Obsessive Compulsive Disorder (OCD), now more popularly known as OCD, is an anxiety disorder where patients suffer from intrusive thoughts which they are unable to control (obsessions), at most times inducing them to perform certain ritualistic routines (compulsions) over and over to somehow relieve their tension.
A majority of the people with OCD are aware that their thoughts and actions are illogical, but without outside help, they are incapable of treating the condition. Performing the 'rituals' such as repeated hand-washing, keeping things in order, or counting objects eats up a lot of time in a the patients' lives and naturally affect performance at work, and perhaps their quality of life as well.
Even children can be affected by Obsessive Compulsive Disorder. However, at their age, they are unable to consider their actions excessive and unnatural.
Physiology behind OCD
Appearing to play a significant role in the development of this condition is the neurotransmitter called serotonin. It is likened to a chemical messenger that facilitates the communication between the nerve cells.
Results of brain imaging for people with OCD demonstrate certain abnormalities in several sections of their brains, including the orbital cortex, the cingulated gyrus, the basal ganglia, the caudate nucleus, and the thalamus. These are the sections which process the information we receive from around us, and instructs us on which items to focus on or prioritize.
For OCD patients, these areas of the brain work double time, causing the intrusion of ideas and thoughts that should otherwise be ignored.
Symptoms
Why OCD assessment can be difficult?
This condition's assessment is highly complex and time consuming, due to the following reasons:
a) OCD patients often experience guilt or embarrassment when discussing their symptoms. Some obsessions and compulsions are already those that would be considered bizarre by the public, and the patient understandably fears being evaluated negatively by the psychiatrist. They also become apprehensive that discussing their fears could make them happen or make them worse; thus, a thorough evaluation of the symptoms is rarely achieved;
b) Although there are extensive lists of OCD symptoms, new and more unusual ones surface regularly
c) It may be difficult for the patient to recall what fears underlie their behavior, or what caused them in the first place; there are instances where patients have been doing the ritual or rituals for so long that he or she no longer considers it an OCD symptom.
The symptoms of Obsessive Compulsive Disorder are split into two general categories: obsessions, or the undesirable, invasive thoughts; and compulsions, or the repeated routines that are performed to relieve anxiety.
Obsessions
• Having doubts, however irrational they may be
• Feeling guilty about harming others, whether intentional or accidental
• Having objectionable thoughts on sex or religion
• Excessive worry over contamination, dirt, and the presence of germs
• Feeling responsible for others' safety
• Apprehension over one's thoughts causing personal harm to others
• Unnecessary concern over keeping things in perfect order
Compulsions
• Endlessly playing back conversations to review them
• Engaging in 'prayer' rituals with repetitive phrases that serve to neutralize the obsessions
• Cleaning compulsions – repeated bathing, prolonged hand washing, spending hours cleaning the house or household items
• Repeating compulsions – uncontrollable repetition of acts, such as passing through a doorway or looking behind back; repetition of phrases or words
• Checking compulsions – overly concerned with security and repeatedly checks door and window locks, seeing to it that appliances are turned off, etc.
• Hoarding compulsions – holding on to objects that have little or no value, such as old newspapers, bottle caps, boxes, or rubber bands.
• Repeatedly arranging and touching items, whether in the home or in other places
Treatment
Obsessive Compulsive Disorder is not considered a fatal condition, but when left untreated, it can significantly interfere with a person's life and those of people the patient interacts with. Schoolwork, job, social activities, and daily routines at home can become trying because the patient spends hours doing mundane rituals over and over.
It is difficult for a person with OCD to stop the habits in an instant, and it isn't realistic for other people to expect them to do so. It takes a lot of effort, and takes a while, after making changes in thinking and behavior.
Behavioral therapy is believed to be effective in treating classical cases of OCD. In 1985, a study published by Dr. Edna Foa showed that 70% of OCD patients treated with behavioral therapy showed significant improvement, if not recovery.
Other professionals deem exposure and response prevention (ERP) as the treatment of choice. This treatment basically involves contact with a person's cause of fear over a certain period. This is supported by the belief that the fears decrease after repeated exposure to the cause of fear. Over time, the patient's fears diminish because he or she realizes that performing the compulsive rituals do not aid at all in decreasing anxiety. A child who is obsessed with keeping away for germs, for example, is placed in contact with objects made to look "germy" until that child's anxiety over it diminishes or completely dissipates.
Antidepressants such as clomipramine and fluoxetine are selective serotonin reuptake inhibitors (SSRIs) that have been found to be effective for OCD treatment, especially when complemented with exposure therapy.
Risks
After a fruitful assessment, the medical practitioner should see to it that the patient is examined for coexistent disorders which could pose complications during the treatment stage. For example, a person with psychosis should not be managed with OCD behavioral interventions. In the same vein, affective disorder patients may require antidepressants in combination with, or prior to, behavioral intervention.
OCD patients should also be checked for the use of alcohol and/or drugs, whether prescriptive or recreational. Prior to treatment, the patent should stop drinking alcohol excessively, and anxiolytic drugs should be discontinued as well because they have been found to interfere with the arousal stage in ERP.
Other medical conditions also do not go well with ERP. For instance, people with cardiovascular problems are not a good fit for ERP treatment because cardiac symptoms may be triggered during the ERP arousal stage.