Obsessive Compulsive Disorder

Definition

Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.

 

ocd-cycle

ocd-general

 

ocd-social-signsSigns and Symptoms

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion, and harm
  • Aggressive thoughts towards others or self
  • Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

  • Excessive cleaning and/or handwashing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
  • Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

  • Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
  • Spends at least 1 hour a day on these thoughts or behaviors
  • Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
  • Experiences significant problems in their daily life due to these thoughts or behaviors

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

If you think you have OCD, talk to your doctor about your symptoms. If left untreated, OCD can interfere in all aspects of life.

Causes of OCD

Although the exact cause of OCD is not fully understood, studies have shown that a combination of biological and environmental factors may be involved.

Biological Factors: The brain is a very complex structure. It contains billions of nerve cells — called neurons — that must communicate and work together for the body to function normally. Neurons communicate via chemicals called neurotransmitters that stimulate the flow of information from one nerve cell to the next. At one time, it was thought that low levels of the neurotransmitter serotonin was responsible for the development of OCD. Now, however, scientists think that OCD arises from problems in the pathways of the brain that link areas dealing with judgment and planning with another area that filters messages involving body movements.

In addition, there is evidence that OCD symptoms can sometimes get passed on from parents to children. This means the biological vulnerability to develop OCD may sometimes be inherited.

Studies also have found a link between a certain type of infection caused by the Streptococcus bacteria and OCD. This infection, if recurrent and untreated, may lead to the development of OCD and other disorders in children.

Environmental Factors: There are environmental stressors that can trigger OCD in people with a tendency toward developing the condition. Certain environmental factors may also cause a worsening of symptoms. These factors include:

  • Abuse
  • Changes in living situation
  • Illness
  • Death of a loved one
  • Work- or school-related changes or problems
  • Relationship concerns

How Is OCD Diagnosed?

There is no lab test to diagnose OCD. The doctor bases his or her diagnosis on an assessment of the patient’s symptoms, including how much time the person spends performing his or her ritual behaviors.

Treatment of OCD

There is no cure for OCD, but there are methods of treatment that provide relief from the symptoms to the extent that most patients can lead normal lives. Treatment-resistant OCD does not seem to respond to therapies; however, all OCD cases were once considered resistant to treatment. After further study, it is now possible to treat 40 to 60 percent of OCD patients using medication alone, and new information emerges as treatments progress, according to the National Center for Biotechnology Information (NCBI).

Therapies for OCD

Therapies for obsessive-compulsive disorder typically consist of medication, psychotherapy or both. OCD responds well to cognitive behavioral therapy. This type of therapy coupled with prescribed medication, usually antidepressants or anti-anxiety medications, alleviates the symptoms for most people who suffer from OCD.

Cognitive Behavioral Therapy Treatment for OCD

Cognitive behavioral therapy treatment for OCD may take place in individual, group or family sessions. OCD patients can experience some relief through cognitive behavioral therapy, particularly a form called exposure and response prevention. This entails gradually exposing the patient to the feared obsession. For instance, if the patient is obsessed with cleanliness, they are exposed to dirt for gradually increasing amounts of time. This helps the patient to learn new thought patterns and behaviors about their obsession with dirt. Although this form of therapy takes a lot of effort and practice, the reward is a much better quality of life for the patient.

The basic premise behind exposure and response prevention is that compulsion allows obsession to exist by interrupting the habituation process. The process of habituation is what causes a person to have less interest in a certain event once that person has witnessed the same event many times. For example, if your friends threw you a surprise party every day, you would eventually stop being surprised and thrilled. In the same manner, if the compulsion did not exist, the obsession would become less and less interesting until it eventually disappeared. Once a compulsion is fulfilled by an obsession, the person feels short-term relief of anxiety. The relief serves to reinforce the compulsion like a reward, and it becomes a perpetual cycle. Simply put, without compulsion, obsession would not occur and vice versa.

Medically Assisted OCD Therapy

The National Library of Medicine (NLM) lists medications commonly prescribed in medically assisted OCD therapy. The most effective medications prescribed for obsessive-compulsive disorder are selective serotonin reuptake inhibitors (SSRIs), which are antidepressants. These medications include:

  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)
  • Fluoxetine (Prozac)
  • Citalopram (Celexa)

If a patient fails to respond to an SSRI, doctors revert to clomipramine. Clomipramine is an older tricyclic antidepressant and was the first medication used to treat OCD. Although its efficacy is greater than that of other medications, it has unpleasant side effects that may make the patient uncomfortable. Sometimes an SSRI and clomipramine are combined in treatment. The side effects of clomipramine include:

  • Sleepiness
  • Drop in blood pressure when rising from a seated position
  • Difficulty starting urination
  • Dry mouth

Atypical antipsychotics have also proven to be helpful in low doses. Among these antipsychotics are:

  • Risperidone
  • Quetiapine
  • Olanzapine
  • Ziprasidone

In some cases, benzodiazepines can offer anxiety relief, but they are typically only used in conjunction with more reliable treatments. Cognitive therapy is the preferred form of treatment, but many patients benefit from combining medication with therapy.

Psychosurgery

Psychosurgery is used to alleviate symptoms of obsessive-compulsive disorder in patients who do not respond to medications or behavioral therapy. As per the International OCD Foundation, four types of brain surgery have proven effective in treating OCD. The first is anterior cingulotomy. This surgery involves drilling into the skull and burning an area of the brain called the anterior cingulate cortex with a heated probe. This surgery has provided benefits for 50 percent of those with treatment-resistant OCD.

The second surgery is known as anterior capsulotomy. This surgery is similar to the anterior cingulotomy surgery, but doctors operate on a different area of the brain called the anterior limb of the internal capsule. The surgery has succeeded in giving relief to 50 to 60 percent of patients with treatment-resistant OCD.

The third procedure is called the gamma knife. This treatment does not involve opening the patient’s skull. Rather, the skull is penetrated by multiple doses of gamma rays. While a single dose of gamma rays will not harm brain tissue, when multiple sources of gamma rays intersect, they create an energy level adequate to destroy targeted brain tissue. The gamma knife procedure has been helpful to about 60 percent of treatment-resistant OCD patients.

Finally, there is deep brain stimulation (DBS). Although this procedure requires opening the patient’s skull, it does not involve destroying brain tissue. Instead, electrodes are placed at strategic points inside the brain and wired to a pulse generator. The battery-powered generator, also called an implantable neurostimulator, sends pulses to the brain. It works in a similar fashion to a pacemaker. So far, only small studies have been conducted with deep brain stimulation, but the response rate is similar to the other surgeries.

Other Therapeutic Methods

Intensive treatment programs are available. Some programs last only a weekend while others require a three-month stay at a treatment center. At these facilities, OCD patients undergo intensive individual, group and family cognitive therapy every day. A specifically devised medication regimen is also used. Other therapeutic methods are in development. Research involving the manipulation of neurotransmitters is currently under way.

The National Alliance on Mental Illness (NAMI) discusses the use of electroconvulsive therapy (ECT). During ECT, the psychiatrist uses a machine to deliver electric shocks to the brain of the patient. The shock triggers a controlled seizure to activate neurons that bring about changes in neurochemical levels in the brain. This method is very effective for OCD.

Transcranial magnetic stimulation utilizes magnetic fields to stimulate the nerve cells in the patient’s brain. This process decreases the severity of some symptoms of depression. The method is used when others fail.