Obsessive-compulsive disorder (OCD) is a chronic mental disorder in which a person experiences repeated, uncontrollable, unwanted thoughts, ideas, or sensations (obsessions) and/or behaviours (compulsions) that drive them to do something over and over.
The spectrum of symptoms may vary from patient to patient. Some only have symptoms of obsessions or compulsions. While some people experience symptoms of both obsessions and compulsions,
In general, there is lots of physical and emotional discomfort due to OCD. It causes disturbance in day-to-day life. They may have difficulty concentrating or focusing at college, the office, or elsewhere.
People with OCD typically spend several hours a day fulfilling their obsessions, leaving less time for their families and friends. So generally, they have poor family and social lives. It can also ruin relationships.
We have all acknowledged some obsessions and compulsions in our daily lives at various times, for example, most of us check our gas or locks twice before leaving the house, and we constantly check our phones for new messages or emails. Also, many people like their work to be done perfectly, while others place special emphasis on maintaining proper cleanliness and hygiene everywhere. But this doesn’t mean they have OCD. Symptoms of OCD are excessive, i.e., far beyond the norm.
General Guidelines for OCD Diagnosis:
There’s no definite diagnostic test for OCD. A clinician can make the diagnosis only after evaluating the complete set of symptoms.
Most clinicians follow the criteria given in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). The various points given in this manual are very helpful for health professionals to diagnose and classify psychiatric and mental disorders. With few exceptions, the definitions and criteria given in this manual are widely practised by most psychiatrists.
According to DSM-5, the main criteria for OCD are as follows:
- The presence of obsessions, compulsions, or both
- 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.
- 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 (e.g., a head injury).
The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalised anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; etc.).
Obsessions are insistently repetitive, involuntary, unwanted thoughts, urges, or mental images that cause distressful, unpleasant emotions like anxiety, fear, or disgust. The most common symptoms are:
- Fear of germs, disease, and dirt
- Fear of contamination fear of coming into contact with perceived contaminated substances or things, such as:
- Body Fluids (e.g., urine, feces)
- Germs/diseases (e.g., herpes, HIV, COVID-19);
- Environmental contaminants (e.g., asbestos, radiation);
- Household chemicals (e.g., cleaners, solvents, battery acid)
- Disturbing, unwanted, or unacceptable sexual thoughts or mental images
- Excessive religious and moral consciousness: fear of offending God (blasphemy), curses, sin, etc.
- Fear of losing control and doing something inappropriate, aggressive, or violent that causes harm to oneself or others.
- Fear of losing loved ones (that something bad will happen to their loved ones).
- There is a strong desire for everything to be perfectly symmetrical.
- Extreme concern about losing items that might be needed one day, as well as an excessive emotional attachment to objects
- Excessive concern about having a physical illness or disease (not from contamination, e.g., cancer)
- Fear of being responsible for something terrible happening (e.g., fire, burglary, car accident)
- Excessive worry about one’s sexual orientation
- Excessive concern with one’s gender identity
Compulsions are repetitive, unwanted, and distressing behaviours that create an uncontrollable urge in a person to perform certain acts in response to an obsession.
With the intent to get rid of their obsessive thoughts and anxiety, people with OCD are compelled to do some acts repetitively. Even if they realise that this is not a permanent solution, they continue to perform those unnecessary works/deeds. They have a strong feeling that if they don’t do these things, then their anxiety will definitely increase and even get worse. These compulsive behaviours provide only temporary relief. Very soon the obsessive thoughts are back again, activating the compulsive behaviours. This cycle continues, leading to continuous anxiety.
Examples of compulsions:
- Extreme or immoderate hand washing, bathing, brushing teeth, or toileting
- Recurrent cleaning of household objects (floors, tiles, dishes, etc.)
- Giving undue emphasis to keeping things in order with proper symmetry and making appropriate arrangements again and again in a specific manner
- Repeatedly inspecting items such as locks, doors, electrical appliance switches, and so on.
- Compulsive counting or repeating certain phrases
- Always in need of acceptance, compassion, and reassurance.
- Continue touching something a certain number of times.
- Continuously reminding yourself that you haven’t harmed anyone.
- Repeated counting or saying specific words or prayers while performing other tasks
- Eating food in a specific order
- Refusing to shake hands or touch objects that other people touch a lot, like doorknobs.
- Performing a task a predetermined number of times, such as turning on a light switch seven times every day.
- Continue to monitor the body for disease symptoms and check body parts for abnormalities on a regular basis.
- Frequently repeating certain body movements (for example, tapping, touching, blinking)
- Collecting or hoarding objects that have no personal or financial value or buying the same thing several times.
- Continually checking your actions to make sure you have not hurt, mistreated, or injured anyone.
To relieve their anxiety and distress caused by obsessive thoughts, OCD patients are compelled to repeat these actions a particular number of times or until things appear right for them.
