Obsessive Compulsive Disorder (OCD): by Meher Singh

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Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects people of all ages and walks of life. OCD may be developed at a very young age and may run in the family. It occurs when a person gets caught in a cycle of obsessions and compulsions. Most people have obsessive thoughts and/or compulsive behaviours at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of obsessive-compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it consumes a lot of time and gets in the way of important activities that the person values

Obsessions are unwanted, intrusive thoughts, images or urges that occur over and over again and feel outside of the person’s control and they trigger intensely distressing feelings. In most cases, people with OCD realize that these thoughts don’t make any sense.  Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time-consuming and get in the way of important activities the person values.

Common Obsessive thoughts in OCD may include:

Contamination:

  • Fear of germs and contamination
  • Body fluids (examples: urine, faeces)
  • Germs/disease (examples: herpes, HIV)
  • Environmental contaminants (examples: asbestos, radiation)
  • Household chemicals (examples: cleaners, solvents)

Losing Control:

  • Fear of acting on an impulse to harm oneself. Fear of getting hurt or others getting hurt. Fear of violent or horrific images in one’s mind.
  • Fear of blurting out obscenities or insults.
  • Fear of stealing things.

Harm:

  • Fear of being responsible for something terrible happening (examples: fire, burglary)
  • Fear of harming others because of not being careful enough (example: dropping something on the ground that might cause someone to slip and hurt him/herself)

Obsessions Related to Perfectionism. Need for things to be in an exact order:

  • Concern about evenness or exactness.
  • A concern with a need to know or remember
  • Fear of losing or forgetting important information when throwing something out
  • Inability to decide whether to keep or to discard things
  • Fear of losing things

Unwanted Sexual Thoughts:

  • Intrusive sexually explicit or violent thoughts and images.
  • Forbidden or perverse sexual thoughts or images
  • Forbidden or perverse sexual impulses about others
  • Obsessions about homosexuality
  • Sexual obsessions that involve children or incest
  • Obsessions about aggressive sexual behaviour towards others

Religious Obsessions (Scrupulosity):

  • A concern with offending God, or concern about blasphemy
  • Excessive concern with right/wrong or morality

Other Obsessions:

  • A concern with getting a physical illness or disease (not by contamination, e.g. cancer)
  • Superstitious ideas about lucky/unlucky numbers certain colours. A belief that certain numbers or colours are good or bad.
  • Constant awareness of blinking, breathing or other bodily sensations.

Compulsions are the second part of obsessive-compulsive disorder. These are repetitive behaviours or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time-consuming and get in the way of important activities the person values.

Similar to obsessions, not all repetitive behaviours or “rituals” are compulsions.  You have to look at the function and the context of the behaviour. In most cases, individuals with OCD feel driven to engage in compulsive behaviour and would rather not have to do these time consuming and many times torturous acts. In OCD, compulsive behaviour is done with the intention of trying to escape or reduce anxiety or the presence of obsessions. Compulsions are behaviours an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress. They are inevitable urges to carry out certain benefits (rights) or rituals that diminish or reduce anxiety. It is a persistent idea or instinct of unwelcome thoughts, images or desires that evoke anxiety.

Common Compulsions in OCD:

Washing and Cleaning:

  • Washing hands excessively or in a certain way
  • Excessive showering, bathing, tooth-brushing, grooming, or toilet routines
  • Cleaning household items or other objects excessively
  • Doing other things to prevent or remove contact with contaminants

Checking:

  • Checking that you did not/will not harm others
  • Checking that you did not/will not harm yourself
  • Checking that nothing terrible happened
  • Checking that you did not make a mistake
  • Checking some parts of your physical condition or body

Repeating:

  • Rereading or rewriting
  • Repeating routine activities (examples: going in or outdoors, getting up or down from chairs)
  • Repeating body movements (example: tapping, touching, blinking)
  • Repeating activities in “multiples” (examples: doing a task three times because three is a “good,” “right,” “safe” number)

Mental Compulsions:

  • Mental review of events to prevent harm (to oneself others, to prevent terrible consequences)
  • Praying to prevent harm (to oneself others, to prevent terrible consequences)
  • Counting while performing a task to end on a “good,” “right,” or “safe” number
  • “Cancelling” or “Undoing” (example: replacing a “bad” word with a “good” word to cancel it out)

Other Compulsions:

  • Putting things in order or arranging things until it “feels right”
  • Telling asking or confessing to get reassurance
  • Avoiding situations that might trigger your obsessions

OCD is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, images and sensations thus engaging in behaviours or mental acts in response to these thoughts and obsessions. Along with anxiety, it may also be accompanied by depression and eating disorders. The thoughts are generally distasteful that come into one’s mind. Obsessions may include fear of germs. It may be characterized by obsessive thoughts, images and compulsions that are difficult to suppress and take a considerable amount of time and energy away from living your life.

