What is obsessive-compulsive disorder?
Obsessive-compulsive disorder (OCD) is one the anxiety disorder in which an individual have unnecessary and repetitive thoughts, ideas, feelings, obsessions or behaviors that let them or drive them to do something (Stein & Hollander, 1993). They feel being compelled to do something.
An obsession is defined as an unnecessary disturbing thought, illustration or urge, which constantly enters the mind of an individual. Compulsions are recurring behaviours or cerebral acts that the individual feels driven to execute. A compulsion may either be observable and overt by others, for example checking a door lock, or a secret mind act that cannot be viewed as in repeating a certain expression in the mind.
The symptoms of OCD may directly affect the well-being of not only that particular affected person but also his/her family members, such as, concerns regarding contamination can intermittently cause severe hygiene measures and these are particularly applied to the members of the family. The frequency and intensity of symptoms of OCD varies among different people.
An obsessive-compulsive disorder is a treatable disorder. With psychological interventions for example behavioral and cognitive-behavioral therapy in addition to pharmacological treatment can bring about considerable decrease of symptoms of OCD. However, the symptoms of obsessive-compulsive disorder remain at modest levels even after ample treatment course and a totally symptom-free interval is unusual.
Although much progress has already been made in management of obsessive-compulsive, still many more research and studies are needed. It is believed that a better understanding of this disease will lead to better treatment.
Symptoms of OCD
OCD is characterized by a number of symptoms. There is appearance of a lot of problems in individuals suffering from OCD. Some of them are given below:
Common obsessions observed in patients with OCD
- Contamination from germs dirt, faeces, or dangerous chemicals
- Sexual thoughts
- Too much concern with symmetry or order
- Fear of mischief such as door locks are not secured
- Obsessions with the physical symptoms
- Sacrilegious, religious, or irreligious thoughts
- Thoughts of aggression or belligerence
- Urge to save useless or weary possessions
Common compulsions observed in patients with in OCD
- Checking again and then
- Washing, cleaning repeatedly
- Repeating acts
- Psychological compulsions
- Ordering, evenness or precision
- Hoarding
- Counting
The severity of this disease varies noticeably from one person to another. People may be able to conceal their obsessive compulsive symptoms often from their own members of the family. Nevertheless, the disorder may have a main pessimistic impact on social relationships causing frequent family and marital conflict, disagreement or frustration, even separation or break up (Koran, 2000).
A number of studies have found decrease rates of marriage among individual with OCD in comparison to those of the general population. It also impedes with relaxation activities or spare time recreeation (Antony et al., 1998) in addition to a person’s ability to work or study, leading to reduced occupational or educational achievement and unemployment (Leon et al., 1995; Koran, 2000). The end result is that person become socially secluded and cannot do well in the society.
As obsessive compulsive develops, the unwanted and obsessive terrors that can be overpowering differ from person to person. This is also same for the people with compulsive behaviour who try to control their worries.
Treatment for OCD
Treatment of OCD is expected to involve two major techniques, such as
- Medical treatment: This is done by using different medicines. These medicines control the symptoms of the disease.
- Psychological treatment or behavioral therapy: Behavioral therapy is believed to be a good adjuvant. It has been shown to be even more effective than the medicine therapy alone. There are numerous such therapies available that altogether change the way a person thinks or behaves and eventually reduces anxiety and apprehension (Abramowitz, 1997).
Healthcare professionals think of the disturbance of daily function as being the functional disturbance and impairment.
Obsessive compulsive disorder with mild functional impairment of a person is usually managed with a only a course of cognitive behavioral therapy (CBT). Moderate form of OCD requires intensive course of CBT couple with antidepressant medication e.g. selective seretonin reuptake inhibitors (SSRIs).
Medical Treatments and Recommended Drugs for OCD
The outlook for Obsessive compulsive disorder has been considerably improved by the invention of effective drug treatments (Montgomery, 1980). Serious pharmacological investigation has constantly shown that OCD reacts selectively to drugs that perform a role as strong inhibitors of the synaptic reuptake of serotonin (Montgomery et al., 2001). Presently, this comprises
- Tricyclic drug such as clomipramine
- Selective serotonin reuptake inhibitors (SSRIs) fluoxetine, citalopram, fluvoxamine sertraline, and paroxetine
SSRIs prevent surplus serotonin to be removed by the neurons of the brain, thus keep the levels high and available all the time. It has been seen that downregulation of high level of serotonin can lead to problems of mental health.
Clomipramine: Clomipramine as mentioned before is one of the member of a tricyclic antidepressant (TCA) family that can be utilized as a substitute to SSRIs for treating OCD. Generally TCAs are not commonly prescribed as do the SSRIs owing to their more side effects. Still, they can be useful in treating individuals with OCD who cannot endure SSRIs. The Possible side effects of clomipramine are a dry mouth
- Constipation
- Extreme tiredness
- Diarrhea
- Dizziness
- Blurred vision
Results of studies have suggested that for obsessive-compulsive disorder less selective agents for example clomipramine have a better outcome size as compared to that of selective agents.
