Obsessive-compulsive disorder (OCD) is a common and long-lasting disorder of thought process and behaviors. The patient experiences recurring thoughts or actions with such urge that they are forced to think or do it again and again.
Repetitive thoughts and actions can be normal and part of daily lives, but when these become recurring and impulsive enough to interfere with the routine of the patient, it becomes OCD. It reduces the quality of life and the patient may spend more than an hour a day repeating thoughts or actions.
The patient has no control over these and it occurs without their consent. Even if the patient recognizes the symptoms, it is difficult to resist the impulse and there is no contention at the end of the task. There may be a trigger that starts the chain of repetition and reaction.
For instance, almost everyone double checks things every now and then, but a patient of OCD does it repeatedly due to the impulse and obsessive thoughts, without getting contented.
There are two components of OCD:
1. Obsession
Obsession is the state of being obsessed with something, having a thought that preoccupies the person’s mind. Thoughts, ideas, or images occur repeatedly and forcefully so much as to incite anxiety and create disturbance. For example, repetitive thoughts of hand contamination, or the need for properness.
2. Compulsion
Compulsion is the state of being pushed or forced to do something or act a certain way. It is the urge and persuasion to action or behaviours by the repeated thoughts. This is seen when the patient repeatedly washes hands to get rid of contamination or recheck the stove knobs to avoid burning down the house.
Cause:
The exact mechanism behind the disorder is still to be unfolded, but researchers believe it is secondary to reduced or disturbed response to serotonin in the brain. Serotonin is a chemical that brings about mood stabilization, happiness, and satisfaction. A genetic susceptibility is also suggested to contribute to OCD that is if a family member has OCD, it is likely that an immediate family member will also develop it. Trauma, stress, and possibly strep throat infections also relate to development of OCD.
The vicious cycle of OCD:
Signs and symptoms
Patient may present with signs of obsession, compulsion, or both.
Obsessive symptoms include:
- Fear of contamination
- Fear of losing control
- Excessive focus on religion or culture
- Idea of perfection and order
- Violent or sexual thoughts
- Superstitious thoughts
Compulsion can present with:
- Repeatedly hand washing, cleaning and scrubbing
- Rechecking the stove knobs or plug outlets again and again or door locks
- Putting the things in an order, maintaining symmetry
- Collecting useless items and hoarding
- Continuously counting, tapping or repeating words
- Spending a lot of time cleaning and washing
- Behavioral tics like blinking, throat clearing, shrugging.
Management
Self-help forms a big part of the management, in addition to the available medical and psychiatric treatments.
Self-help comprises of recognizing symptoms and taking steps to break free from OCD.
- Identifying the triggers that provoke to obsession or compulsion helps prevent the vicious cycle to begin in the first place. For example, may be the thoughts of germ contamination are triggered by touching the door handle of a shop; avoiding this trigger may prevent the chain reaction of obsession and compulsion that follows it.
- Resisting the urge– sometimes avoiding one thing leads to bigger fear of that thing. In such cases, triggering it repeatedly intentionally to incite obsessive thoughts but not following it through to compulsion makes it feel less impulsive. This gives the feeling of control and power to the patient. Continuing the example, touching the shop door intentionally to trigger thought of contamination but not washing hands till slowly the thought fades away. This process is called exposure and response prevention.
- Break down the task into smaller steps and focus on the main goal. This adds to the resisting of urge as the patient focuses on the goal, the anxiety develops until eventually the goal is achieved and the anxiety disappears. Repeating the process every time a task is done helps develop control over the situation and lessen the anxiety.
- In addition, writing down the obsessive thoughts, rescheduling compulsive actions, questioning the thoughts, managing stress by relaxation exercises, and maintaining a healthy lifestyle all help towards controlling OCD.
Treatment:
Psychiatric treatment for OCD is done in the form of cognitive-behavioral therapy (CBT). It includes two points of care; exposure and response prevention (discussed above), and cognitive therapy. These focus on training the patient healthy ways to respond to obsessive thoughts without resorting to compulsive actions.
Family and group therapies promote understanding of the condition and interaction provides support and encouragement to the patient.
Antidepressant and, sometimes, antipsychotic medications aide the CBT and other therapies but have no benefit if used alone.
Conclusion
Obsessive-compulsive disorders are disorders of thought and behavior and present in different ways. Seek help when the obsessive thoughts or compulsive actions negatively affect the life, take up more than an hour of the day, get in the way of the routine, and they are insuppressible.
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