Obsessive-compulsive disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 18, 2016
StartDiseasesObsessive-compulsive disorder

Obsessive-compulsive disorder, or OCD, is a mental disorder characterized by obsessions (intrusive thoughts or excessive worry pertaining to a particular topic) and compulsions (repetitive behaviors that the sufferer feels compelled to do in relation to the obsessive thoughts). It is a chronic disorder that has no cure, but can be managed with therapy.

Contents

Definition & Facts

Obsessive-compulsive disorder can affect anyone, but particularly manifests between the ages of early adolescence (7-13) and late teens to adulthood. OCD affects about 1 in 100 adults, or roughly 2.5 million Americans. The characteristic obsessions are intrusive thoughts that get replayed over and over in the mind of the patient, and are often focused on taboo subjects (sex), commonplace dangers or worries (like diseases or cleanliness), or thoughts about being personally responsible for catastrophic problems.

The compulsions involved in OCD are the actions that are associated with reducing the anxiety caused by the obsessions or that are thought to somehow ward off the potential worry. An example of this would be compulsive hand washing to ward off disease or germs when the obsession is cleanliness. Because of the prevalence of OCD in America, treatment is relatively easy to find, and there are many options, but there are also many mental health disorders that have similar symptoms to OCD, and a positive diagnosis needs to be given before the correct treatment is approached.

Symptoms & Complaints

A person suffering from obsessive-compulsive disorder will be plagued with recurrent, intrusive thoughts, often characterized as an inability to focus mentally on anything other than the obsession. This is distressing and can cause significant anxiety and depression for the patient. Common focuses for obsessions include:

  • Hygiene - diseases, germs, and dirt
  • Sex - Sexual taboos
  • Personal responsibility - Worrying about something that is not at all the patient's responsibility, often catastrophic events like a disaster or accident
  • Losing control - fearing that they will harm themselves or others
  • Religious obsessions - concerns about sin, morality, or the way one lives one's life

In addition to obsessions, compulsions to perform ritualized actions like checking a door before leaving the house over and over, or making sure everything on a desk points the same direction, can occur in an OCD sufferer. Though they often occur concurrently, they do not need to, and many times a person can suffer one significantly more than the other.

Though most people at times check a door or a lock, a person suffering from OCD cannot control their thoughts or mental images, they get no pleasure from the compulsion although they may have an easing of the associated anxiety, and the associated action is performed far beyond what would be considered normal. Depression, anxiety, and other disorders also have increased prevalence in people suffering from OCD.

Causes

Though there's no known direct cause of OCD, scientists have some understanding of the associated factors. In people suffering from OCD, there are interruptions and deficits of brain chemicals that connect the deeper brain structures to the frontal lobe. The frontal lobe helps manage impulse control and conscious action, and so a chemical imbalance could be the cause.

In addition, genetics seems to play a significant role, particularly in childhood. Cases of twins who developed OCD in childhood suggested genetics plays a more than 50% role, whereas in adult cases it was less, around 25%. People who suffer abuse as a child are at an increased risk to develop OCD later on in life, but at about the same rate of developing it as a child.

In addition, the disease, pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections (PANDAS) are responsible for a portion of childhood OCD cases as well. These cases differ in that they come on very quickly following an infection, and are often characterized by the presence of other symptoms, mood, and behavioral problems.

Diagnosis & Tests

Diagnosis of obsessive-compulsive disorder will focus on three main factors: whether or not the patient has obsessions, whether or not they have compulsions, and whether these factors interfere with daily life. Often a model of abnormality in psychopathology - the "4 Ds" - can help establish whether the person is actually clinically afflicted by OCD (or any other psychological disorder).

These 4 d's are distress, deviance, dysfunction, and danger. These criteria are considered influential to the diagnosis if the obsessions and associated compulsions are deviant or dangerous to themselves or to others, if they cause dysfunction in normal daily living, or if they cause the person significant distress.

In children, the appearance of symptoms following an illness is considered important, and also genetic factors and family history, as well as environmental factors, will always be considered. Though the primary diagnosis relies on the reporting of the obsessions and/or compulsions, the associated factors of family and surroundings cannot be discounted.

Treatment & Therapy

OCD is treated with medication or psychotherapy, and oftentimes both. The severity of the disorder and the amount if affects daily life will be considered, but many patients find that treatment is highly effective. In terms of medication, SSRIs (selective serotonin reuptake inhibitors) are the primary drugs prescribed. In some cases, older antipsychotic drugs will have a positive effect on the disease, and since SSRIs are the main treatment for depression and anxiety, they often work double-time, helping with the other mental disorders that often accompany OCD.

Psychotherapy focuses on helping the patient find other ways to acknowledge and then dismiss the intrusive thoughts, as well as channeling the compulsion to perform an activity into something else, or allowing the impulse to well up and then dismiss it. Personal awareness is a major part of the psychological treatment of obsessive-compulsive disorder, as well as behavioral therapy, helping the patient focus on other thoughts and actions and take back control of their life.

Prevention & Prophylaxis

Since the main cause of OCD isn't well-established, prevention is mainly a case of being aware of family history and potential contributing factors. If there is a family history of OCD, then being aware of the signs and symptoms can help establish early treatment options that mitigate the influence of the disease on the life of the patient. Most important is getting help, no matter the severity or the age of presentation.