Obsessive Compulsion Disorder

All we need to Know about Obsessive Compulsive Disorder (OCD)

 

What is Obsessive Compulsive Disorder (OCD)?

 

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder in which one is often or always troubled by ideas or images that stick in one’s mind.  These thoughts, called obsessions, cause you to feel anxious and force you to behave in ways that make no sense.  One may perform repeated, ritualized acts to reduce associated anxiety. These acts are called compulsions.   OCD affects between 1% and 2.5% of people. OCD symptoms usually begin during adolescence. The symptoms can range from mild to severe. It often runs chronic course.  

 

What are the signs and symptoms of OCD?

Most patients with OCD develop a cycle of obsession leading to anxiety followed by compulsive ritual which result in temporary relief. The obsession and anxiety soon returns and the cycle continues.

 

Some of the common obsessions in OCD include

  1. Fear of contamination
  2. Obsessive doubt
  3. Blasphemous thoughts
  4. Fear of causing harm
  5. Fear of committing unpleasant acts
  6. Need for symmetry, orderliness

 

Some of the common compulsions or rituals of OCD include: 

  1. Cleaning: Fearing germs, you may shower over and over again during the course of a day or wash your hands until the skin is cracked and painful. 
  2. Repeating: To reduce anxiety, you may repeat a name or phrase many times. 
  3. Need for order: You may perform a series of complex steps in an exact order or repeat them until they are done perfectly. 
  4. Checking: If you fear harming yourself or others by forgetting to lock the door or unplug the toaster, you will check over and over again to see that it is done. 
  5. Counting:
  6. Hoarding: You may collect useless items that you repeatedly count and stack. 

 

OCD symptoms often create problems in relationships and daily living. In extreme cases, you may become totally disabled, have no friends, and be unable to leave home because you spend your days engaged in rituals or having obsessive thoughts. 

 

What causes OCD?

 

The exact cause of OCD is not fully understood but there are many factors which act together to cause the disorder. These could be complex mix of biological, psychological and social factors. Biological factors include genetic factors with increased vulnerability among individuals with family history of OCD in either the immediate family or close relatives; functional abnormalities in some parts of brain like Basal Ganglia, changes in brain neurotransmitter serotonin which is a chemical used by brain for transmitting information from one brain cell to another. A stressful or traumatic event can sometimes trigger the illness in particularly vulnerable individuals.

 

How to recognize OCD?

 

It may take time to recognise the symptoms of OCD when the onset is gradual. The symptoms may be considered as normal functioning till they become severe enough to interfere with daily functioning.  Patient often consider the obsessions and compulsions as irrational and may feel ashamed for not being able to control the same. This leads to delay in treatment. As early detection of OCD and treatment is associated with better outcome, it is necessary to recognise the symptoms mentioned above and consult the nearest doctor or psychiatrist.

 

What are the treatment options?

 

Combining drugs and behaviour therapy has been most helpful in treating OCD.

Medications:

Antidepressant drugs, particularly those with specific action on serotonin receptors in higher dosage are used in the treatment of OCD. Commonly prescribed drugs are fluxetine, fluvoxamine, Sertraline and clomipramine.  Other classes of drugs can also be used depending on the severity of the illness. It takes about 8-12 weeks before one begins to notice any benefit. The common side effects of the medicines are headache, nausea, The medicines need to be taken after food to minimize the gastrointestinal side effects. The response to medicines differs in different patients. Some may respond adequately to single medicine while other may require combination of medicines to elicit response.

 

Behaviour Therapy:

 

Cognitive behaviour therapy (CBT) is most widely used treatment for OCD. It is based on the principle that most unwanted thinking patterns, beliefs and emotional reactions are learned over a period and this can be replaced with more realistic and rationale thoughts. 

 

Exposure and response prevention (ERP) is type of CBT commonly used in OCD. ERP involves exposing the patient to situations or objects that cause fear and anxiety. It can be done in actual situations or in imagination. Once patient is exposed to such stimuli, he/she often feels need to engage in compulsive behaviour to reduce the anxiety. The therapy involves working with patient to delay or prevent this response. Over a time this leads to decrease in anxiety associated with the feared stimuli. This technique can be used to work through all such feared stimuli in graded manner.

 

Besides these two commonly practised treatment options, in cases with severe OCD with minimal or no response to even combination of drugs over a long period of time causing significant dysfunction and restriction of daily activities, surgery is considered as a last resort treatment. The surgery involves use of electric current or pulse of radiation to burn a small part of limbic system which is a structure in brain responsible for development of OCD.

 

Does OCD recover completely?

 

The response to treatment in individual patient may vary with some patients responding very well to treatment while in others it may be more challenging with patients requiring more than one medicine trial or need for combination of medicines. The recurrence of symptoms after successful treatment can be seen in nearly half the patients. Drug treatment usually needs to be continued for longer period. Lifelong maintenance therapy may be required in some patients to prevent recurrence.

 

 

What is the role of family?

 

As mentioned earlier during the patient is often aware of the irrationality of the obsessions and compulsions and may feel embarrassed or ashamed about not being able to control the thoughts or behaviour. This often interferes with help seeking and treatment is delayed. For some patients the severity of symptoms may affect the social functioning and activities significantly making the person almost home bound. The patient thus depend mainly on family for their treatment and care. The understanding and attitude of family towards illness also influence the course and outcome. The family thus need to understand the illness, understand the ways of coping with the illness, need for medications and continuation of treatment. Family can also play significant role in therapy by helping the patient gain control over the behaviour.

 

Can OCD be prevented?

 

There are no known ways to prevent development of the disorder. However early detection of illness and early intervention can be greatly beneficial. Adopting healthy lifestyle, avoiding stressful situations, effective use of stress reduction strategies help manage the condition more effectively.

 

What are the Rehabilitation options for patients with chronic OCD?

 

The rehabilitation of OCD patients places more emphasis on work and leisure than on other areas of adjustment such as personal and family relationships. The main objective in the rehabilitation of OCD patients is the removal of the compulsive rituals, which leaves the patient with considerable free time that needs to be filled up with recreational and other social activities.  Efforts are also made to help the patient find alternative interests.  Specific help may also be needed in overcoming the strained relationships that may have built up in the family as a result of the patient's obsessional symptoms

 

Living with OCD- What can you do or help your patient do?

 

  1. Recognize the illness in its early stage
  2. Consult the doctor immediately
  3. Discuss the treatment options with your doctor.
  4. Avoid self medicating.
  5. Take medications as prescribed. Continuing medications will help prevent relapse.
  6. Follow up with your doctor regularly. Regular contact with doctor and timely review help preventing recurrence.
  7. Learning the behaviour techniques for controlling obsessions & compulsions
  8. Keeping oneself engaged in activities
  9. Avoid excess tea, coffee, nicotine as well as  drugs like cannabis, Alcohol
  10. Eat and sleep well. Adequate sleep and healthy diet is necessary for good physical and mental health.

( This document is compilation of information from Web and Print Media for purpose of making the scientific educative material easily available for patients and families)