Obsessive Compulsive Disorder

• Symptoms: Divided into obsessions (dysfunctional thought patterns that cause anxiety) and compulsions (repetitive behaviour to address the associate fvgd obsession)
• Causes: No conclusive causal factor (Environmental triggers such as work-related stress, alongside genetic history, have been associated with the condition)
• Risk Factors: Family history of related mental disorders, childhood abuse, recent psychological or physical trauma
• Severity: Mild to moderate (Can become severely disabling in rare cases)
• Which Doctor to Consult: Clinical Psychologist

Overview

Obsessive-compulsive disorder (OCD) is a mental condition characterized by recurrent ideas, unwanted thoughts and sensations (obsessions). As such, people with OCD engage in repetitive behavioural patterns (compulsions) to deal with their obsessions.

A typical example in this case is a patient's obsession with hygiene and cleanliness. To eliminate the anxiety associated with their obsession, the individual may resort to washing their hands in a specific manner and for a prolonged period.

OCD patients have thought and behavioural patterns that are significantly more rigid and persistent. For instance, not carrying out a specific compulsion may result in profound anxiety and distress for a patient. Someone with OCD can have only symptoms related to obsession or compulsion.

The condition typically manifests during the early teenage years or young adulthood. Regardless of the specifics of individual cases, most OCD patients experience varying symptoms as they age. The condition can sometimes become severely disabling if not managed or treated accordingly.

When to Consult A Doctor?

On Symptoms: The clinical markers for OCD are divided into obsessions and compulsions. No two patients demonstrate similar symptoms. Nonetheless, the condition manifests in specific themes.

A patient with OCD will have persistent anxiety over one thought, such as the fear of bacterial or viral contamination, difficulty dealing with spontaneous situations, and requiring things to be organized properly. 
Subsequently, compulsions will directly address the related obsession. For instance, if an individual wants things to be organized, he/she may have unusual demands for how it should be done (making objects face a particular direction or be positioned in a precise spot).

Family History of Mental Disorders: While there are no conclusive studies on the association between genetics and mental disorders, medical professionals have observed a correlation between the two. For example, clinical depression is commonly seen in people with immediate relatives suffering from the condition. Thus, it is critical to consult a clinical psychologist if the individual has a family history of OCD. While symptoms might not be present currently, identifying risk factors and potential signs might be advantageous if required.

Regular Counselling or General Therapy: In a few cases, a person with no history of OCD or any other related disorder may develop the condition as a response to daily stressors, anxiety and general mental trauma. Visiting a therapist or counsellor can help pinpoint such issues before the symptoms worsen. Regular counselling can also enable patients to manage the condition effectively.

Diagnosis

Psychological Evaluation: There are no specific tests for rendering a clinical diagnosis for OCD. In most cases, mental health professionals will rely on a psychological evaluation of the patient. This process includes discussing the symptoms of obsessions and compulsions and how they impact the person's daily life. In some cases, a clinical psychologist, with the patient's permission, may also approach his/her friends and family to gain a deeper insight into the individual's issue.

Diagnosis Based on the DSM-5: According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a clinical diagnosis of OCD requires three specific conditions to be met. First, the individual in question must have obsessions/compulsions that are time-consuming (they last more than an hour a day). Second, the associated symptoms must cause significant distress to the person. Finally, the patient must have experienced some form of disruption in their professional or social life due to the condition.

Additional Physical Tests: In most cases, doctors and mental healthcare providers will recommend a patient to undergo supplementary physical examinations. This includes imaging tests like Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI). However, these assessments are not meant to diagnose OCD but rather rule out the possibility of the symptom being caused by other factors (chemical imbalances in the brain, neurological disorders, elevations in bodily fluids).

Treatment

Cognitive-Behavioural Therapy (CBT): CBT is a form of psychotherapy that involves the discussion of the related mental condition with a counsellor or therapist. This treatment method is typically structured over several sessions where the medical professional helps the patient recognize and manage the symptoms of OCD. However, CBT works best when supplemented with other remedial options, including medications and exposure therapy.

