Obsessive Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a prevalent psychiatric disorder with a 12- month occurrence of 1.2% in the United States and globally. The pervasiveness of childhood OCD is 1% to 2% in the United States, and 50% of the affected children have comorbid psychiatric disorders (Fenske & Petersen, 2015). Regardless of increased distress and rates of impairment, people with OCD are usually undiagnosed and hence do not receive evidence-based care, which is challenging in rapidly growing primary care settings because of high medical use and costs related to OCD. The disorder features obsessive thoughts and compulsions. Obsessions refer to recurrent, undesirable, upsetting thoughts or images, for example, of being dirty or worries of injuring others unwillingly. People with OCD attempt to prevent such thoughts by repressing or counteracting them. Compulsions refer to mental or behavioral rituals that a person feels obliged to execute to minimize distress or avoid a dreaded outcome, for instance, washing hands and checking for locks regularly. Compulsions are not reasonable safety efforts but rather out-of-proportion responses to circumstances.
Causes of Obsessive Compulsive Disorder
OCD results from ‘dysfunctional’ beliefs as well as elucidations. People who experience OCD think that they are more responsible for a circumstance than they are. Therefore, their response may be beyond proportion. For instance, several individuals undergo sudden and invasive thoughts, for instance, imagining that they might push another person in front of a train on a crowded stage. Typically, individuals dismiss such as passing thoughts and do not believe that they can do them. Nevertheless, people with OCD are inclined to believe that they might act on the thoughts, which results in anxiety or fear, and therefore, they may develop a compulsion to stop its occurrence (Craner, Skillings & Barnes, 2017).
Psychological theories assert that OCD results from personal experience. People who had a painful childhood experience or underwent trauma or abuse may learn to utilize obsessions and compulsions in coping with anxiety. Nevertheless, the theory does not illustrate why individuals who cannot point to any painful experiences may suffer from OCD. Also, if an individual’s parent has similar anxiety or same forms of behavior, one can learn to utilize such kind of behavior as a coping strategy.
Certain biological theories indicate that lack of the brain chemical serotonin has a function in OCD. Nonetheless, specialists disagree on the role, and no research confirms whether the absence of serotonin leads to OCD or is the effect of having the condition. Research has also examined genetic factors and contributions of different parts of the brain to OCD. However, they did not identify a conclusive statement. The biological theories do not explain how the condition develops differently in various individuals. Several experts have discovered that some children appear to develop OCD symptoms abruptly after having a streptococcal infection, for example, strep through or scarlet fever (Kohl, Baldermann, Denys & Kuhn, 2016).
Signs and Symptoms of Obsessive Compulsive Disorder
Individuals withobsessive-compulsive disorder experience symptoms differently. The majority of the patients have random obsessive thoughts or compulsive. Nevertheless, in obsessive-compulsive disorder, such symptoms usually last over an hour every day and interrupt daily life. Obsessions are insensitive, illogical thoughts or impulses that continually happen. Compulsions are repetitive acts that temporarily release stress caused by an obsession. Just as the obsession, individuals may attempt to avoid performing compulsive acts but feel compelled to do so to release anxiety. Obsessive behaviors include quilt feelings of having offended others and committed a mistake. Others include hostile sexual images or worries of speaking or shouting odd things in public. Compulsive behavior includes hand washing because of worrying about germs, counting and recounting money because someone is not certain of having added correctly, and checking to confirm if a door is locked or the stove is off. Moreover, it entails “mental checking” that displays intrusive thoughts (Park, Storch, Pinto, Lewin, Park, Storch & Lewin, 2016).
The most common obsessions are unwanted thoughts about damage or violence, undesirable sexual thoughts, and unwanted blasphemous thoughts. Obsessions are closely linked to a person’s condition. For instance, a loving parent may worry about hurting a child. Other examples of common obsessions include fear of getting dirty, extreme concern with order, and a disease or physical symptoms. Common compulsions involve physical compulsions, such as frequent washing or checking, or mental compulsions, for example, repeating a particular word. Other examples include repeating actions, touching, focusing on a number and ordering or arranging.
Diagnosis of Obsessive Compulsive Disorder
The first step in seeking professional help is visiting a general practitioner. The physician conducts examination and diagnosis and assists an individual to access proper treatment. When discussing OCD, doctors ask direct questions regarding probable symptoms. For instance, the frequency of hand washing and checking things, the presence of any thought that persistently troubles an individual and cannot stop it, whether daily activities take a long time to complete, and the concern of putting things in a special order. The physician also finds out whether such issues trouble the person and their effect on everyday life. A doctor then deliberates the answers against a list of medical measures to make a diagnosis. The diagnosis of OCD also indicates the severity of the condition, for instance, mild, moderate or severe OCD. Individuals find it challenging to share experiences with a doctor, especially if they experience upsetting thoughts regarding subjects like religion, sex or violence. Nevertheless, it is necessary to talk as honestly as possible for the practitioner to recommend the right form of assistance required (Pauls, Abramovitch, Rauch & Geller, 2014).
