Obsessive Compulsive Disorder : An Overview
Obsessive thoughts that are unwelcome and bothersome or painful compulsive behaviours are diagnostic indicators of obsessive compulsive disorder (OCD).
Introduction
OCD is frequently one of the most severely incapacitating mental disorders since it results in a lower quality of life and significant functional disability. Obsessive thoughts and ideas are typically accompanied by compulsive behaviours that are used to block them out or to avoid a feared circumstance. To be more precise, obsessions are defined as persistent and recurrent intrusive thoughts, visions, or urges that are perceived as uncomfortable, inappropriate, or uncontrollable. Such obsessions are actively sought for to be neutralized by other thoughts or actions, resistance, or suppression.
Compulsions can entail overt repetitive actions carried out as time-consuming rituals (like repeatedly washing hands, checking, or placing orders) or more subtle mental routines (like counting, praying, or softly repeating a few words over and over). The repetitive, ritualistic behaviour of an OCD sufferer is typically driven by an obsession, and there are frequently strict guidelines for how the compulsive behaviour should be carried out. The purpose of the compulsive behaviours is to avoid or lessen distress or to avoid some dreaded circumstance or event.
Prevalence, Age of Onset, and Gender Differences
It turns out that obsessive-compulsive disorder is more common than previously believed. Although lifetime prevalence in other studies has reached as high as 3 percent, the National Comorbidity Survey-Replication research found that the average 1-year prevalence rate of OCD was 1.2 percent and the average lifetime prevalence was 2.3 percent. Over 90% of OCD sufferers who seek therapy report having both obsessions and compulsions. This number increases to 98 percent when mental routines and compulsions like counting are taken into account.
Adults in some studies found minimal to no gender difference, which would set OCD apart from the majority of the other anxiety disorders. A British epidemiological investigation did, however, discover a gender ratio of 1.4 to 1 (women to men). Despite the fact that the illness typically manifests in late adolescence or early adulthood and is most common then, it can also occur in children, when its symptoms are very comparable to those of adults. Boys are more likely than females to experience childhood or early teenage start, which is frequently correlated with greater severity and more heredity. The problem typically manifests gradually, and if it becomes a serious condition, it tends to be chronic, even though the severity of the symptoms can occasionally wax and wane with time.
Comorbidity with Other Disorders
Obsessive-compulsive disorder usually co-occurs with other mood and anxiety disorders, just like all the anxiety disorders do. According to estimates, up to 80% of persons with OCD may experience substantial depressive symptoms and at least 25 to 50 percent of them may experience serious depression at some point in their lives.
The four types of anxiety disorders that co-occur most frequently with OCD are social phobia, panic disorder, GAD, and PTSD. Body dysmorphic disorder (BDD), a similar disorder that is currently classified as somatoform and has only recently received considerable research attention (within the last 15 years), frequently co-occurs with OCD.
Causal Factors of OCD
- Psychological Causal Factors
a) OCD AS LEARNED BEHAVIOR
The two-process hypothesis of avoidance learning developed by Mowrer in 1947 is the foundation of the prevalent behavioural or learning perspective on obsessive-compulsive disorder. According to this view, anxiety is a result of neutral stimuli developing a classical conditioning relationship with terrifying ideas or events. This theory was supported by several well-known experiments carried out by Rachman and Hodgson in 1980.
They discovered that exposure to a circumstance that sparked an obsession would, in fact, cause difficulty for the majority of OCD sufferers (for example, a doorknob or toilet seat for someone with obsessions about contamination). This suffering would last for a fair amount of time before gradually fading away. However, if the obsessive ritual was allowed to be performed right after the provocation, the person’s anxiety would typically quickly subside (albeit only momentarily), reinforcing the compulsive habit.
b) OCD AND PREPAREDNESS
Compulsive washers often have ideas about contamination and dirt, which makes their occurrence seem nonrandom. According to the general view, human obsessions with filth, pollution, and other potentially hazardous conditions did not develop in a vacuum but rather have a long evolutionary history.
Additionally, some theorists have contended that compulsive rituals associated with obsessive-compulsive disorder are similar to the displacement behaviours that many species of animals participate in when faced with conflict or high levels of arousal. When there is a lot of tension or dissatisfaction present, a bird could brush its feathers or engage in grooming or nesting behaviours. They may consequently be linked to the anxiety-provoking thoughts that frequently prompt the grooming or organizing procedures that are observed in OCD sufferers.
