Abstract
Obsessive-compulsive disorder is a syndrome, the causes of which rarely lie on the surface. It is characterized by obsessive thoughts (obsessions), for which a person responds with certain actions (compulsions). Obsession is a thought or desire that constantly emerges in the mind. It is difficult to control this thought or get rid of it, and it causes a lot of stress. In this paper I would like to tell what is obsessive-compulsive disorder, by what factors it may be caused, reasons of its appearance, what factors contribute to the development of this disease and how it is treated.
Briefly about OCD
Common obsessions during the OCD are:
fear of infection (from dirt, viruses, bacteria, biological fluids, excreta or chemicals)
concerns about possible hazards
excessive worry about the accuracy, order or symmetry
sexual thoughts or images
Almost everyone experienced similar obsessions. However, a person with OCD has an exceeded anxiety level from these thoughts. And to avoid too much anxiety, a person is often forced to resort to certain "protected" actions - compulsions.
Compulsions in OCD are somewhat similar to rituals. These are actions that a person repeats again and again in response to an obsession to reduce the risk of damage. Compulsion can be physical and mental.
Usually, in the OCD syndrome compulsions are in the form of endless inspections (e.g., gas taps) or mental rituals (special words or prayers which are always repeated).
The most common is the fear of getting an infection from microbes in combination with obsessive washing and cleaning. Because of this fear of infection people do not touch door handles, toilet seats, avoid shaking hands. With the syndrome of OCD a person ceases to wash his hands not when they are clean, but when he finally feels "relieved".
Avoidance behavior is the central part of OCD, it includes:
1. The desire to avoid situations that cause anxiety;
2. The need to perform intrusive actions.
Obsessive-compulsive neurosis can cause a lot of problems, it is usually accompanied by shame, guilt and depression. The disease creates chaos in human relations and affects the ability to work. People with OCD do not seek professional help because they are embarrassed, afraid or do not know that their illness is treatable (Mayo Clinic Staff, 2013).
What causes OCD?
Despite many studies on OCD, we still cannot say with certainty what the main cause of the violation is. For this condition may respond physiological and psychological factors. Let us consider them in detail.
Genetics
Studies have shown that OCD can be transmitted through the generation to close relatives in the form of a greater tendency to the development of painful obsessions.
The genes that might play a role in the development of OCD - hSERT and SLC1A1 – deserve special attention.
The task of hSERT gene is to collect the "wasted" serotonin in the nerve fibers. The neurotransmitter serotonin is required for the transmission of impulses in neurons. There are some studies that confirm the unusual hSERT mutations in some patients with obsessive-compulsive disorder. As a result of these mutations a gene starts to work too quickly, collecting the whole serotonin before the next nerve "hears" the signal.
SLC1A1 is another gene which may be involved in the occurrence of obsessive-compulsive disorder. This gene is similar to hSERT, but his job is to transport other neurotransmitters - glutamate.
Autoimmune reaction
Some cases of the rapid emergence of OCD among children can be caused by streptococcal infection that causes inflammation and dysfunction of the basal ganglia. These cases are grouped into the clinical condition called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection).
Neurological problems
Methods of visualization in brain allow researchers to study the activity of specific brain areas. It is proved that the activity of certain parts of the brain of people suffering from OCD has an unusual activity. OCD symptoms include:
orbitofrontal cortex
anterior cingulate gyrus
striatum
thalamus
caudate nucleus
basal ganglia
The chain which includes the above mentioned areas regulates primitive aspects of behavior, such as aggression, sexuality, etc. The activation the chain triggers the corresponding behavior, such as hand washing after contact with something unpleasant. Normally, after the necessary act the desire is reduced, that is, the person ceases to wash his hands and moves to the next activity. However, the brain of patients with a diagnosis OCD experiences some difficulties with ignoring the urges from the chain. It creates communication problems in these areas of the brain. Obsessions and compulsions continue, leading to a repetition of certain behavior.
Reasons for OCD in terms of behavioral psychology
According to one of the fundamental laws of behavioral psychology, the repetition of a behavioral act facilitates the reproduction of it in the future. People with OCD syndrome try to avoid things that can launch the fear, “struggle” with the thoughts or perform “rituals” in order to reduce anxiety. Such actions temporarily reduce the fear, but, paradoxically, according to the above mentioned law, increase the likelihood of compulsive behavior in the future.
It turns out that the cause of OCD is avoidance. Avoiding the object of fear rather than enduring it can lead to tragic consequences. The most susceptible to the emergence of pathology are people who are under stress. For example, a person who always calmly used public restrooms, suddenly in a state of stress begins to "cheat" himself (a toilet is dirty and there is a risk to catch the disease). Further, according to the association, the fear may be extended to other similar objects: social sinks, showers, etc. If a person starts to avoid public toilets or begins to perform complex rituals of purification (cleaning of seats, door handles, followed by thorough handwashing procedure), rather than deals with the fear, it could lead to the development of a real phobia. (Smith & Segal, 2016).
Cognitive causes of OCD
Cognitive theory explains the occurrence of OCD by inability to correctly interpret your thoughts. For most people, unwanted or intrusive thoughts occur several times a day, but all people suffering from the disorder greatly exaggerate the importance of these thoughts.
The researchers suggest that patients with OCD give exaggerated importance to their thoughts because of false beliefs, received in childhood. Among them:
exaggerated responsibility
belief in the materiality of thoughts
an exaggerated sense of danger
exaggerated perfectionism
Environment and distress
Stresses and psychological traumas can trigger OCD process in people who have a tendency to develop this condition.
