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
|
Common Obsessions
|
Common Compulsions
|
|
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
|
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
|
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.