OBSESSIVE COMPULSIVE DISORDER

OBSESSIVE COMPULSIVE DISORDER (OCD)
Questions to help identify OCD

• Do you check things a lot?
• Do you wash or clean a lot?
• Is there any thought that keeps bothering you that you would like to get rid of but can’t
• Do your daily activities take a very long time to finish?
• Are you concerned about orderliness or symmetry?

If the answer is “YES”!! then you need treatment

Obsessions consist of intrusive, recurrent images, urges, or thoughts that are perceived as distressing and frequently frightening. They produce shame, fear and anxiety in the sufferer .

Compulsions are repetitive behaviours, thoughts or rituals that the person feels compelled to perform, often to reduce the distress caused by the obsession.

Many people with OCD experience intense fears of something terrible happening to themselves or others, have constant doubts about their behaviour, and frequently seek reassurance from others.

Common Types of OCD

• Washing and Cleaning–concerns with contamination can include chemicals, germs, secretions, electricity, people and places.
• Repeating – after an intrusive thought, impulse or image, the person is compelled to repeat some action so as to undo the thought, impulse or image.
• Checking – to prevent catastrophe a person will check and recheck such things as stoves, furnaces, appliances, possible mistakes at work, roadways and food in case the person thinks that may have inadvertently poisoned a meal.
• Ordering – this includes a need for symmetry. Individuals are directed out of a sense of discomfort to arrange until the discomfort subsides.
• Hoarding – frequently worry about leaving things behind. They may also be unable to throw out things such as napkins plastic bags, etc.
• Ritualistic Thinking– repetitive thoughts or images to decrease anxiety from intrusive thoughts or images that are not welcome. This can be called compulsive thinking.
• Pure Obsession – These individuals have the obsessions only and thoughts that may revolve around what would happen should the thought, image or impulse come true.

Age of Onset -OCD can start at any time from preschool to adulthood. Although OCD does occur at earlier ages, there are generally two age ranges when OCD first appears: Between ages 10 and 12 and between the late teens and early adulthood.

Symptoms

Most people with obsessive-compulsive disorder (OCD) have both obsessions and compulsions, but some people experience just one or the other.

Common obsessive thoughts

• Fear of being contaminated by germs or dirt or contaminating others
• Fear of causing harm to yourself or others
• Intrusive sexually explicit or violent thoughts and images
• Excessive focus on religious or moral ideas
• Fear of losing or not having things you might need
• Order and symmetry: the idea that everything must line up “just right”
• Superstitions; excessive attention to something considered lucky or unlucky

Common compulsive behaviors

• Excessive double-checking of things, such as locks, appliances, and switches
• Repeatedly checking in on loved ones to make sure they’re safe
• Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety
• Spending a lot of time washing or cleaning
• Ordering or arranging things “just so”
• Praying excessively or engaging in rituals triggered by religious fear
• Accumulating “junk” such as old newspapers or empty food containers

Causes of OCD

• • Psychological Factors – Many psychological theories have been introduced to explain the development of OCD. The two that have received the greatest support are the behavioural and cognitive theories mentioned below –
    • Behavioural Theory – The behavioural theory suggests that people with OCD associate certain objects or situations with fear, and that they learn to avoid the things they fear or to perform rituals that help reduce the fear.This pattern of fear and avoidance/ritual may begin when people are under periods of high emotional stress, such as starting a new job or ending a relationship.At such times, we are more vulnerable to fear and anxiety. For example, a person who has always been able to use public toilets may, when under stress, make a connection between the toilet seat and a fear of catching an illness.Once a connection between an object and the feeling of fear becomes established, people with OCD avoid the things they fear, rather than confront or tolerate the fear. For instance, the person who fears catching an illness from public toilets will avoid using them. When forced to use a public toilet, he or she will perform elaborate cleaning rituals, because these actions temporarily reduce the level of fear, the fear is never challenged and dealt with and the behaviour is reinforced.
    • Cognitive Theory – The cognitive theory focuses on how people with OCD misinterpret their thoughts.For example, parents under stress from caring for an infant may have an intrusive thought of harming the infant and they might exaggerate the importance of the thought, and respond as though it represents an actual threat. They may think, “I must be a danger to children if I have thoughts of harming children.” This can cause a high level of anxiety and other negative emotions, such as shame, guilt and disgust and they try to avoiding situations that might spark such thoughts or else engage in rituals, such as washing or praying.
  • Biological Factors

