The obsessive-compulsive disorder is the anxiety disorder in which there are recurrent thoughts, urges or images (obsessions) intruding one’s mind followed by repetitive behaviors (compulsions) aimed at reducing the distress or anxiety caused due to obsessions. From a cognitive perspective, these acts intend to neutralize or prevent the feared events. The essential criteria for diagnosing an individual to be having OCD are that obsessions and compulsions must consume the time of more than one hour a day and that the individual must have recognized at some time that these repetitive thoughts (obsessions) or repetitive acts or behaviors (compulsions) is excessive and unreasonable.
The Epidemiological Catchment Area Survey indicated that the lifetime prevalence of OCD was 2.5% and the six-month prevalence rate was 1.6% and making it the 4th most common psychiatric disorder in the USA.
The common themes of obsessions are clustered in six categories:
These are thoughts about being contaminated or having germs by touching other things. Even the routine things such as touching the door can trigger these obsessions. These are a very common obsession in OCD patients.
(e.g. My two best friends are going to be murdered.)
Individuals with OCD can experience undesirable sexual thoughts, images, and impulses about others and sometimes children. This causes feelings of disgust. They try to avoid the situations that trigger them. Patients realized that these are foolish thoughts and tries much to resist them.
These are usually in the form of blasphemous thoughts, negative thoughts about religion, or questions about the existence of God. Patients realize that these thoughts are foolish and try to resist them.
repeated thought to organize the things, or to perform a task in specific sequences.
The compulsions or repetitive acts or behaviors can be overt (observable or behavioral) or covert (hidden or cognitive).
The overt compulsions include
The covert compulsions are mental acts like
Compulsive acts are repetitive and the person feels a lack of control about these activities. In severe cases, the patient performs these tasks even for the whole day. His daily life and routine are compromised.
These compulsive acts alone do not account for subsiding the anxiety caused by the obsessions but are also responsible for maintaining the vicious cycle of OCD (see figure 1). The following model describes how the individual is trapped in a vicious cycle by performing the compulsive acts
The exact cause for the development of OCD is not discovered yet but researches are being conducted in order to know the cause of this disorder. There are some risk factors that can lead to obsessive-compulsive disorder.
It is observed that parenting style has a significant role in the development of Obsessive-Compulsive Disorder. Strict parents, strict discipline at home, harsh toilet training, can predispose children for the development of this disorder
Obsessive-compulsive disorder is treatable through medications or psychotherapy and both types of treatment are really helpful for the patient. And sometimes both are given side by side.
Mostly used drugs used for the treatment obsessive compulsive disorder are SSRIs (such as Paroxetine, sertraline, fluvoxamine, etc.). Among tricyclic antidepressants, only clomipramine is indicated for OCD. Medicine is usually started at a low dose and gradually dose is increased until the desired response to medicine is achieved. Multiple medicines are avoided as much as possible. Once the response is achieved, medicine is continued for a longer period, usually two years.
Various psychological interventions are available for the treatment of an obsessive-compulsive disorder, ranging from self-help techniques to structured psychotherapeutic techniques such as exposure and response prevention. Few are discussed here
This technique is based on the idea that in OCD, there is repeated, the intrusive flow of thoughts and patients feel helpless to resist these thoughts. In this technique, the patient is helped to break this chain of thoughts. When the thoughts come, the patient is asked to strike his hand on the table forcefully and say the word, “Stop”. All signals such as pain by striking the hand, sound striking hand and uttering word stop, help to temporarily block the flow of thoughts. For details see thought stop technique
This is a highly effective technique for the obsessive compulsive disorder. According to some researches, this is as effective as a medicine. The idea behind this technique is that if a patient stops compulsions, obsessions will fade away. For example, if the patient stops washing his hand repeatedly obsessional about dirt and contamination will disappear. For details see exposure and response prevention therapy
If the severity of OCD is mild medicine is not usually required. The individual can also help himself by breaking the routines. For example, if you have a compulsive habit of washing your hands three times before eating anything, then change it to two times and after some time wash your hands just one time before eating food. Similarly, if you have a habit of checking the locks often, then just try once to not check the locks and you will see that nothing bad will happen. If self-help techniques are not working then structured psychotherapy will be required. This is done by trained psychologists
Mrs. X “I ‘avoid catching something from other people. I spend hours bleaching all the surfaces in my house to stop the germs, and I spend hours washing my hands and taking a bath. Whenever my hands are touched with any surface such as door, repetitive thoughts of germs and contamination continue to come to my mind until I wash my hands. I realize that these fears are stupid. My family is sick of it, but it has gone on for so long now I can’t stop”.
If my hands are dirty then definitely I will be having the thoughts of washing them but what happens in this disorder that these thoughts of dirt or germs do not go away with washing resulting in repeated hand washing and prolonged cleansing
Mr. Y “My whole day is spent checking that nothing will go wrong. It takes me an hour to get out of the house in the morning, because I am never sure that I’ve turned off all the electrical appliances like the cooker, and locked all the windows. Then I check to see that the gas fire is off five times, but if it doesn’t feel right I have to do the whole thing again. In the end, I ask my partner to check it all for me again anyway. At work, I am always behind as I go through everything several times in case I have made a mistake. If I don’t check I feel so worried I can’t bear it. It’s ridiculous I know, but I think if something awful did happen, I’d be to blame”.
In 2nd case study again there is a repetition of thoughts but now the thought is about “DOUBTS”. That means doubts about whether the task is completed or not, doors locked or not, gas fire if off or not, electrical appliances are turned off or not, etc.
As a result of repetitive thoughts, there are repetitive actions. In 1st case study that is washing and cleansing and in 2nd case study that is frequent checking
We call these repetitive thoughts as obsessions and repetitive actions as compulsions.