The finding that these drugs are helpful even when depression is severely excluded in the reference population entails a particular anti-obsessional effect. Medicines lacking these properties for instance the monoamine-oxidase inhibitors (MAOIs) and standard tricyclic antidepressants have been established to be unsuccessful in randomized controlled trials (RCTs) (Insel et al., 1983). Studies researching for the effectiveness of lithium and benzodiazepines have also not generated positive results in patient with OCD. Additionally, antipsychotics have not been appeared to be helpful but may have a function as means of augmentation in cases where the reaction to an SRI is meager or partial. The selectivity of the drug response for serotonergic agents differentiates OCD from depression.
Psychological Treatment
Behavioural therapy was the primary psychotherapy for which cautious practical support was got and is helpful in obsessive-compulsive disorder. An essential constituent of behavioural therapy is contact to the alarmed stimuli.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is the most generally accepted psychological treatment for obsessive compulsive disorder (Bridget and Michael, 2010).). It is an approach more colloquially called a psychotherapeutic approach that tackles a wide range of disorders related to emotions and behaviours. It works via several goal-oriented, clear systematic methods to deal with maladaptive behaviours, cognitive practices and dysfunctional emotions. OCD, from the viewpoint of cognitive-behaviour theory, are regarded as learned behaviours that are attained through experience (Lorraine, 2011). If OCD is not treated, it can lead to more worsening of the individual’s general health, in addition of producing negative consequences in the personal, professional, cultural and social contexts (Lieber, 1995).
Cognitive behavioural approach has been found a superlative mean of dealing with obsessive compulsive disorder. The main interventions of the CBT have been used in the management of OCD are exposure and response prevention. In spite of the good response rate of cognitive behavioural therapy with OCD it is imperative to remember that a considerable proportion either reject treatment or escape treatment near the beginning, often due to the requirements of exposure and response prevention.
Cognitive Behavioural Therapy (CBT), by working on the notion that thoughts determine humans’ sentiments and behaviour, helps people to cope with their obsession and compulsion behaviour. It teaches them how they can unlearn detrimental behaviours, discard depression-prone thoughts and take on different and more flexible reactions. CBT can be combined with different medicines and different other approaches for better outcomes. Some researchers may criticise CBT because it does not work on past aspects of a person, but still it holds much potential to bring about constructive change in the behaviour of an individual with OCD.
Exposure And Response Prevention (ERP)
Exposure and response prevention (ERP) entails recognizing a number of states that cause one’s anxiety. It is based on cognitive behavior therapy. It is done by letting the person exposed to the situation that trigger obsessions and then let them to engage in the coping strategies so to prevent compulsions.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT), also termed as shock therapy has also been established to have efficacy in some strict and unruly cases. It is considered to be a standard psychiatric treatment for patients suffering from certain psychiatric illnesses. This therapy is the last resort in patients of OCD.
Deep Brain Stimulation
It is an alternative approach to surgical technique for patients with persistent OCD. At present, it is only and mainly used as component of medical research. The stimulation of brain involves implanting of an electrical generator into the chest and small metal discs are implanted into the brain. The electrical signal is delivered from the device placed in the chest to the electrodes placed in the brain. This technique has been shown to improve the condition of people with OCD. However, there are some potential grave adverse effects linked with the method, including bleeding and infection within the brain.
A healthy lifestyle is also the part of the treatment for OCD. The healthy lifestyle is characterized by an adequate rest, exercise, and well balanced nutrition. All this can also assist to decrease the impact of anxiety and depression.
References
Abramowitz, J.S. (1997). Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: a quantitative review. J Consult Clin Psychol, 65, 44–52.
Antony, M.M., Roth, D., Swinson, R.P., et al. (1998) Illness intrusiveness in individuals with panic disorder, obsessive-compulsive disorder, or social phobia. Journal of Nervous and Mental Disease, 186, 311–315.
Bridget, A.H. and Michael W. (2010). Otto Cognitive-Behavioral Therapy for Substance Use Disorders. Psychiatr Clin North Am. 33(3), 511–525.
Insel, T.R., Murphy, D.L., Cohen, R.M., et al.(1983) Obsessive-compulsive disorder:a double-blind trial of clomipramine and clorgyline. Archives of General Psychiatry, 40, 605–612.
Koran, L.M., Ringold, A.L., & Elliott, M.A. (2000) Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder. Journal of Clinical Psychiatry, 61, 514–517.
Leon, A.C., Portera, L., & Weissman, M.M. (1995). The social costs of anxiety disorders. British Journal of Psychiatry, 166 (Suppl 27), 19–22
Lieber, C.S. (1995). Medical disorders of alcoholism. N Engl J Med, 333, 1058 – 65.
Lorraine, L. (2011).Spiritually Modified Cognitive Behavioral Therapy In The Treatment Of Substance Abuse: A Case Conceptualization. NACSW Convention.
Montgomery, S.A. (1980) Clomipramine in obsessional neurosis: a placebo controlled trial. Pharmacological Medicine, 1, 189–192.
Montgomery, S.A., Kasper, S., Stein, D.J., et al.(2001) Citalopram 20 mg, 40 mg and 60 mg are all effective and well tolerated compared with and well tolerated compared with placebo in obsessive compulsive disorder. International Clinical Psychopharmacology, 16, 75–86.
Stein, D.J. & Hollander, E. (1993). The Spectrum Of Obsessive-Compulsive Relateddisorders. In: Hollander E, eds. Obsessive-compulsive related disorders. Washington: American Psychiatric Press.
