Obsessive Compulsive Disorder

What is Obsessive Compulsive Disorder?

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.

Signs and Symptoms of OCD

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

• Fear of germs or contamination
• Unwanted forbidden or taboo thoughts involving sex, religion, and harm
• Aggressive thoughts towards others or self
• Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

• Excessive cleaning and/or handwashing
• Ordering and arranging things in a particular, precise way
• Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
• Compulsive counting

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

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.

If you think you have OCD, talk to your doctor about your symptoms. If left untreated, OCD can interfere in all aspects of life.

Risk Factors

OCD is a common disorder that affects adults, adolescents, and children all over the world. Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen.

The causes of OCD are unknown, but risk factors include:

Genetics

Twin and family studies have shown that people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. The risk is higher if the first-degree relative developed OCD as a child or teen. Ongoing research continues to explore the connection between genetics and OCD and may help improve OCD diagnosis and treatment.

Brain Structure and Functioning

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.

Environment

People who have experienced abuse (physical or sexual) in childhood or other trauma are at an increased risk for developing OCD.

In some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

Treatment Options For OCD

OCD is typically treated with medication, psychotherapy, or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.

Sometimes people with OCD also have other mental disorders, such as anxiety, depression, and body dysmorphic disorder, a disorder in which someone mistakenly believes that a part of their body is abnormal. It is important to consider these other disorders when making decisions about treatment.

Medication for OCD

Medications that have been proven effective in both adults and children with OCD include Clomipramine, which is a member of an older class of “tricyclic” antidepressants, and several newer “selective serotonin reuptake inhibitors” (SSRIs), including:

• Fluoxetine
• Fluvoxamine
• Sertaline
• Escitalopram
• Paroxetine

SRIs often require higher daily doses in the treatment of OCD than depression and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.

Psychotherapy/ counseling for OCD

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including

• Cognitive Behavior Therapy (CBT)
• Habit Reversal Training
• A specific type of CBT called Exposure and Response Prevention (ERP) is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication.

For many patients, ERP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms.

Other Treatment Options

Include

• rTMS (Repetitive Transcranial Magnetic Stimulation)
• DBS (Deep Brain Stimulation)
• Augmentation Strategies (medicines other than SRIs)
• Others are in various phases of scientific development

Self-help tips for OCD:

Here are other tips that may help you or a loved one during treatment for OCD

• Be active and alert including physical exercise
• Try not to isolate yourself, and let others help you.
• Try to spend time with other people and confide in a trusted friend or relative.
• Continue to educate yourself about OCD
• Maintain a regular daily schedule and keep yourself occupied and engaged.
• Be well assured that OCD is a treatable illness, and will improve if help is sought on time
• Many times it would help to tell yourself that it’s not you who is behaving erratically it’s your OCD, your illness
• Be assured that this is not a quirk or: just in the mind, please go ahead and seek help
• Encourage your friend/family to seek a consultation if he seems to be having any of OCD symptoms
• Set realistic goals of treatment and discuss them with your Doctor/therapist

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