Obsessive compulsive disorder (OCD)

What is obsessive compulsive disorder?

Obsessive compulsive disorder (OCD) is a long-term disorder in which a person can experience reoccurring thoughts which they can’t control (obsessions) or repetitive behaviors (compulsions), or both. It’s common for the obsessive thoughts to be connected to the behaviors (for example:” if I don’t wash my hands a specific number of times something horrible will happen”). These symptoms create significant stress in the everyday life of the individual and can consume a lot of time and make the simplest of actions difficult. This disorder affects many people around the world, including not only adults, but children and adolescents as well.

What are the most common symptoms of OCD?

Obsessions are thoughts, ideas, images or impulses that appear in the mind of the individual again and again. They are usually disturbing, and the individual often tries to fight them off and remove them from their mind. These obsessions are recognized by the individual as their own even though they are unwanted and unpleasant, not as that of others, which is an important diagnostic criterion.

Compulsive behavior or rituals are mental or physical behaviors which are repeated again and again. They are not practical or instrumental in the accomplishment of some task. Their function is most often to prevent the realization of some very unlikely event which is usually connected to some form of misfortune, pain or damage that would befall the individual or those close to them, or the individual would act them out themselves. The belief that these pointless actions and behaviors somehow stop these horrible events is a key part of this disorder. It’s common that individuals recognize these behaviors as nonsensical and pointless and try to fight them, like the obsessions, but often to no avail. Anxiety is created by the obsessive thoughts and gets drastically worse if the compulsive behaviors aren’t fulfilled or are trying to be stopped.

The presence of obsessions, compulsions or both are the clearest indications of this disorder.

Common obsessions are:

• Fear of germs, filth and contamination
• Fear of forgetting or losing something
• Fear of losing control over one’s own behavior
• Aggressive thoughts directed towards oneself or others
• Unwanted, forbidden or taboo themes concerning sex, religion or violence
• The wish for things to be symmetrical, in perfect order and organization

Common compulsions are:

• Excessive cleaning or hand washing
• Arranging objects in a certain, precise way
• Repeated checking of things, like if the door is locked or if the stove is turned off
• Compulsive counting
• Silent word repetition or prayer

Not all repeated thoughts are obsessions, and not all rituals and habits are compulsions. The main difference is that people with OCD cannot control their excessive thoughts and behaviors, they often spend more than an hour daily thinking obsessive thoughts or doing compulsive activities, they gain no pleasure from completing them but only the reduction of anxiety.

Because of all of this, individuals with OCD have significant problems in their everyday functioning and lives.

Some people who suffer from OCD can demonstrate repetitive unwanted movements or sound tics. The movement tics are sudden and short, like blinking, eye movements, facial grimacing, shoulder shrugging or sudden movements of the head or shoulder. The vocal tics can be clearing of the throat, sniffing or other similar sounds.

Adults with this disorder often understand the pointlessness of the content of their obsessions and compulsions, but children might not, and this often has a significant impact on them. Parents and teachers are often able to recognize OCD symptoms in children.

The symptoms of OCD can begin in any age but it’s most common for them to appear in the period between late childhood and adolescence. Symptoms can be weaker or easier to handle in the beginning and get worse over time, or they can disappear and then return. In stressful periods the symptoms often worsen. The contents of the obsessions and compulsions can also change over time.

The causes of OCD:

As with many mental disorders, a specific cause isn’t clear, but many of the risk factors that contribute to the development of this disorder are.

• Genetics: research shows that family history and the presence of OCD in closer relatives is a significant factor that contributes to the chances of development of this disorder.
• Biology: research shows that differences exist in the neural structures and their functioning in those who suffer from OCD, especially in the regions that are designated to control behavior and emotional responses. Further research is being conducted to better understand the connectedness of neural structures and their functioning in this disorder.
• Temperament: temperament is the predisposed biological base of interaction between the individual and the world on top of which other characteristics of personality are developed. Research has shown that people who demonstrate reclusive behaviors, are susceptible to negative emotions and show symptoms of depression and anxiety as children have higher chances of developing OCD later in life.
• Trauma: some research has shown the connection of trauma, specifically in early childhood, and OCD symptoms. Further research is needed in order to better understand this relationship.

Diagnosing OCD:

OCD has common comorbidity and overlapping with other mental disorders such as Tourette syndrome, bipolar disorder, anxiety disorders, depressive disorders, schizophrenia and ADHD.

This makes diagnosing OCD difficult and speaks to the complexity of the disorder.

People with OCD often consume alcohol and other psychoactive substances in order to cope with their symptoms.

If you doubt that you or someone in your vicinity has OCD symptoms you should consult a doctor, psychiatrist, psychologist or other qualified healthcare experts. Expect questions about the symptoms, health history, familial health history and potential redirection toward mental health experts in order of precise understanding of the diagnosis.

OCD treatment:

The good news is that therapy can help many who suffer from even the most intense types of OCD.  The most common ways of treating OCD are through psychotherapy, pharmacotherapy or their combination. It is important to follow the instructions of your doctor or therapist who assists in the making of the therapy plan, because both psychotherapy and pharmacotherapy can take some time to start working. There isn’t a clear way to get rid of OCD completely, but there are many ways and techniques which help regulate symptoms and help implement functionality and normality into everyday life.

Psychotherapy: research shows that some forms of psychotherapy can be, in many cases, as effective as pharmacotherapy in the reduction of OCD symptoms. Cognitive behavioral therapy (CBT) is the most efficient and focused on the problem of the symptomatology form of psychotherapy that has significantly positive results with OCD. Techniques within CBT like exposure therapy and response prevention therapy have proven to be significantly successful with OCD symptoms, even when individuals don’t react well to the pharmacotherapy.

Pharmacotherapy: the most common pharmacotherapy that is used with OCD is antidepressants, specifically selective serotonin reuptake inhibitors (SSRI). The betterment of the symptoms can appear after 8 – 12 weeks of using the antidepressant. Sometimes unwanted reactions to this therapy can be expected such as: headaches, sleep disorders, lightheadedness and nausea.

The medical expert with which the individual in consulting regarding the therapy can lower or increase the dosage of the antidepressant, if necessary, as to regulate the unwanted symptoms or avoid the possibility of creating an addiction to the medication. It is important to stick to the prescribed therapy and not abandon the medication without consultation.

Written by: Bachelor of Psychology, Aleksa Holcer

British Psychological Society (UK). (2006). Diagnostic criteria. Obsessive-Compulsive Disorder - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK56452/

ICD-10 version:2019. (n.d.). https://icd.who.int/browse10/2019/en#/F42

Obsessive-Compulsive Disorder. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd#part_2230

Singh, A., Anjankar, V. P., & Sapkale, B. (2023). Obsessive-Compulsive Disorder (OCD): A comprehensive review of diagnosis, comorbidities, and treatment approaches. Curēus. https://doi.org/10.7759/cureus.48960

*This text is intended for informational purposes only. If you experience any symptoms, it is recommended that you seek advice from your doctor or a qualified healthcare professional.*

*Image taken from the site: https://unsplash.com/photos/person-in-grey-t-shirt-washing-hands-O2jdGcXmgAw*