 

• • • Regulating of Brain Chemistry – Research into the biological causes and effects of OCD has revealed a link between OCD and insufficient levels of the brain chemical, serotonin. Serotonin is one of the brain’s chemical messengers that transmit signals between brain cells. Serotonin plays a role in the regulation of mood, aggression, impulse control, sleep, appetite, body temperature and pain.

 

• • • Changes in Brain Activity
      – Modern brain imaging techniques have allowed researchers to study the activity of specific areas of the brain. Such studies have shown that people with OCD have more than usual activity in three areas of the brain. These are: the caudate nucleus which brain acts as a filter for thoughts coming in from other areas and is important in managing habitual and repetitive behaviours.The prefrontal orbital and more activity may therefore cause more worry about social concerns like being meticulous, neat and preoccupied with cleanliness, and being afraid of acting inappropriately. The cingulate is believed to contribute the emotional response to obsessive thoughts and tells you to perform compulsions to relieve anxiety.

• • Genetic Factors – OCD often seems to “run in the family.” In fact, almost half of all cases show a familial pattern. Research studies report that parents, siblings and children of a person with OCD have a greater chance of developing OCD than does someone with no family history of the disorder.One study involving identical twins showed that if one twin develops OCD, the other is likely to follow, which suggests that the tendency to develop obsessions and compulsions may be genetic.

Treatment approaches

• Pharmacotherapy (Medications) – Antidepressants that have been approved by the Food and Drug Administration (FDA) to treat OCD include:
  • Clomipramine
  • Fluvoxamine
  • Fluoxetine
  • Paroxetine
  • Sertraline (Zoloft)
• Psychotherapy – The most effective treatment for obsessive-compulsive disorder is often cognitive-behavioral therapy. Antidepressants are sometimes used in conjunction with therapy, although medication alone is rarely effective in relieving the symptoms of OCD.
  • Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD) involves :-
    • Exposure and response prevention i.e.repeated exposure to the source of your obsession. Then you are asked to refrain from the compulsive behavior you’d usually perform to reduce your anxiety. For example, if you are a compulsive hand washer, you might be asked to touch the door handle in a public restroom and then be prevented from washing.
    • Cognitive therapy focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior

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• • 4 steps for conquering symptoms of OCD –
    • Relabel – Recognize that the intrusive thoughts and urges are the result of OCD.
    • Reattribute – Realize that the intensity and intrusiveness of the thought or urge is caused by OCD.
    • Refocus – Focus your attention on something else for a few minutes.
    • Revalue.
• Family Therapy
  • Family therapy promotes understanding of the disorder and can help reduce family conflicts.
  • It can motivate family members and teach them how to help their loved one.
• Group Therapy – Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.

Risk Factors

• • • Having parents or other family members with the disorder can increase your risk of developing OCD.
    • Stressful life events – If you’ve experienced traumatic or stressful events or you tend to react strongly to stress, the chances that you may develop OCD may increase.

Protective Factors

• • • Refocus your attention
    • Write down your obsessive thoughts and worries
    • Anticipate OCD urges
    • Practice relaxation techniques
    • Adopt healthy eating habits
    • Exercise regularly
    • Avoid alcohol and nicotine
    • Get enough sleep

We at Mumbai Psychiatry Clinics have a dedicated team of counsellors and clinical psychologists who will help you with your problems, cite interventions and assess the progress on regular intervals. There are experienced psychiatrists who will be guiding you throughout your journey and our Multidisciplinary team will try to assure you with the best help possible.

Reference –

Psychiatrist Jeffrey Schwartz, author of Brain Lock: Free Yourself from Obsessive-Compulsive Behavior

Abnormal Psychology and Modern Life, 11th ed. Carson, Butcher and Minekalsive Behavior

Abnormal Psychology and Modern Life, 11th ed. Carson, Butcher and Mineka