People with OCD can either have obsessive thoughts, urges or compulsive repetitive behaviour. Some have both obsessions and compulsions. Often a person carries out the behaviours to reduce the impact or to get rid of the obsessive thoughts to bring temporary relief. Not performing these obsessive rituals can cause great anxiety but if left untreated, it can limit the individual’s ability to function at work or school or even to lead a comfortable existence at home around family and others.

OCD is NOT about habits like biting your nails or always thinking negative thoughts. It can affect your job, school and relationships and keep you from living a normal life. Your thoughts and actions are beyond your control. Obsessive thoughts, for example, are to think that your family members might get hurt if they don’t put their clothes in the exact same order every morning. A compulsive habit may be to wash your hands 7 times after touching something that might be dirty.

Compulsions are repetitive behaviour or mental acts that a person feels driven to perform in response to an obsession. The behaviours are aimed at preventing or reducing distress or a feared situation. Constant repetition of rituals may fill the day, making a normal routine impossible. Obsessions are repetitive and intrusive urges or images frequently well up in the mind of the person with OCD. Paranoid fears and unreasonable concern with becoming contaminated or an excessive need to do things perfectively are common in OCD. Individuals may experience disturbing thoughts which are unpleasant and produce a high degree of anxiety.

Only trained therapists can diagnose OCD.

OCD may be diagnosed when obsessions and compulsions

  • Consume excessive amounts of time
  • Cause significant distress.
  • Interfere with daily functioning at work or school, family and relationship and normal routine.

Cause and risk factors of OCD

Biology: Changes in your body’s own natural chemistry or brain function. Genetics also plays an important role in the cause of OCD. There is also a higher rate of OCD among first degree relatives of adults with the disorder. OCD may also link to the interaction between behaviour and the environment which are not incompatible with biological explanations.

Risk factors:

Family history: When someone in the family has been diagnosed with OCD disorder, chances of the children getting the same disorder are high.

Stressful life events: The risk of getting the disorder is higher if one has experienced a traumatic life experience.

Signs and Symptoms

Just because you have obsessive thoughts or perform compulsive behaviours does NOT mean that you have OCD. The thoughts and behaviours cause a lot of distress. The symptoms of other disorders such as ADHD, autism and Tourette’s syndrome can also look like OCD, so a thorough medical and psychological exam is essential before and diagnosis is made. Co-existing disorders can make OCD more difficult both to diagnose and treat. Symptoms of OCD are seen in association with some other neurological disorders. People with OCD get no pleasure from engaging in the behaviours or rituals but do receive some relief from the anxiety the thoughts cause. Some people may struggle to banish their unwanted thoughts and compulsive behaviours. Symptoms may come and go easily over time or even get worse. If it becomes severe, it can keep a person from working or carrying out normal responsibilities at home or at work. It so happens with some people that they try to help themselves by avoiding situations that trigger their obsessions or may use alcohol or drugs to deal with their anxieties and fears. Other illnesses that may be linked to OCD are hoarding behaviours, trichotillomania which is repeated urge to pull out scalp hair eyelashes. Body dysmorphic disorder is a mental illness involving an excessive focus on an imaginary defect or flaw in one’s appearance.

Treatment for ODC

OCD is not about people who collect things that interest them like books or stamps. People collect items because it interests them and something for them to talk about. Hoarders, on the other hand, may not be very happy to talk about the things they have collected over the years. Most of the things may be considered junk and the individuals may feel that the items they have collected over time may harm others if they discard them.

Cognitive –Behavior Therapy (CBT) is the most effective for this disorder and may involve:

  • Exposure and response prevention
  • CBT; Exposure and response prevention requires repeated exposure to the source of your obsession.
  • CBT is teaching you healthy and effective ways of responding to obsessive thoughts without resorting to compulsive behaviours.
  • Medication: Antidepressants are used in conjunction with therapy for the treatment.
  • Family therapy: Most of the time OCD causes problems in the family, the therapy can promote understanding of the disorder and reduce family conflicts.
  • Group therapy: It provides support and encouragement and decreases the feeling of isolation.

A specific behaviour therapy approach called ‘exposure and response prevention’ is effective for many people with OCD. The patient deliberately and voluntarily confronts the feared objects or ideas either directly or by imagination. The therapist offers support and structure that strongly encourages the individual to refrain from using ritual or avoidance. The treatment then proceeds on a step by step biases guided by the ability of the individual to tolerate the anxiety and control the ritual.

Stress management techniques and meditation can help people with anxiety disorder to calm them, and enhance the effectiveness of therapy. Aerobic exercises may have a calming effect. Caffeine may aggravate the symptoms of anxiety and should be avoided.

Some benefit from behaviour therapy and others are helped by pharmacotherapy. Some may start with medication to gain control over their symptoms and then continue with behaviour therapy. Drugs can affect the neurotransmitter serotonin which can decrease the symptoms of OCD. The first of these serotonin re-uptake inhibitors specifically approved for the use in the treatment of OCD was tricyclic antidepressant clomipramine followed by SSRIs. SRI may give a better response. At times when medications are discontinued, relapse may follow.

Meher Singh