Most people with OCD symptoms have suffered stress or a traumatic event in life before the onset of the disease. Such events can also strengthen the already existing manifestations of the disorder. Here is the list of the most traumatic environmental factors:
violence
change of the house
disease
death of a family member or friend
changes or problems in school or at work
relationship problems (International OCD Foundation).
What contributes to the progression of OCD?
For effective treatment of obsessive-compulsive disorder the knowledge of the causes of pathology is not so important. What is important is to understand the mechanisms that support OCD. This is the key to overcome the problem.
Avoiding and compulsive rituals
Whenever a person avoids situations or actions, his behavior is "fixed" in the form of appropriate neuronal chain in the brain. The next time in a similar situation he will act in a similar manner, and thus he will miss the chance to reduce the intensity of neurosis.
Compulsions are also fixed. The person feels less anxious after checking whether the light is turned off. Consequently, in the future he will act in the same way.
Avoidance and impulsive actions initially "work": the patient thinks that he prevented the harm, and it stops the anxiety. But in prospect they will create even more anxiety and fear because they feed the obsession.
The exaggeration of your possibilities and "magical" thinking
A person with OCD exaggerates his capabilities and the ability to influence the world. He believes in his power to cause or prevent bad things by the power of thought. "Magical" thinking presupposes the belief that the fulfillment of certain specific activities or rituals will prevent something undesirable (like superstition).
It enables a person to feel the illusion of comfort, like he has a greater influence on events and control over what's happening. As a rule, the patient with a desire to feel safer makes rituals more and more and it leads to the progression of neurosis.
Excessive concentration on thoughts
This means the degree of importance that a person gives to obsessive thoughts or images. It is important to understand that obsessive thoughts and doubts - often absurd and contrary to what a person wants or does – happen with everyone.
The actual content of obsessive thoughts comes from human values: the things that are most important for him. The thoughts represent the deepest fears of the individual. For example, a mother is always worried about the child's health because it is the greatest value in life for her, and she will be in despair if something bad happens. That is why obsessive thoughts about causing the harm to the child are so common among mothers.
The difference is that people with obsessive-compulsive disorder have painful thoughts more often than others. But it happens due to too the great importance that patients attribute to these thoughts. It is not a secret: the more attention is paid to the obsessive thoughts, the worse they seem. Healthy people may simply ignore obsessions and do not concentrate their attention on them.
Reassessment of risks and intolerance of uncertainty
Another important aspect is the overvaluation of danger of the situation and underestimating your ability to cope with it. Many patients suffering from OCD feel that they need to know for sure that something bad will not happen. For them, OCD is a kind of absolute insurance policy. They think that if they try hard, do a lot of rituals and better insure, then they get more certainty. In the reality, big efforts lead only to an increase in doubts and strengthen the feeling of uncertainty.
Perfectionism
Some species of OCD require the belief that there is always a perfect solution, that we should do everything perfectly, and that the slightest error would have serious consequences. It often occurs with people who seek for discipline and is particularly common with those who suffer from anorexia nervosa.
Fixation
There are typical ways to "cheat" yourself, to strengthen the anxiety by your own hands:
“Everything is terrible!” - means the tendency to describe something as “horrible”, “terrible” or “end of the world.”
«Catastrophe!" - means considering the disaster as the only possible outcome.
Low tolerance to frustration - when any excitement is perceived as “intolerable” (Smitha Bhandari, 2016).
OCD Treatment
Studies show that psychotherapy significantly helps 75% of patients with obsessive-compulsive disorder. There are two main ways to treat neurosis: medicines and psychotherapy. They can also be used together.
Nevertheless, treatment without drugs is more preferable because OCD can be corrected well without medical intervention. Psychotherapy does not have any side effects on the body and has a more stable effect. Medications may be recommended as a treatment if a neurosis is serious or as a short-term measure to alleviate symptoms while you are just starting a course of psychotherapy.
For the treatment of obsessive-compulsive disorder cognitive-behavioral therapy, EMDR-therapy, short-term strategic psychotherapy and hypnosis are used.
The first effective psychological method of struggle with OCD was recognized a confrontation technique with a parallel suppression of disturbing reactions. Its essence lies in carefully dosed collision with fears and intrusive thoughts, but without the usual avoidance response. As a result, the patient gradually gets used to them and fears begin to fade.
However, not everyone feels able to go through such treatment, so the technique was perfected with the help of CBT, which focuses on changing values of obsessive thoughts and impulses (the cognitive part), as well as on changing the impulse (behavioral part).
Each of these psychotherapeutic methods of treating a disorder helps to get out of the cycle of obsession, anxiety and avoidance reactions. And it does not matter if you firstly focus on thinking about the values that a person attaches to the thoughts and events with subsequent study of alternative responses to them. Or the focus will be made on the reduction of the level of discomfort from obsessions. Or it will be the restoration of the ability to unconsciously filter out obsessive thoughts before they reach the conscious level.
All the way to the complete deliverance from suffering from OCD symptoms a person can pass with a qualified professional in the most comfortable conditions (National Institute of Mental Health, 2016).
References
International OCD Foundation. (n.d.) What is OCD? Retrieved from https://iocdf.org/about-ocd/
Mayo Clinic Staff. (2013). Obsessive-compulsive disorder (OCD). Retrieved from http://www.mayoclinic.org/diseases-conditions/ocd/basics/definition/con-20027827
Smith, M. and Segal, J. (2016). Obsessive-Compulsive Disorder (OCD). Retrieved from http://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder-ocd.htm
National Institute of Mental Health. (2016). Obsessive-Compulsive Disorder. Retrieved from http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
Smitha Bhandari. (2016). Obsessive-Compulsive Disorder. Retrieved from http://www.webmd.com/mental-health/obsessive-compulsive-disorder?page=3
