Obsessive-compulsive disorder(OCD) is a chronic anxiety provoking condition in which individuals may have obsessions and compulsive behaviors. It is a condition shrouded with stigma and shame. Hence most people try to hide it which may make it a chronic condition. Although effective psychological and pharmacological treatments are available, not surprisingly delays in diagnosis and treatment of the disorder often occurs.
It is estimated that Obsessive-compulsive disorders (OCD)Prevalence is 1-3 %. Most people with OCD may also have depression (60%) and other anxiety disorders (10-20%)
What causes Obsessive-compulsive disorder(OCD)
OCD is now predominantly considered as a neuropsychiatric disorder although the psychological theories are equally important in understanding and treating them.
There is robust an increasing evidence from imaging studies to suggest a role for neural circuits linking prefrontal and orbitofrontal cortices with basal ganglia structures in the origins of OCD. One of the main pathways implicated is the Fronto-striatal circuity, involving the orbitofrontal cortex, caudate, and thalamus.
More importantly, functional imaging studies tells us that the abnormal functioning of this cortico-striatal thalamic circuitry can be normalized by successful pharmacotherapy and behavioral therapy.Furthermore, Impulsivity, attentional deficits and set-shifting abnormalities (rigid thinking) has been found in patients with OCD and their non-affected relatives, strongly suggesting these cognitive changes represent inherited ‘trait’ abnormalities. To know more about this link between impulsivity and compulsivity, refer to the inverted iceberg hypothesis mentioned under anxiety disorders (https://mindoc.com.au/anxiety).
Serotonin and dopamine are the chemicals believed to be involved in the causation of OCD. Hence anti-depressant medications are generally prescribed for treatment of OCD as well. OCD can run in families and can be associated with Tourette’s. Some forms of streptococcal infections can cause OCD and Tourette’s(TICS) in children.
Symptoms of Obsessive-compulsive disorder(OCD)
Obsessions are unwanted images or ideas that keep repeating in an individual’s mind. These thoughts are often considered unwanted and irrational. But people suffering from OCD already are biased in their thinking which enables these thoughts to continue. Individuals with OCD often over-estimation of the likelihood of harm occurring due to their actions. They assume excessive responsibility, they often need clarity and control.
Some examples are fear of contamination, fear of making a mistake, fear of causing harm to self or someone else.
Compulsions and safetybehaviors
Compulsions are repetitive, disablingbehaviors or it can be an imagined act in the mind. They are usually felt as annoying set of acts that one need to do to overcome the anxiety provoked by obsessive thoughts. However, it does not help to reduce anxiety long term. Hence the frequency of compulsions builds to unmanageable levels.
Common compulsions include cleaning, checking, asking for reassurance, ordering and arranging, hoarding, counting, repeating words and chanting.
Some people use neutralizing behaviors and avoidance to control their anxiety.
Obsessive-compulsive related (spectrum) disorders share characteristics with OCD and cane be a co-morbidity as well, these include Dysmorphophobia, hair pulling, eating disorders, Autism spectrum disorders and Tourette’s as mentioned above.
Treatment of OCD
Cognitive-behavioral therapy (CBT) is the psychological approach of choice for OCD.The most effective component of CBT has been shown to be a prolonged graded exposure to the feared situation with self-imposed ‘response prevention’ (ERP). Graded exposure encourages prolonged periods of contact with the anxiety-provoking triggers until anxiety levels reduce by a process called habituation. It usually takes couple of hours to achieve this result. As it can be really distressing to do it at once, a graded approach based on the comfort levels of the patient is usually adopted. This followed by a self-imposed response prevention or trying not to engage in compulsion such as washing hands. Up to three quarters of patients experience symptom reduction by half at the end of ERP. These beneficial effects can last for a number of years. Sometimes ERP is combined with cognitive therapy to change unhelpful thinking patterns.
Medicines for OCD
OCD responds well to drugs that inhibit the synaptic reuptake of serotonin such as selective serotonin reuptake inhibitors (SSRIs), SNRI’s such as Venlafaxine and the tricyclic antidepressant Clomipramine. Symptoms start improving slowly with SSRIs and Clomipramine; although they can be noticeable within a few days, improvements usually continue for months. Limited response to one medication does not rule out response to another. Around 30% of patients continue to experience troublesome residual symptoms despite prolonged treatment. Hence it is important to seek help from a specialist.
There are a number of options available for treatment resistant OCD. Psychiatrists at mindoc, Glen Waverley, VIC has the expertise to undertake a comprehensive assessment to look at the reasons behind treatment resistance and to prepare a complex management plan, which would assist in getting you back to your feet at the earliest. Call us to know more.