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An overview of Obsessive-Compulsive disorder

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.

Symptoms of obsessive-compulsive disorder

 Let’s track our obsessions!!

The common themes of obsessions are clustered in six categories:

  • Dirt and contamination:

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. 

  • Aggressive or horrific impulses

 (e.g. My two best friends are going to be murdered.)

  • Sexual obsessions

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.

  • Religious obsessions

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. 

  • Orderliness 

repeated thought to organize the things, or to perform a task in specific sequences.

  • Illness

    (e.g. recurrent thoughts of probably getting sick)
  • Obsessional Doubts


    In this type of obsession, a patient is doubtful whether he has completed the task or not. Whether he locked the door or not

Compulsions – Helpful but not helpful in Long Run!!

The compulsions or repetitive acts or behaviors can be overt (observable or behavioral) or covert (hidden or cognitive). 

The overt compulsions include 

  • Repeated hand washing, 
  • Frequent checking, 
  • Orderliness and alignment of objects.

 The covert compulsions are mental acts like 

  • Frequent praying, 
  • Counting 
  • repeating words. 

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.

Being trapped in a Vicious Cycle

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

Four facors that predict the development of this disorder:

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.

  1. Genetics:


    Genes play an important role in many disorders. The gene studies were conducted to find the risk factors involved in OCD and the results showed that most of the people who develop OCD have a family member or first-degree relative suffering from this disorder with a high risk if the family member developed it in his childhood or teenage.
    The identical twins have more chances of developing this disorder than fraternal twins.
  2. Biological Abnormalities:


    The exact connection between the brain areas and OCD is not found yet but dysfunction in the frontal cortex, subcortical structures, anterior cingulate cortex, and striatum have been mostly associated with OCD with the help of imaging studies. 
  3. Environment:


    Environment also plays a huge role in the development of many disorders. Children have a high risk of developing OCD if they had experienced any kind of traumatic events like accidents or physical or sexual abuse in their childhood. For example, a boy developed OCD symptoms because his best friend died a year back.
    And also OCD is associated with the post-infectious autoimmune syndrome.
  4. Role of Parenting

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

Treatment for Obsessive Compulsive 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. 

Treatment with Medications

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.

Treatment with Psychotherapy

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

Thought Stop technique

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

Exposure and Response Prevention

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

  1. Make a hierarchy of obsession producing situations from less severe to more severe
  2. Teach the relaxation techniques to patient
  3. Expose the patient to obsession producing situation such is touching the floor with hand. This is best done by modeling. That means the therapist himself touches the floor with hand then asks the patient to touch the floor.
  4. A patient develops a strong urge to wash his hand but he is asked not to do so.
  5. If a patient doesn’t wash his hands, anxiety will be produced. This will be overcome by relaxation techniques

Self-help tips for OCD

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

Case studies

Case Study 1

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”.

Explanation

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

Case Study 2

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”.

.Explanation

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.

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