SRIs & Tricyclic Antidepressants: Serotonin reuptake inhibitors (SRIs) and tricyclic antidepressants are commonly used for most OCD patients. These prescription drugs increase the production and levels of serotonin in the patient's body, thereby mitigating the anxiety associated with obsessions and compulsion. Some examples include fluoxetine, sertraline, paroxetine and fluvoxamine.

Exposure/Response Prevention (EX/RP) Therapy: Considered a more nuanced treatment method, EX/RP therapy involves introducing an individual to a stressor. In the case of OCD patients, a clinical psychologist may expose the patient to an object or bring up a thought pattern that causes recurrent anxiety. The idea here is to get a person acclimated to their obsessions just enough so they do not produce the subsequent response (compulsion).

Electroconvulsive Therapy (ECT):  In more severe cases, medications, CBT and EX/RP therapy may not be effective. In such instances, clinical psychologists could suggest ECT. The procedure involves applying a mild electrical current to a patient's scalp. That stimulates particular areas in the brain and causes a minor seizure. Subsequently, the patient experiences a significant reduction in the recurrence of the related symptoms.

Transcranial Magnetic Stimulation (TMS): Similar to ECT, TMS is a treatment method involving stimulating brain parts. A magnetic device is placed on the patient's head, following which the apparatus sends out electrical impulses. These signals temporarily improve an individual's mood while reducing the effects associated with OCD.

Deep Brain Stimulation (DBS): DBS only applies to patients over 18. The procedure involves the surgical implantation of electrodes in specific brain regions. These electrodes then produce electrical signals that help regulate the symptoms related to OCD.

Risks & Complications If Left Untreated

Severe Social Isolation: As mentioned earlier, OCD affects people differently, with no two cases being precisely the same. As such, specific sub-types of the condition can severely impact a patient's social relationships. For example, someone with paedophile OCD (PCOD) will have sexual or harmful thoughts regarding children. However, unlike criminal offenders with sexually deviatory behaviour, this will cause the patient immense distress and anxiety to the point that he/she will not go near children. It may even result in individuals isolating themselves entirely to avoid potential contact with minors.

Depression & Anxiety Disorders: The symptoms associated with obsessions and compulsions cause significant anxiety to the affected person. Without clinical help, this can get progressively worse and lead to other related mental conditions. For instance, an OCD patient may develop severe anxiety due to how their compulsive behaviours are perceived in social or public settings. That could lead to additional mental stress or, in some cases, depression.

Excessive Reliance on Alcohol or Recreational Drugs: Often, OCD patients resort to drugs and alcohol to deal with their obsessions and compulsions. Without treatment, this reliance on drugs or alcohol may become an addiction.

Enabling Behaviour: Due to the challenges associated with identifying the condition, family members and friends often tend to allow an individual's obsessions and compulsions. Typically, this stems from how patients respond with anger, anxiety or verbal abuse when prevented from engaging in dysfunctional behavioural patterns. However, this only leads to the disorder getting worse.

Suicidal Tendencies: Although rare, OCD can make it immensely challenging for some patients to lead a relatively normal life. When the affected person recognizes their debilitating behaviour or thought patterns, they may become convinced that there is no way to remedy the situation. In such cases, the individual could start developing suicidal tendencies.

Additional Information

• Causal Factors of OCD

Recent medical research has established that OCD occurs due to inconsistencies in communication signals within specific brain areas, including the anterior cingulate cortex, the striatum and the thalamus. As such, the neurotransmitters that deliver these electrical signals are biologically different in OCD patients.

However, there is no conclusive evidence on what causes this issue with cerebral communication and neurotransmitters. Medical experts now consider a combination of genetic, behavioural, neurobiological and environmental triggers when diagnosing the condition.

• Global Prevalence of OCD

Ethnicity, biological gender or racial background don’t increase the risk of a person developing OCD. As such, the condition is relatively rare in the global population, affecting approximately 1% of it.

Regardless, certain factors, like childhood abuse and physical or mental trauma, can cause an individual to develop persistent habits or fears. If left unaddressed, this can develop into OCD.