Obsessive–Compulsive Disorder (OCD)

Obsessive–Compulsive Disorder (OCD)

What is Obsessive–Compulsive Disorder (OCD)?

Once characterized as a rare psychiatric disorder, Obsessive-Compulsive disorder (OCD) affects more than one in forty individuals (2.5%), or approximately five million Americans —that’s more than those who experience other mental illnesses like schizophrenia, bipolar disorder, and panic disorder. Obsessive–compulsive disorder was initially considered as a sub-dimension of depression, the so-called “ananchastic depression.” The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) defines obsessions as “persistent and intrusive inappropriate ideas, thoughts, or impulses which cause marked anxiety and distress” and compulsions as repetitive behaviors or mental acts whose goal is to “prevent or reduce such distress, not to provide pleasure or gratification”.

Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.

From hoarding to hand-washing to forever checking the stove, obsessive-compulsive disorder (OCD) takes many forms. It is an anxiety disorder that traps people in repetitive thoughts and behavioral rituals that can be completely disabling.

The DSM IV sub divides symptoms by type, the most familiar being obsessions about contamination, partly alleviated, for example, by repetitive hand washing. Other common symptoms include the need for order or symmetry; obsessions with sexual conduct; sexual thoughts that the patient views as inappropriate; and perhaps the most intriguing and recently newsworthy form of OCD, compulsive hoarding and saving, the tendency to stow away trash such as old newspapers.

Although the ritual may temporarily alleviate anxiety, the person must perform the ritual again when the obsessive thoughts return. This OCD cycle can progress to the point of taking up hours of the person’s day and significantly interfering with normal activities. People with OCD may be aware that their obsessions and compulsions are senseless or unrealistic, but they cannot stop them.

Symptoms of Obsessive–Compulsive Disorder

Symptoms of OCD seem to have been documented as early as the early modern period; according to contemporary psychologists, Martin Luther and John Bunyan exhibited tendencies that would meet the criteria of religious scrupulosity, a subtype of OCD in which religionists ruminate excessively over their spiritual standing. The symptoms vary according to the subjects, but the most common ones are

Common Obsessions include:

  • Fear of dirt or contamination by germs
  • Fear of causing harm to another
  • Fear of making a mistake
  • Fear of being embarrassed or behaving in a socially unacceptable manner
  • Fear of thinking evil or sinful thoughts
  • Need for order, symmetry, or exactness
  • Excessive doubt and the need for constant reassurance

Common Compulsions include:

  • Repeatedly bathing, showering, or washing hands
  • Refusing to shake hands or touch doorknobs
  • Repeatedly checking things, such as locks or stoves
  • Constant counting, mentally or aloud, while performing routine tasks
  • Constantly arranging things in a certain way
  • Eating foods in a specific order
  • Being stuck on words, images or thoughts, usually disturbing, that won’t go away and can interfere with sleep
  • Repeating specific words, phrases, or prayers
  • Needing to perform tasks a certain number of times
  • Collecting or hoarding items with no apparent value

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

  • Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
  • Spends at least 1 hour a day on these thoughts or behaviors
  • Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
  • Experiences significant problems in their daily life due to these thoughts or behaviors

Causes of Obsessive–Compulsive Disorder

Scientists believe that both a neurobiological predisposition and environmental factors jointly cause the unwanted, intrusive thoughts and the compulsive behavior patterns that appease the unwanted thoughts.

According to Freud, obsessive symptoms are essentially substitutive infantile sexual activities to which the individual has regressed because of his inability to meet the demands of normal genital functioning after puberty or because of his failure to satisfy his libidinal desires in a normal way later in life.

Freud also observed that obsessive neurotics frequently showed the character traits of compulsive orderliness, parsimony and obstinacy, which are believed to be reaction formations against the infantile pleasures regarding defecation or the results of sphincter discipline generally stressed during early childhood in Western society.

Biological Factors

The brain is a very complex structure. It contains billions of nerve cells — called neurons — that must communicate and work together for the body to function normally. Neurons communicate via chemicals called neurotransmitters that stimulate the flow of information from one nerve cell to the next. At one time, it was thought that low levels of the neurotransmitter serotonin were responsible for the development of OCD. Now, however, scientists think that OCD arises from problems in the pathways of the brain that link areas dealing with judgment and planning with another area that filters messages involving body movements.

In addition, there is evidence that OCD symptoms can sometimes get passed on from parents to children. This means the biological vulnerability to develop OCD may sometimes be inherited.

Studies also have found a link between a certain type of infection caused by the Streptococcus bacteria and OCD. This infection, if recurrent and untreated, may lead to the development of OCD and other disorders in children.

Environmental Factors

There are environmental stressors that can trigger OCD in people with a tendency toward developing the condition. Certain environmental factors may also cause a worsening of symptoms. These factors include:

  • Abuse
  • Changes in living situation
  • Illness
  • Death of a loved one
  • Work- or school-related changes or problems
  • Relationship concerns

Brain structuring

Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear. Research is still underway. Understanding the causes will help determine specific, personalized treatments to treat OCD.

Complications and Comorbidity of Obsessive–Compulsive Disorder

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

he occurrence of specific anxiety disorders and MDD in case relatives was independent of the same comorbid diagnosis in the OCD probands. OCD, panic disorder, generalized anxiety disorder, and MDD occurred together more often than expected by chance among individuals with OCD. Multiple associations of panic disorder, OCD, and social phobia are not rare among patients with affective psychoses and are likely to be associated with more severe psychopathology than is found in patients without anxiety disorders.

Patients with OCD are at high risk of having comorbid (co-existing) major depression and other anxiety disorders. In a series of 100 OCD patients who were evaluated by means of a structured psychiatric interview, the most common concurrent disorders were: major depression (31%), social phobia (11%), eating disorder (8%), simple phobia (7%), panic disorder (6%), and Tourette’s syndrome (5%).

If you think you or your loved one have OCD, then must be consulted with an expert psychiatrist. If left untreated, OCD can interfere in all aspects of life. OCD cannot be prevented. However, early diagnosis and treatment can help reduce the time a person spends suffering from the condition.

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