What is Obsessive compulsive disorder (OCD)?
Obsessive compulsive disorder (OCD) is a psychological condition, characterised by high anxiety, which can significantly interfere with normal life.
OCD usually involves having both obsessions i.e. recurring, obtrusive, unwanted thoughts that are experienced and result in unreasonable fears, and compulsions i.e. act or rituals carried out in response to fears caused by the obsessions. A person may however have only obsessive thoughts without their expression as compulsive behaviour.
An individual usually feels less anxious once they have carried out the compulsion.
Failure to complete the compulsion often results in severe anxiety or panic – but continuing to try to live with the rituals often also leads to anxiety or depression.
Examples of compulsions are:
- excessive hand washing,
- excessive neatness,
- and repeating tasks or actions.
Examples of obsessions are worrying excessively about germs, contamination, dirt, fearing having harmed others, intrusive sexual thoughts or urges, death and illness.
People with OCD are aware that their compulsions and obsessions are irrational or excessive.
Perception of reality is not distorted. However, this knowledge is not sufficient to enable them to stop the obsessions and compulsions.
OCD affects approximately 2% of the population. Males and females are equally affected. Although the symptoms of OCD typically begin during the teenage years or early adulthood, children can develop the condition at earlier ages, even during the preschool years. Research indicates that at least one-third of cases of OCD in adults began in childhood.
There is a higher incidence in people with Tourette’s Syndrome with approximately 35-50% of patients having OCD.
Symptoms of OCD
Symptoms and behaviors associated with obsessive compulsive disorder are varied. Generally it is characterized by unwanted behaviors and/or thoughts that occur frequently. Some of symptoms and behaviors may include:
- Excessive fear of contamination and germs, leading to excessive cleaning, sometimes – asking other people to repeat their actions.
- Constant checking things, such as doors, locks etc.
- Constant counting, while performing routine tasks.
- Feelings of having to do things a certain number of times or doing things in a certain order.
- Obsessively arranging things in an methodical, orderly fashion.
- Intrusive unwanted thoughts, often of a disturbing nature.
- Intrusive unwanted words or phrases repeating themselves in the individual’s mind.
- Hoarding of objects, usually of no apparent value.
- Trichotillomania (compulsive hair-pulling) may be associated with obsessive- compulsive disorder.
- Depression, social phobia, and panic disorder are more common in people with OCD.
What are causes of obsessive compulsive disorder?
The exact cause of OCD is unknown.
OCD may involve abnormal functioning of the neurotransmitter serotonin in the brain. It is believed that insufficient levels of serotonin are involved in OCD. Drugs that increase and sustain the serotonin levels in the brain often help improve OCD symptoms.
Stress does not cause OCD; however, a stressful event seems in some cases to trigger the onset of the condition.
OCD tends to run in families.
Research suggests multiple genes are involved.
The type of personality may also be important – perfectionists seem to be more prone to developing OCD.
How to diagnose OCD?
OCD tends to be under-diagnosed and under-treated. A GP who diagnoses OCD will refer the individual to a psychiatrist or psychologist who is experienced in treating OCD.
The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) classifies OCD as an anxiety disorder since the recurrent obsessions and compulsions can be severe enough to be time-consuming, cause marked distress or significant impairment.
Diagnosis is based on the following:
- Symptoms cause significant distress
- Symptoms take up more than 1 hour a day
- Symptoms significantly interfere with work, relationships, or daily functioning
- The person recognizes that his or her obsessions and compulsions are unreasonable or excessive.
In some cases complicated forms of obsessive compulsive disorder, especially where disturbing thoughts are involved, can develop into a long term depression.
Treatment of obsessive compulsive disorder
There are two methods of treatment for OCD, drug therapy and cognitive behavioral therapy. A combination of the two therapies is often an effective method of treatment for most people.
Antidepressant medication is commonly prescribed (whether depression is present or not present). Clomipramine, a tricyclic antidepressant (TCA) used to be the usual treatment, this worked well.
However TCAs have more side effects than the newer Selective Serotonin reuptake inhibitors (SSRI’s). Therefore initially in most cases now, SSR’s are prescribed because of the improved safety, tolerability, and equivalent effectiveness.
However, no SSRIs except fluoxetine (Prozac) should be prescribed to children and adolescents under the age of 18, due to increased risks. Medications will usually relieve the symptoms of OCD, but often, if the medication is discontinued, relapse will follow.
Medication usually works within 4 weeks but may take up to 10 weeks to work fully. If successful, it is usual to take medication for at least a year. The doses needed to treat OCD are sometimes higher than those needed to treat depression. Symptoms can improve by up to 60% with medication.
Cognitive Behavioural Therapy (CBT)
CBT involves exploring the nature of anxiety and stress responses. The therapist will then gradually expose the individual to the feared object or idea, either directly or by imagination, and then discourages or prevents them from carrying out the usual compulsive response.
The aim is for the individual to gradually experience less anxiety from the obsessive thoughts and become able to forgo the compulsive actions for extended periods of time.
Some people with OCD find CBT too stressful. CBT is not available in all areas of the United States. However, some people successfully manage their own therapy with the help and advice of support groups.