OCD

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What Is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions). To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviours, such as hand washing/cleaning, checking on things, and mental acts like (counting) or other activities, can significantly interfere with a person's daily activities and social interactions.

Many people without OCD have distressing thoughts or repetitive behaviours. However, these do not typically disrupt daily life. For people with OCD, thoughts are persistent and intrusive, and behaviours are rigid. Not performing the behaviours commonly causes great distress, often attached to a specific fear of dire consequences (to self or loved ones) if the behaviours are not completed. Many people with OCD know or suspect their obsessive thoughts are not realistic; others may think they could be true. Even if they know their intrusive thoughts are not realistic, people with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions.

A diagnosis of OCD requires the presence of obsessive thoughts and compulsions that are time-consuming (more than one hour a day), cause significant distress, and impair work or social functioning. OCD affects 2-3% of people in the United States, and among adults, slightly more women than men are affected. OCD often begins in childhood, adolescence, or early adulthood. Some people may have some symptoms of OCD but not meet the full criteria for this disorder.

Obsessions

Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety, fear, or disgust. Many people with OCD recognize that these are a product of their minds and that they are excessive or unreasonable. However, the distress caused by these intrusive thoughts cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of obsessive thinking or to undo the perceived threats by using compulsions. They may also try to ignore or suppress the obsessions or distract themselves with other activities.

Examples of common content of obsessive thoughts:

  • Fear of contamination by people or the environment
  • Disturbing sexual thoughts or images
  • Religious, often irreverent, thoughts or fears
  • Fear of perpetrating aggression or being harmed (self or loved ones)
  • Extreme worry something is not complete.
  • Extreme concern with order, symmetry, or precision
  • Fear of losing or discarding something important
  • It can also be seemingly meaningless thoughts, images, sounds, words, or music.
Compulsions

Compulsions are repetitive behaviours or mental acts that a person feels driven to perform in response to an obsession. The behaviours typically prevent or reduce a person's distress related to an obsession temporarily, and they are then more likely to do the same in the future. Compulsions may be excessive responses that are directly related to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.

Examples of compulsions:

  • Excessive or ritualized hand washing, showering, brushing teeth, or toileting
  • Repeated cleaning of household objects
  • Ordering or arranging things in a particular way
  • Repeatedly checking locks, switches, appliances, doors, etc.
  • Constantly seeking approval or reassurance.
  • Rituals related to numbers, such as counting, repeating, excessively referencing, or avoiding certain numbers
  • People with OCD may also avoid certain people, places, or situations that cause them distress and trigger obsessions and compulsions. Avoiding these things may further impair their ability to function in life and may be detrimental to other areas of mental or physical health.
Treatment

Patients with OCD who receive appropriate treatment commonly experience increased quality of life and improved functioning. Treatment may improve an individual's ability to function at school and work, develop and enjoy relationships, and pursue leisure activities.

Cognitive Behavioral Therapy

One effective treatment is a type of cognitive-behavioural therapy (CBT) known as exposure and response prevention (ERP). During treatment sessions, patients are exposed to feared situations or images that focus on their obsessions. However, it is standard to start with those that only lead to mild or moderate symptoms; initially, the treatment often causes increased anxiety. Patients are instructed to avoid performing their usual compulsive behaviours (known as response prevention). By staying in a feared situation without anything terrible happening, patients learn that their fearful thoughts are just thoughts. People learn that they can cope with their thoughts without relying on ritualistic behaviours, and their anxiety decreases over time. Using evidence-based guidelines, therapists and patients typically collaborate to develop an exposure plan that gradually moves from lower anxiety situations to higher anxiety situations. Exposures are performed both in treatment sessions and at home. Some people with OCD may not agree to participate in CBT because of the initial anxiety it evokes. Still, it is the most powerful tool available for treating many types of OCD.

