OCD is a mental health disorder that you may have heard about. But, what is OCD? Is it a disease that can be cured? And what are the challenges with OCD? This article is focused on answers all questions related to obsessive compulsive disorder.
What is OCD?
Obsessive compulsive disorder, or OCD, is a chronic mental illness with a lifetime prevalence of 2 to 3 percent in the general population. It is characterized by obsessions (ideas or thoughts preoccupying the mind of the person persistently) and/or compulsions (irresistible urge to do something repetitively). The affected person is forced to perform these rituals to avoid a feared event. For instance, a person with OCD might repeatedly check time, alarm clocks, ovens, or repeatedly wash their hands after touching something. These obsessions and compulsions can make day to day life of the person extremely wearisome and have a substantial impact on their social life.
Symptoms of OCD
In a nutshell, obsessions are recurrent and persistent thoughts, impulses and images that enter the person’s mind without them having any control over it. Compulsions, on the other hand are repetitive actions or thoughts that a person use in order to make their obsessions go away.
These include thoughts, images, ruminations (act of thinking deeply about something), doubts and impulses.
These are repeated but meaningless activities. These maybe mental activities in which a person counts repeatedly or repeat certain phrases. Behavioral rituals involve the person washing their hands excessively or checking if the door lock is appropriately in place. Following these rituals, the patient Is temporarily relieved but can also be followed by indecisiveness regarding whether they performed the ritual correctly leading them to perform the specific task again and again.
Types of OCD Behaviors
- Checking: like repeatedly checking time, alarm clocks, etc.
- Contamination involves excessive hand washing due to a fear of germs
- Order and symmetry mean that the person will want certain things ordered up in a certain way. For example, they’ll want their cutlery to be lined up in a unique and specific way and they’ll be distressed if it is mingled with.
- Ruminations and intrusive thoughts maybe single words, phrases, or rhymes.
- Hoarding this is collecting items that are of limited value to others for example, junk, notes, containers, etc.
Examples of Obsessions
- Contamination with body fluids, diseases like HIV, environmental contaminants like radiation, and dirt.
- Fear of stealing things
- Fear of acting on an impulse to harm oneself or another
- Fear of babbling out insults or obscenities
- Fear of being responsible for something bad happening
- Fear of harming others by not being careful of one self’s actions
- Concern about perfectionism
- Fear of offending god or having blasphemous thoughts
- Obsessions involving homosexuality or that involves children or incest
- Obsessions about violent sexual behaviors against others
Examples of Compulsions
- Excessive showering, tooth-brushing, grooming
- Cleaning household items or other objects repeatedly
- Needless checking on certain things like checking nothing terrible happened, checking if you didn’t harm anyone, or checking some parts of your body.
- Repeating body movements
- Repeating routine activities
- Rewriting and rereading
- Putting things in a certain way which feels right
How Do You Get OCD?
Genetic factors may predispose a person to OCD. In addition to this, structural organic abnormalities in the brain specifically of the caudate nucleus and frontal lobes picked up on brain scans also indicates a possible cause for OCD.
Dysregulation of the 5HT pathway (serotonin pathway) in the brain maybe associated with development of OCD because of the efficacy of SSRIs (selective serotonin reuptake inhibitors) in treating this chronic disorder.
Autoimmune factors, diseases like Sydenham’s chorea (an autoimmune disease) is associated with OCD in two-thirds of cases.
Treatment and Prognosis
With appropriate management, majority of OCD patients improve remarkably. For the rest of the unfortunate patients, their treatment involves relapses over the course of years.
The key to manage an OCD patient is to appropriately diagnose them in the first place. Following the diagnosis, patients are given psychoeducation and self-help books so that patients can understand their illness better and work on it along with the clinician. Patients are offered brief cognitive behavioral therapy if they have mild symptoms. For moderate functional impairment, patients are offered SSRIs (selective serotonin reuptake inhibitors, like citalopram, escitalopram, fluoxetine, etc.) and a full course of CBT (cognitive behavioral therapy). For severe functional impairment, combined regimen with SSRIs and full course of CBT along with a drug clomipramine (a tricyclic antidepressant) are a preferred choice.
Addiction and OCD
Addiction and OCD have one strong mutual factor, impulse.
Addiction is a brain disorder that involves compulsive engagement in an activity or a behavior despite their harmful consequences. A person, who drinks alcohol even after being aware of the fact that it causes liver damage, is addicted to alcohol. A person smoking cigarettes even though he knows that there are 90% chances of him developing a lung cancer is addicted to cigarettes.
So, does a person with OCD more likely to develop an addiction?
The Potential For Addiction
Considering OCD as an anxiety disorder, people suffering from OCD are usually subject to overwhelming anxiety and fear. They keep fearing about what might happen next and what if something bad happens or the things don’t turn out the way they’re supposed to. In order to mask these feelings of fear and anxiety, people usually opt for different kind of substances to feel the calm. The Journal of Anxiety Disorders estimates that over 25 percent of those who seek treatment for OCD also meet the criteria for a substance use disorder. These substances include alcohol, opioids, etc. These drugs activate the pleasure sensitive areas in our brains, making it easier for the individual to cope with the fear, stress and anxiety.
However, it becomes difficult to treat these kinds of patients since they are highly dependent on substances.
Interestingly, addiction and OCD appear to affect the same areas of the brain. These brain areas are associated with decreased capability of the person to fight off strong compulsions.
Disorders like OCD should be treated before they become a bigger problem.
Finding help for you or a loved one can seem challenging. However, without reaching out, there is no way of starting the journey of recovery. There are many treatment centers in your area that can help you.
Oxford Psychiatry fourth edition with Michael Gelder and Richard Mayou