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Understanding
Obsessive Compulsive Disorder

Obsessive-compulsive disorder ( OCD ) is a persistent and disabling condition and mainly involves intrusive thoughts about the thought process around that fact that some form of harm will occur if the individual does not perform those acts. The performance of these acts helps in reducing the anxiety surrounding them. OCD includes both obsessions and compulsions which have different characteristics. OCD is often one of the most disabling mental disorders and it often leads to a lower quality of life and functional impairment (Stein et al., 2009). Research has shown that approximately 2 to 3 per cent of people meet criteria for OCD at some point in their lifetime, and around 1 per cent meet criteria in a particular year (Ruscio et al., 2010). OCD mostly co-occurs with other disorders most common social phobia, panic disorder, GAD, and PTSD (Kessler, Chiu, Demler, et al., 2005; Mathews, 2009). Also, approximately 25 to 50 per cent of people with OCD experience major depression at some point in their life (Steketee & Barlow, 2002; Torres et al., 2006. With OCD, however, the thoughts are excessive and much more persistent and distressing, and the associated compulsive acts interfere with everyday activities.

 

OBSESSIONS AND COMPULSIONS

Obsessions can be defined as persistent thoughts of impulses or images that are a constant source of anxiety and distress due to their intrusive or inappropriate nature. These obsessions are also seen as inappropriate or uncontrollable at times. To resist or neutralise them people try to compensate them with another thought or action.


Compulsions, on the other hand, are behaviours that are performed repetitively such as washing hands. They can also be mental acts that one performs constantly such as repeating words silently or chanting. Compulsions are therefore overt behaviours and can also be performed as lengthy rituals. They can also be overt when an individual performs mental tasks or rituals. An individual feels compelled to act on the compulsions in response to a particular obsession and are often rigid rules about how compulsive behaviour should be performed. This behaviour is always performed with the particular goal of preventing or reducing the distress over a situation or event.


Many obsessive thoughts may involve contamination fears, fears of harming oneself or others, and other pathological doubt. There are other common themes are concerns about or need for symmetry, for instance, having books stacked in a particular way or sexual obsessions, and obsessions concerning religion or even aggression in some cases. Though such obsessive thoughts are rarely acted on, they remain a source of often excruciating torment and distress to a person facing them and a high source of anxiety.

 

DSM 5 Criteria

Obsessive - Compulsive Disorder

A. Presence of obsessions, compulsions, or both:

  • Obsessions are defined by (1) and (2):

  1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

  2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

  • Compulsions are defined by (1) and (2):

  1. Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

  2. The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereo types, as in stereotypic movement disorder; ritualized eating behaviour, as in eating disorders; preoccupation with sub- stances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behaviour, as in autism spectrum disorder).

 

PSYCHOLOGICAL CAUSAL FACTORS

  • COGNITIVE CAUSAL FACTORS: When people try and attempt to suppress unwanted thoughts they sometimes experience a paradoxical increase in those thoughts later which disrupt daily life and as the thoughts increase the anxiety surrounding them also increases. 


  • OCD AND THE BRAIN: brain-imaging techniques have contributed to findings of brain abnormalities that have been linked to OCD. It has been revealed that abnormalities occur in certain cortical and subcortical structures such as the basal ganglia. The basal ganglia are further linked at the amygdala to the limbic system, which controls emotional behaviours People with OCD also have extremely high levels of activity in the subcortical caudate nucleus, which is part of the basal ganglia These primitive brain areas are involved in executing primitive patterns of behaviour such as those involved in sex, aggression, and hygiene concerns. Activity in some of these areas is also increased when symptoms are provoked by relevant stimuli that activate obsessive thoughts. 

  • GENETIC FACTORS: Evidence from twin studies points out to a moderately high concordance rate for OCD for monozygotic twins and a lower rate for dizygotic twins. Compelling evidence of a genetic contribution to some forms of OCD concerns a type of OCD that often starts in childhood and is characterized by chronic motor tics (Lochner & Stein, 2003).

 

TREATMENTS

  • Behavioural and cognitive treatments: One of the most effective treatments for ocd is exposure therapy and response prevention. Homework is assigned and the treatment is planned according to what the performed behaviour. Cognitive behaviour therapy ( CBT ) has also been effective in the treatment of OCD.

  • Medications : Other anxiety disorders respond to a range of drugs however ocd has been shown to respond well to medications that directly affect serotonin. These medications are clomipramine (Anafranil) and uoxetine (Prozac) reduce the intensity of OCD symptoms.

 

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