Treatments for Obsessive Compulsive Disorder
Many people prefer a combination of medicine and therapy, as a better treatment method. The most common type of medications utilized in treating ODC is selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine, fluvoxamine, paroxetine, citalopram, and sertraline. The treatment of OCD with antidepressants usually takes longer to effect compared to the treatment of depression. Also, such medicines should be provided in larger doses and for longer durations than for depression. Tranquillizers, such as diazepam, are offered to patients who experience severe anxiety. Beta-blockers, such as propranolol (Inderal) are sometimes recommended to treat the physical symptoms of anxiety (Abramowitz, Taylor, & McKay, 2009).
Two kinds of psychotherapies are useful for treating OCD include exposure and response therapy (ERT) and cognitive behavioral therapy (CBT). Exposure and response therapy (ERT) is a form of therapy that exposes individuals to the cause of their anxiety. This therapy assists patients to stop a recurrent behavior that develops from fear and hallucinations.
Cognitive behavioral therapy (CBT) concentrates on the imaginations that result in pain and transforming the negative imagination as well as behavior linked to them. For obsessive-compulsive disorder, the objective of the cognitive behavioral therapy is to identify negative thoughts and, with practice, slowly reduce their intensity to the level of harmlessness. Exposure and response prevention (ERP) is a form of CBT that is suggested for treating OCD. ERP functions by enabling an individual to challenge obsessions and fight the desire to proceed with compulsions. During ERP, the therapist supports the patients to put themselves in a condition that can make them feel anxious. Rather than conducting normal compulsion, the individuals are motivated to endure the anxiety. ERP assists the individuals in realizing that the uncomfortable feelings eventually disappear without performing a compulsion. The progression of ERP enables individuals to realize that their obsessions cause them less anxiety, and the anxiety they feel disappears faster. They feel less need to do compulsions, which is known as habituation (Scheeler, 2017).
Neurosurgery, which is a surgery on the brain, is not a commended treatment for OCD. It is rarely issued in severe cases when not all other treatments are successful. The Mental Health Act sternly controls neurosurgery.
Management of Obsessive Compulsive Disorder
People can do various things to support individuals with OCD, which include the following:
Self Help Resources
Several individuals with mild OCD know that they can utilize self-help resources to establish their coping strategies. Such resources can also be used while waiting for treatment, or together with the treatment. They are normally based on cognitive behavioral therapy (CBT).
Developing a Support Network
Most individuals find it difficult to discuss OCD. It is important for a person to talk to someone trustworthy about OCD in a quiet space where there are no interruptions. This process enables many people, particularly family and friends, to understand the condition. Some individuals prefer writing their feelings down in a letter to discuss it together. Moreover, spending more time with friends and family assists one to feel more comfortable around them and eventually become more willing to share experiences.
Peer support joins individuals with same experiences to support one another. Its benefits include the feeling of acceptance, high self-confidence, learning new information and places for support, and challenging stigma and discrimination.
Looking After Self
Having enough sleep provides energy for coping with difficult feelings as well as experiences. Also, taking balanced diet regularly and maintaining a stable blood sugar level has a positive impact on mood and energy levels. Besides, exercise is useful for mental wellbeing, as it naturally minimizes the baseline level of anxiety that an individual undergoes. Aerobic exercise is a major complementary intervention that enhances the quality of life for individuals with OCD (Koran, Hanna, Hollander, Nestadt & Simpson, 2007).
It is important to manage stress because OCD becomes worse if someone is stressed or anxious. A patient can engage in different ways of easing stress, which are also healthy to the mind. Stress can be relieved through the patients avoiding over thinking and worrying about their behavior, which they have no control over. They need to identify individuals who understand them to help them walk through this journey.
Obsessive-compulsive disorder is a chronic disease that can result in distress as well as disability. Appropriate identification and treatment using OCD-specific therapies may enhance outcomes; however, diagnosis is usually delayed. OCD patients require a lot of care and support to help them overcome the challenges that are associated with the condition. Patients who fail to react to therapies and medications need to be referred to a psychiatrist.
Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive Disorder. The Lancet, 374(9688), 491-499.
Craner, J. R., Skillings, J. L., & Barnes, C. R. (2017). Obsessive-compulsive disorder: Under-Recognized and Responsive to Treatment. Journal of Family Practice, 66(8), 503-506.
Fenske, J. N., & Petersen, K. (2015). Obsessive-Compulsive Disorder: Diagnosis and Management. Am Fam Physician, 92(10), 896-903.
Kohl, S., Baldermann, J. C., Denys, D., & Kuhn, J. (2016). A Synergistic Treatment Strategy for Severe Obsessive Compulsive Disorder. Neuromodulation, 19(5), 542-544.
Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., & Simpson, H. B. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. The American journal of psychiatry, 164(7), 1.
Park, J., Storch, E., Pinto, A., Lewin, A., Park, J. M., Storch, E. A., & Lewin, A. B. (2016). Obsessive-Compulsive Personality Traits in Youth with Obsessive-Compulsive Disorder. Child Psychiatry & Human Development, 47(2), 281-290.
Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive disorder: an integrative genetic and neurobiological perspective. Nature Reviews Neuroscience, 15(6), 410-424.
Scheeler, C. (2017). “Here’s What It Really Feels like to Have OCD …welcome to my brain.” Good Housekeeping, 265(1), 96-98.