to be physical flaws, be they on their body, in their facial features, or on their skin. Their perception of flaws is skewed, and others may not even notice them. This obsession with flaws is accompanied by related repetitive behaviours. They may, for example, obsessively groom themselves in front of the mirror. The onset of BDD is typically in adolescence. Body dysmorphic disorder commonly occurs with major depressive disorder or social anxiety disorder.
• Hoarding disorder is a condition in which a person amasses and keeps an excessive number of possessions. They have an intense need to keep all of their belongings, and they have an extremely difficult time parting with any of their belongings, which is why they have so much. This results in very cluttered living situations. Many people with hoarding disorder will continue to buy more and more items even though they know there is no space for them at their home. Typically, there are feelings of embarrassment and shame around hoarding, especially if other people see their home. The condition is chronic, usually starting in adolescence and continuing into adulthood.
• OCD-induced by a medication or due to another medical condition: Some medications or substances have been linked to the development of obsessive compulsive disorder. For example, some studies have reported that certain antipsychotics may induce obsessive compulsive disorder in some patients. Obsessive compulsive disorder can also be caused by medical conditions. One example of this is Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) (PANDAS).

Another diagnosis to consider here is obsessive compulsive personality disorder. While it sounds very similar to obsessive compulsive disorder, there are clinical differences that set them apart from one another. It falls under the umbrella of personality disorders. People with obsessive compulsive personality disorder are extreme perfectionists and are fixated on doing everything their way, which is what they believe to be the only correct way. They may be preoccupied with lists, rules, and organisation. Typically, they do not question themselves or feel ashamed of this obsession to do everything perfectly. Relationships can be harmed by obsessive-compulsive personality disorder, especially if it is present in the home.

Many people with obsessive compulsive disorder commonly also experience major depressive disorder (MDD) (MDD). Anxiety symptoms such as agitation, apprehension, and worry are common in people with OCD and depression. Both of these conditions are also commonly treated by the same SSRI medications.

Obsessive-Compulsive Disorder Treatment (OCD)

Obsessive compulsive disorder is treatable. OCD can’t be cured, but it can be made easier to deal with through treatment. OCD can be treated with therapy or medication. Oftentimes, the two treatment types are used in conjunction with each other for the best results. The type and duration of treatment will depend on the severity of the obsessions and compulsions, as well as the effect that they have on the person’s quality of life.

In many cases, people who have obsessive compulsive disorder also have other co-occurring mental health conditions such as depression and anxiety. When a mental health professional decides on the best course of action for treating obsessive compulsive disorder, they will take these other conditions into account.

Types of therapy for obsessive compulsive disorder

Therapy can be very helpful for people with OCD. Their problems will be solved, new ways of dealing with stress will be learned and their compulsive behaviours will be confronted head on.

• A form of psychotherapy known as cognitive behaviour therapy (CBT) aims to teach patients new ways of dealing with their problems by teaching them new ways of thinking and acting. Using cognitive behavioural therapy (CBT), an individual can learn to recognise their unhealthy thought patterns and the ways in which they influence their actions, and then develop more helpful, healthy thought patterns and healthy behavioural patterns. Cognitive behavioural therapy (CBT) frequently incorporates instruction in relaxation techniques. Patients must also work outside of therapy sessions if they want to see the best results. CBT can be very effective for various mental health conditions, such as anxiety and depression, not just OCD.
• Treatment of OCD with ERP, a variation of cognitive behavioural therapy (CBT). It entails exposing the patient to anxiety-inducing or obsession-triggering stimuli (exposure). This is followed by preventing the patient from engaging in the compulsive behaviour that is often associated with the obsession (response prevention). For example, with the guidance of the trained professional, a patient with contamination obsessions will be exposed to a trigger such as shaking hands with someone or touching a doorknob that many other people have touched. In order to stop themselves from washing their hands to the point of exhaustion, they’d have to break the habit. Over time, this can help people become desensitised to their triggers.

Types of medications for obsessive compulsive disorder

Patients with more severe symptoms often require psychiatric OCD medication as well as therapy. In order to treat OCD, a variety of medications are available, and the prescribing physician will select the most appropriate one for each patient based on their unique circumstances. The following are the four main classes of OCD medications:

• A class of antidepressants called SSRIs, which selectively block the serotonin reuptake, may be used to treat OCD. These include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft) (Zoloft). These are the most commonly prescribed medications for OCD.
• SNRIs, or serotonin and norepinephrine reuptake inhibitors, are antidepressants in the same family as SSRIs. Studies have shown that the SNRI venlafaxine (Effexor) is effective in treating OCD.
• Anxiolytics, such as tricyclic antidepressants TCAs are antidepressants from a more venerable family. One TCA, clomipramine (Anafranil), has been shown to be effective in treating OCD. In fact, it was the first medication that proved to benefit patients with OCD. However, the side effects and risks of clomipramine are greater than those of SSRIs and SNRIs, so it typically is not prescribed as a first line of treatment.
• Antipsychotics: An antipsychotic can be added to an antidepressant if the effects of the first medication aren’t sufficient. The antipsychotic drug Risperidone (Risperdal) is the most extensively researched for treating OCD, for example.

It’s important to keep in mind that the effects of any of these drugs will take time to manifest. In order for an SSRI to be fully effective and have a noticeable impact on symptoms, patients may need to take it for 10-12 weeks. Additionally, people with OCD typically require a higher dose of these medications than people who are taking the meds for another condition such as depression.

If you think that you might have obsessive-compulsive disorder, do not hesitate to seek professional help. You can begin your search for an OCD diagnosis by taking one of the many tests and evaluations available. The sooner you’re diagnosed with OCD, the sooner you can start feeling better and adjusting to your new normal.