Obsessive Compulsive Disorder

Obsessions are persistent, unwanted thoughts, feelings, or cravings that make a person feel uncomfortable, repulsed, or anxious.

Compulsions are repetitive behaviours that develop in reaction to obsessions in an effort to reduce anxiety.

Obsessive-compulsive disorder (OCD) is a frequent, persistent, and chronic mental and behavioural disorder in which a person has intrusive thoughts (an obsession) and feels compelled to repeatedly engage in particular behaviours (compulsions) to lessen the distress these thoughts cause, to the point where they interfere with daily functioning.

Signs and symptoms

OCD symptoms can take many different forms. Typical symptom groups are considered as dimensions, or clusters, which may indicate an underlying process. These sets of symptoms frequently occur together. Patients with OCD may have compulsive, obsessional, or both types of symptoms.Every element of life, including work, school, and interpersonal interactions, can be affected by these symptoms.

One study that examined the age of OCD onset found that there were disparities between males and females. According to a study, children’s OCD typically manifests at ages 9.6 for boys and 11.0 for girls. A study that included both adults and children discovered that the typical onset ages for males and females were 21 and 24, respectively. According to a different study, 62% of participants who were women reported that their symptoms grew worse at a premenstrual age. All demographics and research showed that the mean age of onset was less than 25.

Obsessions are recurring, anxious-inspiring wants, ideas, or mental images. Typical signs include:

• aversion to contamination or germs
• undesirable ideas about harm, sex, or other taboo or prohibited subjects
• aggressive ideas about oneself or others
• having everything in perfect symmetry or order

Compulsions are repetitive behaviours that an OCD patient feels compelled to do as a result of an intrusive thought.Common compulsive behaviours include:

• excessive washing of hands or cleaning
• putting things where they should go and arranging them precisely.
• repeatedly ensuring that everything is in working condition, for example, by making sure the oven is off and the door is secured.
• Constant counting

Not every ritual or habit results in compulsion. Everyone occasionally checks things twice. But typically, an OCD sufferer:

• lacking the ability to control one’s behaviour or ideas, especially when they are excessive
• spends at least an hour each day pursuing these thoughts or behaviour
• doesn’t enjoy engaging in the behaviours or routines, but may experience momentary reprieve from the discomfort they bring on
• has severe issues with these ideas or behaviours in their day-to-day lives

Treatments and Therapies

OCD is frequently treated with medication, psychotherapy, or a combination of the two.Some OCD sufferers continue to experience symptoms despite the fact that the majority of individuals benefit from treatment.

OCD can occasionally coexist in a person with anxiety, melancholy, and body dysmorphic disorder, a condition in which a person incorrectly believes a part of their body is abnormal. When choosing a course of treatment, it’s crucial to take these other illnesses into account.

Psychotherapy

Both adults and children with OCD may benefit from psychotherapy.The specific CBT method employed is known as exposure and response prevention (ERP), and it teaches the patient to consciously expose themselves to situations that conjure up obsessive thoughts and fears without engaging in the compulsive behaviours that are typically associated with the obsession (response prevention). Through this method, patients progressively learn to accept the discomfort and worry that come with abstaining from their compulsions. For many patients, selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are the add-on treatments of choice when they are ineffective in treating OCD symptoms, or vice versa for those who start treatment with psychotherapy.

Medication

OCD symptoms might be lessened with the aid of selective serotonin reuptake inhibitors (SSRIs), a kind of serotonin reuptake inhibitors (SRIs).SRIs may take 8 to 12 weeks to begin working in the treatment of OCD compared to the treatment of depression, and some patients show more rapid improvement. SSRIs are used as a first-line treatment for adult OCD patients with moderate or severe functional impairment and as a second-line treatment for individuals with mild functional impairment. With careful monitoring for unfavourable psychological effects, SSRIs can be used as a second-line therapy in children with moderate to severe impairment.

Research indicates that some patients may respond favourably to an antipsychotic medication if symptoms do not get better with these kinds of treatments.

Tricyclic antidepressants like clomipramine appear to work as well as SSRIs, although they are more likely to have negative effects.

Psychosurgery

In cases where alternative treatments are ineffective, surgery may be performed as a last option. A surgical lesion is created in the cingulate cortex during this surgery. In one trial, this technique greatly benefited 30% of the subjects.[170] The vagus nerve and deep brain stimulation are two alternative surgical procedures that don’t involve removing brain tissue. In the US, the Food and Drug Administration approved deep brain stimulation for the treatment of OCD under a humanitarian device exemption, stipulating that only hospitals with the necessary credentials could carry out the therapy.

As a last resort, psychosurgery is not used to treat OCD unless the patient has failed multiple courses of medication (at the recommended dosage) with augmentation and many months of rigorous cognitive-behavioural therapy that includes exposure and ritual/response prevention.

Family

The success of such interventions depends heavily on family engagement, expressed in the form of behavioural observations and reports.Parental treatments also offer a child who displays suitable behaviours as an alternative to obsessive responses and positive reward. Family-focused individual CBT was identified as “probably efficacious” in a recent meta-analysis of evidence-based therapy of OCD in children, making it one of the most effective psychosocial therapies for young people with OCD.

Other Treatment Options

Transcranial magnetic stimulation (TMS) was given FDA approval in 2018 as an adjunctive therapy for treating OCD in adults.Combination and add-on (augmentation) treatments, as well as cutting-edge methods like deep brain stimulation, are some more emerging strategies.

Finally, innovative and novel approaches are being developed to assist OCD patients.

~Adrija Ghosh, KRSH Welfare Foundation