Medication

A class of medications known as selective serotonin reuptake inhibitors (SSRIs), typically used to treat depression, can also be effective in the treatment of OCD. The SSRI dosage used to treat OCD is often higher than that used to treat depression. Patients who do not respond to one SSRI medication sometimes respond to another. The maximum benefit usually takes six to twelve weeks or longer to be fully visible. Patients with mild to moderate OCD symptoms are typically treated with either CBT or medication depending on patient preference, the patient's cognitive abilities, and level of insight, the presence or absence of associated psychiatric conditions, and treatment availability. The best treatment for OCD is a combination of CBT and SSRIs, especially if OCD symptoms are severe. 

Neurosurgical treatment

Some newer studies show that gamma ventral capsulotomy, a surgical procedure, can be very effective for patients who do not respond to typical treatments and are very impaired. Still, it is underused due to historical prejudice and its invasiveness. Deep brain stimulation, which involves an implanted device in the brain, has data to support the efficacy and does not permanently destroy brain tissue as done in a capsulotomy. However, it is still highly invasive and complex to manage, and there are limited providers and hospital systems trained to offer this treatment and able to provide the long-term support needed by DBS patients.

How to Support a Loved One Struggling with OCD

In people with OCD who live with family, friends, or caregivers, enlisting their support to help with exposure practice at home is recommended. In fact, the participation of family and friends is a predictor of treatment success.

Self-care

Maintaining a healthy lifestyle can help in coping with OCD. Getting enough good quality sleep, eating healthy food, exercising, and spending time with others can help with overall mental health. Also, using basic relaxation techniques (when not doing exposure exercises) such as meditation, yoga, visualization, and massage can help ease stress and anxiety.

Related Conditions

Four conditions related to OCD: HOARDING DISORDER, BODY DYSMORPHIC DISORDER, TRICHOTILLOMANIA (HAIR-PULLING DISORDER, EXCORIATION (SKIN-PICKING) DISORDER.

Source From psychiatry.org

FAQs

The often off-hand or casual way OCD is referred to in the media or everyday conversations may make it seem that the obsessions or compulsions are just something annoying or amusing that a person could “get over.” But for people with OCD, it’s not a simple annoyance; it is all-consuming anxiety associated with obsessive thoughts.

Many people will, at times, have concerning thoughts or prefer a clear routine and structure. But for people with OCD, the thoughts become overwhelming and create a great deal of anxiety. Compulsions associated with OCD disrupt normal daily activities. A diagnosis of OCD requires that the obsession or compulsions take more than one hour a day and cause major distress or problems at home, work, or other functions.

Talking about your ODC and deciding who to tell are personal decisions. Family and friends can be an important source of support and understanding. They may have noticed changes in your behaviour, and talking about it could provide them with a better understanding and the ability to be more supportive.

In addition to the basic information on this help page, suggestions for other sources of information include the National Institute on Mental Health – NIMH-OCD page, the International OCD Foundation, and NAMI’s OCD page.

Personal stories of people living with OCD can also be very useful in helping someone understand what it is like. Some examples include:

Some people with mild OCD improve without treatment. More moderate or severe OCD usually requires treatment. However, there are often periods when the symptoms get better. There may also be times when symptoms get worse, such as when a person is stressed or depressed.

Try to learn as much as you can about OCD, what it’s like, and what options are available to treat and manage the disorder. Remember to view compulsive behaviours as part of a medical condition and not personality traits or a matter of simple choice. Recognize small accomplishments – what may seem like a small change may actually take significant effort. Be patient – remember progress may be slow, and symptoms may increase or decrease at times. Be mindful of changes — any change, including positive change, can be stressful and increase OCD symptoms. Work together with your family members to develop a family plan with agreed-upon actions for managing symptoms. For example, set limits on discussions relating to obsessions/compulsions. Assistance from a mental health professional may be useful.

Yes, OCD is more common among people who have a family member who has the disorder. People with an immediate relative (parent or sibling) with OCD are two to five times more likely to experience OCD than someone without a close relative with OCD.

Source From psychiatry.org

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