What is Obsessive Compulsive Disorder?
Imagine an individual who is checking their car door every five minutes to ensure it is locked or not. What would you call it if this occurred more than 105 times in the same moment? Such behavior is beyond one’s control and interferes with daily functioning. But the question remains why such behavior is exhibited in the first place.
We all go through moments of worry or constantly thinking over a subject. But such feelings or emotions are momentary no matter how uncomfortable they may make us feel during that time. However, some of us experience them with such intensity that it makes daily living an uphill task. Such intense feelings of anxiety and worry are the grounds for developing anxiety disorders. One such disorder is obsessive-compulsive disorder (OCD)
Defining features of OCD
The primary symptoms of OCD are obsession/s and compulsion/s. Obsessions are essentially thoughts, images, or impulses that are repetitive and persistent in nature1,2. They are perpetually unwanted by the individual experiencing them as they provoke anxiety. resistance and attempts are made to suppress them with other thoughts, or actions.
It is these suppressing thoughts or actions that are called compulsions. Compulsions are behaviors or mental acts that an individual feels driven to perform in response to obsessive thoughts1,2. They reduce anxiety or distress provoked by an intrusive thought. However, such attempts are not in tandem with the anxiety-provoking situation or are excessive. Figure 1 below enlists some common obsessions and related compulsions in clinical settings
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Common Obsessions
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Common Compulsions
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Fear of contamination; by dirt, germs, diseases, saliva, etc
Doubting doing something in the right way (turning off the stove, locking door/s), fear of making mistakes (while emailing, or writing a cheque)
Ordering things in “symmetrical” way/s out of fear of negative consequences if placed otherwise
Unwanted sexual thoughts or urges or images such as touching someone inappropriately
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Cleaning and Washing: Frequent and excessive washing of hands, household items, bathing, etc in a ritualized way
Checking: Checking for mistakes (re-reading written material, asking others if they have committed errors)
Ordering/Arranging: Ensuring “order” or “symmetry” in things with specific rules (eating or placing things in even numbers)
Mental Rituals: Needing to count objects a certain number of times to “neutralize” bad thoughts or praying repeatedly
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Figure 1: Common Obsessions and Compulsions
Assessment and Diagnosis
Formal assessment begins with a clinical interview conducted by the clinician to collect detailed information about the client’s concerns, and overall personal, medical, and social history. This information is collected only by trained professionals such as psychiatrists, and clinical psychologists for a formal diagnosis.
The diagnosis of OCD is done if the client exhibits symptoms as mentioned in one or both of the classification systems in mental health; the International Classification of Diseases-10 Classification of Mental and Behavioural Disorders (10th Revision) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5., American Psychiatric Association, 2013). Thus, it is recommended to go through a formal procedure for the diagnosis of OCD.
Treatments for OCD
- Exposure and Response Prevention (ERP): This mode of treatment is based on a behavioral learning model. By imbibing new behavioral responses one can unlearn previous behavioural patterns4. It involves exposure to anxiety-provoking situations or conditions, and then preventing the previously learned distress-reducing responses. Exposure can be in-vivo or imagination based
- Cognitive Behavioural Therapy: The vicious cycle of anxiety-provoking triggers, ensuing obsessions, and interplay of interpretations and compulsions is of key importance. Various cognitive strategies are applied to address this.
- Medication: Selective Serotonin Reuptake Inhibitors (SSRIs) are usually the first line of treatment for OCD. Another line of treatment for OCD cases involves the use of Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). Both lines of treatment are widely accepted and are often used in combination with psychotherapy.
Treatment measures for OCD, like any clinical disorder, also consider the prevention of relapses. Therefore, the management of OCD therefore may require additional considerations such as the familial support systems of a client.
References:
1.American Psychiatric Association. (2013). Obsessive compulsive and related disorders. In Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: Author.
2.World Health Organization (1993). Neurotic, stress related and somatoform disorders. In International classification of diseases-Classification of mental and behavioural disorders (5th ed.). Geneva: Author.
3.Burroughs, E., Kitchen, K., Sandhu, V., & Richter, P. (2015). Obsessive Compulsive Disorders-A handbook for patients and families. Retrieved from https://sunnybrook.ca/uploads/1/departments/psychiatry/ocd-information-guide-2015.pdf
4.Brookes, A. & Hohagen, F. (2001). Psychotherapy in OCD. In Fineberg, N., Marazziti, D., & Stien, D.J., Obsessive compulsive disorder-A practical guide (pp. 119-134). United Kingdom: Martin Dunitz.