Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by recurrent and persistent thoughts and feelings as well as repetitive and ritualized behaviors. In other words, patient of OCD shows obsessions (which can elevate anxiety) and/or compulsions (which are used to decrease anxiety) that can be distressing and time consuming (Solomon 646; Stein 180). Late adolescence is the mean age for the onset of the problem in men, whereas in women, the problem may start in early 20s. Children as well as adolescents may also develop the problem, and the prevalence is nearly 0.25% in 5 to 15 year olds (Veale, and Alison 1). It is among the top five most commonly found psychiatric problems of the world. According to the World Health Organization (WHO), OCD is the most important cause of nonfatal illness in the world (Solomon 646).
Cause of OCD
Genomewide association studies have been performed on OCD and some candidate genes have also been suggested but the findings of studies are inconsistent, and the exact cause of OCD is still unclear. Researchers have also found some brain structures as well as functions that are involved in OCD as, for example, orbitofrontal cortex and caudate nucleus show hyperactivity. Moreover, thalamus, anterior cingulate cortex, parietal cortex, and amygdala may also show abnormalities in OCD. Neuropsychological studies also show problems in cognitive abilities that are related to the functioning of the frontal lobe as well as its associated frontosubcortical structures (Solomon 647).
Commonly found symptoms in OCD
According to ICD-11 (international classification of diseases, 11th revision) OCD can be diagnosed by the presence of obsessional symptoms and/or compulsive acts (Veale, and Alison 3). Obsession refers to persistent and repetitive thoughts, images or urges that can result in anxiety or distress. Compulsion refers to an irrational motive for performing trivial and/or repetitive actions that can occur against the will of the patient (Solomon 646). Obsessions and related compulsive behaviors may include (649):
fear of being contaminated and/or contaminating others, thereby cleaning or washing rituals,
recurrent thoughts of inappropriate sexual behavior, thereby avoiding any such kind of situation,
recurrent thoughts of becoming immoral, thereby repetitive request for forgiveness and praying,
recurrent appearance of violent images and/or fear of harming other people, thereby asking others to confirm about being a good person,
fear of talking inappropriately in public, thereby avoiding people,
recurrent thoughts of doing things inappropriately, thereby excessive checking of performing actions in a specific manner, and
Superstitious thoughts, thereby taking extra care of normal things.
Sometimes, depression, anxiety disorders, psychotic disorders, and attention deficit–hyperactivity disorder are misdiagnosed as OCD, but it is important to check the symptoms that are particularly associated with OCD.
Other conditions associated with OCD
Some other problems that can be found in patients of OCD are depression, social phobia, specific phobias, generalized anxiety disorder, alcohol misuse, and certain other related disorders as, for example, body dysmorphic disorder. Patients of some other disorders may also develop OCD. For example, about 10% of patients of schizophrenia can also be diagnosed with OCD; about 10% of patients of bipolar disorder can show the problems of OCD; about 20% of patients of Tourette’s disorder (Stein 181) and about 20% of people with anorexia and bulimia nervosa may also show OCD. On a further note, OCD symptoms are also present in patients of autistic spectrum disorder and those patients may have more repeating and self-damaging behaviors as compared to those having no autism spectrum disorder (Veale, and Alison 3).
Management of OCD
Among the most important management strategies for OCD are psychotherapy including exposure-and-response-prevention therapy and/or cognitive therapy, and pharmacotherapy (Solomon 646-649).
Exposure-and-response-prevention therapy includes repeated and prolonged exposures to fear-causing situations or stimuli along with strict check to avoid compulsive behaviors. In this therapeutic strategy, the patient is initially exposed to moderate level of distressing situations or stimuli and then their level of exposure is increased with the passage of time. During the situation, therapists instruct patients to focus on the aspects of fear-causing situation or stimuli that can increase obsessive thoughts, and they are also instructed to move away from compulsive behavior. The exposure to the situation is performed daily with increase in intensity of situation. Therapists can work with the patient in different formats as, for example, by using telephone, computer, or internet (Solomon 648).
Cognitive therapy is considered as a first-line therapeutic strategy for OCD (Stein 185). It includes the focusing of patients on the identification and rectifying the dysfunctional belief and thoughts that are related to fear. This therapeutic strategy helps patients in decreasing their anxiety and compulsions by recognizing unrealistic thoughts and beliefs that can develop automatically. Moreover, the therapy also helps in changing the interpretations of those thoughts. During the course of therapy, the patients keep the daily record of obsessions as well as interpretations that are related to obsessions. Therapists use Socratic questioning to challenge the unrealistic thoughts and beliefs of the patients, and help them to recognize the cognitive distortion. Therapists may also use behavioral experiments such as asking a patient to touch dirty objects and avoiding the washing of hands after touching the objects (Solomon 649).
In addition to psychotherapeutic strategies, pharmacotherapy can also be used to manage the problem of patients. Pharmacotherapy includes the use of tricyclic antidepressants such as clomipramine, or selective serotonin-reuptake inhibitors (SSRIs) such as paroxetine, fluoxetine, citalopram, fluvoxamine, escitalopram, and sertraline. Research shows that 40% to 65% of patients of OCD show response to SSRIs or clomipramine, i.e. they show 20% to 40% of improvement in the severity of symptoms (Solomon 650). However, most patients would not see significant improvements until 4 to 6 weeks (Stein 185). Moreover, the probability of full remission of the problem with the pharmacotherapy use alone is low. On a further note, start of OCD in the early ages, severe condition of OCD, and presence of other problems could decrease the efficacy of pharmacotherapy (Solomon 650).
Pharmacotherapy can be combined with other therapeutic approaches such as exposure therapy for better outcomes. Research shows that combination of pharmacotherapy with exposure therapy gives better outcomes as compared to pharmacotherapy alone. SSRI can only be used as monotherapy in patients, who show better response to pharmacotherapy or who want to use medicines rather than psychotherapeutic strategies (Solomon 650).
In addition to above mentioned interventions, ablative neurosurgery such as cingulotomy and capsulotomy, and deep-brain stimulation can also be used in severe cases of OCD. However, only few patients having severe conditions qualify for surgical treatment (Solomon 651).
Concluding Remarks
OCD is a neuropsychiatric disorder in which a patient shows obsessive and compulsive activities characterized by repetitive and ritualized behaviors. It can be treated by using psychotherapy and/or pharmacotherapy. However, causes of the development of disorder is not clear, therefore further studies are required. Moreover, further investigations are required to improve the therapeutic strategies without physically disturbing the patient, i.e. noninvasive treatment. Researchers have also to work on the best ways that can help family members of a patient to deal with OCD.
Works Cited
Solomon, Caren G, and Jon E Grant. "Obsessive–Compulsive Disorder." New England Journal of Medicine 371.7 (2014): 646-53. Print.
Stein, DJ. "Obsessive Compulsive Disorder." South African Journal of Psychiatry 19.3 (2016): 7. Print.
Veale, David, and Alison Roberts. "Obsessive-Compulsive Disorder." BMJ 348 (2014): g2183. Print.