OCD patients also tend to avoid certain people, places, or circumstances that cause them anxiety and distress, resulting in obsession and compulsion symptoms. Their social and personal lives suffer as a result of these avoidances. Their ability to function normally is impaired, leading to poor physical and mental health status.
Primary OCD risk factors
- Family History/Genetic: The real cause of OCD is not exactly known, but it is said that a history of this disorder in the family may be the reason. If there is a family history of a close family member having this disorder, you have a higher chance of getting this condition.
- Mental trauma is the history of a potentially life-threatening condition or other stressful event, such as the unexpected death of a loved one. Childhood abuse is one such example.
- Stress … Personal and professional relationships that are stressful can increase the likelihood of developing OCDS or worsen existing symptoms.
- Personality Some personality traits have been linked to an increased risk of developing OCDS.For example, neuroticism, over-perfectionism, and indecision
- Other mental disorders are said to be associated with OCDs, such as anxiety disorders, depression, drug abuse, tic disorders, etc.
- Traumatic Brain Injury.. OCD can develop after a traumatic brain injury or when its symptoms get aggravated.
- Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal Infection (PANDAS). In some children, OCD develops after this infection.
Treatments and Therapies:
Treatment of obsessive-compulsive disorder (OCD) is possible, but it will depend on how much impact OCD has had on a person’s life.
OCD can be treated with medication, psychotherapy, or a combination of the two. The majority of patients with OCD respond to treatment; however, some patients do not. The following are some of the most common OCD treatments and therapies:
1. Medication, mostly antidepressants called selective serotonin reuptake inhibitors (SSRIs), is prescribed. This medicine improves symptoms of OCD by increasing the level of serotonin in the brain, which is a neurotransmitter responsible for boosting mood, regulating appetite, digestion, sleep, and many other bodily functions. According to most of the experts, serotonin in the brain helps to reduce symptoms of anxiety and depression, creates proper emotional balance, and contributes to an overall sense of well-being.
2. Cognitive Behavioral Therapy (CBT). This therapy is said to be the most powerful modality for the treatment of OCD. CBT includes a range of therapy techniques that are considered highly beneficial for treating OCD. Other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Behavioral therapies are found to be effective in managing OCD symptoms.
3. Exposure and Response Prevention (ERP). This is a type of cognitive behavioural therapy (CBT). In this therapy, during treatment sessions, patients are gradually exposed to the anxiety-provoking situations or concerns that are the root cause of their obsessions and compulsions. The goal of ERP is to train patients so that they can effectively manage the distress and suffering caused by their obsessions without involving themselves in compulsive behaviours.
With time, the patient learns to respond differently to these triggering situations, leading to a decrease in the frequency of compulsions and the severity of obsessions.
4. Mindfulness-based cognitive therapy (MBCT): MBCT is a modified form of psychotherapy that includes a combination of cognitive behavioural therapy (CBT), meditation practices, and mindfulness techniques. This therapy definitely aids in coping with the suffering and distress caused by obsessive thoughts in a variety of ways.Mindfulness is focusing your awareness on the present moment while noticing what’s happening inside your body and mind (sensations, feelings, and thoughts) and in your surroundings, without being overwhelmed or judgmental.
Most therapists recommend a combination of ERP and medication as the “first line” treatment for OCD. OCD is a chronic mental illness, and most of the studies show that only 60 to 65% of patients with OCD respond to conventional treatment modalities, which are a combination of psychotherapy and medication.
Some additional treatment options are also available for OCD patients who are resistant to standard treatment modalities. However, these are less commonly used, and many of these procedures are still under research. There are many studies indicating that they could be significantly helpful in reducing the symptoms of OCD patients. Some of these options include;
- Electroconvulsive therapy (ECT),
- Deep Brain Stimulation (DBS)
- Repetitive transcranial magnetic stimulation (rTMS)
- New OCD medications are being tested.
Along with medical treatment, self-care is also important. It includes
- Getting proper sleep
- Doing regular exercise can reduce overall stress and anxiety levels, thus helping to reduce the severity of OCD symptoms.
- Eating a healthy and balanced diet
- Practicing relaxation techniques, such as meditation, yoga, massage, etc., which can be beneficial in reducing stress and anxiety,
- Spending time with loved ones can help with overall mental health.
- It’s always useful to join an in-person or online support group, created for OCD patients.
With professional guidance, patients can learn new strategies to manage their symptoms and reduce or even eliminate the impact of this illness on their lives.
Although there are currently a number of effective medical and psychological treatments for obsessive-compulsive disorder (OCD), these treatments don’t work for everyone. Much research is ongoing to discover new and more effective treatment modalities for OCD or to improve the efficiency of existing methods of treatment.
With adequate treatment, proper self-care, and the proper support of family and friends, the patient may have an increased quality of life and improved social functioning.