2. Cognitive Causal Factors
a) Appraisals of Responsibility for Intrusive Thoughts
Salkovskis (in 1989), Rachman (in 1997), and other cognitive theorists have made a distinction between intrusive or obsessive thoughts themselves and the negative automatic thoughts and dire assessments that people have about having such ideas. For instance, OCD sufferers frequently exhibit an exaggerated feeling of duty. In turn, in some weak people, this exaggerated sense of responsibility can be linked to ideas that simply contemplating doing something — like attacking a patient — is morally equivalent to actually doing it, or that considering committing a sin increases the likelihood that you’ll actually do it. The term “thought-action fusion” describes this. The “perceived awfulness of any harmful consequences” is increased by this elevated sense of responsibility for potential harm, which may also encourage compulsive behaviours like washing and checking in an effort to lessen the likelihood of anything negative happening.
b) Cognitive Biases and Distortions
Obsessive-compulsive disorder has also been linked to cognitive issues. According to research on OCD patients, just like with the other anxiety disorders, they are drawn to disturbing material that relates to their obsessive worries. People with OCD may try to repress negative thoughts sparked by this knowledge since they appear to have trouble blocking out negative, irrelevant, or distracting data. These individuals frequently repeat their ritualistic behaviours because they lack faith in their recall (particularly for events for which they feel responsible).
3. Biological Causal Factors
a) Neurotransmitter Abnormalities
The 1970s saw an increase in pharmacological research into the causes of obsessive-compulsive disorder after it was discovered that a tricyclic medication named Anafranil (clomipramine) was frequently beneficial in treating OCD despite the fact that other tricyclic antidepressants were typically less effective. This, according to research, is a result of clomipramine’s stronger effects on the neurotransmitter serotonin, which is now known to play a significant role in OCD.
Uncertainty exists regarding the precise nature of the serotonergic systems’ malfunction in OCD. According to recent research, OCD symptoms may be caused by increased serotonin activity and enhanced sensitivity of particular brain regions to serotonin. In fact, serotonergic system stimulation medicines make symptoms worse. According to this theory, long-term use of clomipramine (or fluoxetine) results in a down-regulation of some serotonin receptors, which further results in a functional drop in serotonin availability. That is, even while clomipramine or fluoxetine may temporarily raise serotonin levels (and maybe enhance OCD symptoms as well), their long-term consequences are very different.
This is in line with research showing that these medications need to be used for at least 6 to 12 weeks before OCD symptoms significantly improve. It is increasingly becoming obvious that serotonergic system failure cannot fully explain this complicated illness on its own. Although their function is not yet fully understood, other neurotransmitter systems, such as the glutamate, GABA, and dopaminergic systems, also appear to be involved.
b) Genetic Factors
Twin or family studies have accounted for the majority of genetic research. Twin studies show that monozygotic twins have a reasonably high concordance rate while dizygotic twins have a lower rate. In a review of 14 papers, 80 monozygotic twin pairs and 29 dizygotic twin pairs were examined. Of the 80 monozygotic twin pairs, 54 were concordant for the diagnosis of OCD, and 9 were concordant. Although it might be at least partially a general “neurotic” propensity, this is compatible with a moderate genetic inheritance. Most family studies have reported 3 to 12 times higher rates of OCD in first-degree relatives of OCD clients than would be anticipated from current estimates of the incidence of OCD, which is consistent with twin studies.
Numerous molecular genetic research have started to look into the relationship between OCD and particular genetic polymorphisms (gene variants that occur spontaneously) in recent years. According to preliminary research, OCD with Tourette’s syndrome and OCD without Tourette’s syndrome are at least partially genetically distinct from one another. This suggests that various genetic polymorphisms are involved in each kind of OCD.
Treatment
The most successful method for treating obsessive-compulsive disorders appears to be behavioural therapy that combines exposure and response prevention. As part of this therapy, the OCD patients create a hierarchy of upsetting stimuli and rank them on a scale of 0 to 100 based on their propensity to cause anxiety, distress, or disgust. Then, the clients are instructed to repeatedly expose themselves (either through guided fantasy or directly) to triggers for their fixation (for example, touching the bottom of their shoe or the toilet seat in a public lavatory for someone with compulsive washing rituals).
They are instructed to refrain from performing the rituals they typically perform to ease the worry or anguish brought on by their addiction after each exposure. Preventing the routines is crucial so that kids may understand that, even if it takes several hours, the anxiety brought on by the preoccupation will naturally subside down to at least 40 to 50 on the 100-point scale if they give it enough time.
This was written and shared as part of my internship at the KRSH Welfare Foundation. @KRSH Welfare Foundation