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Obsessive Compulsive Disorder (OCD)

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an anxiety disorder in which you struggle with unreasonable thoughts and fears (obsessions) that compel you towards repetitive behaviors (compulsions). An obsessive-compulsive disorder has different effects on different people and is usually centred around a particular thought and behaviour, such as a fear of germs causing you to wash hands repeatedly until sore and chapped, or the need to check things repeatedly. People with OCD get certain thoughts repeatedly or feel the need to perform some action over and over.  This continuous need to perform a particular task can become quite distressful and can affect daily routine life.

People suffering from OCD cannot control these obsessive thoughts and compulsive actions, and the fears and behaviours that stem from these can be a source of immense distress to both – the patient and those around him/her.

What are the causes of the disorder?

The cause for OCD in some people and not others isn’t fully understood yet, though few theories on the subject abound. These include:

  1. Genetic consideration: OCD sometimes runs in families and might have a genetic component, but the genes involved in causing the disorder have not been identified yet.
  2. Environmental factors: Researchers are looking at ways stress and behavioural habits may play a role.
  3. Brain chemistry: Some parts of the brain are responsible for emotions like fear and anxiety. Further, insufficient levels of serotonin (brain’s chemical messenger) might cause OCD, as has been shown by medical studies in patients whose symptoms alleviated upon administration of serotonin.

What you need to know about symptoms or signs?

If you suffer from obsessive-compulsive disorder, you would most likely feel controlled by a particular thought pattern and behaviour. The pattern of thoughts and behaviour is exhibited in four steps:

Obsession – Your mind is continually plagued by a fear or concern that would be termed irrational given its frequency.

  1. Anxiety – A distressed feeling results from the obsessive thought.
  2. Compulsion – You perform a particular task to reduce your level of anxiety and stress.
  3. Temporary relief – The compulsive behavioural action lessens your distressed state for a short time till the anxiety and obsessive thought returns, creating a cyclic pattern.

Look out for thoughts that are unwanted, unpleasant and persistent and dominate and interfere with other thoughts. Such thoughts could signify an obsession.

Common obsessions in OCD include:

  • A need for orderliness or symmetry
  • Fear of infection, disease or an unpleasant item
  • Fear of unintentionally harming yourself or others (For e.g., fear of setting house on fire by leaving the gas on may lead you to check the switches repeatedly.)
  • Fear of deliberately harming yourself (For e.g., a fear that you might attack someone)

Unrealistic and compulsive behaviour arises to reduce the obsessive thought.

Common compulsive behaviours include:

  1. Cleaning, washing hands
  2. Arranging and ordering
  3. Hoarding
  4. Repeating words silently
  5. Prolonged thoughts over he same subject
  6. Neutralizing thoughts to counter the obsessive thoughts
  7. A need to confess and gain reassurance

Which specialist should you consult if you have any of the signs and symptoms?

Visit your general practitioner if you feel you have symptoms of OCD. If diagnosed and dealt with through treatment, the distressful impact of OCD on your daily life can be reduced. It is common for many people to feel embarrassed about their condition and not report the matter to their doctor, or even hide the symptoms from family and friends. However, it is important to understand that OCD is a chronic health condition like blood pressure and diabetes, and you need not hide the symptoms.

 What are the screening tests and investigations done to confirm or rule out the disorder?

Your doctor will run a series of physical and psychological tests to confirm if you have obsessive-compulsive disorder. This will provide confirmative diagnosis, rule out other problems that could be causing similar symptoms and determine any complications.

Tests for diagnosis include:

  1. Physical test – You will be examined for vital signs, heart, lungs, abdomen, weight and height.
  2. Laboratory test – These include blood count, alcohol and drugs screening, and thyroid function test.
  3. Psychological test – Your health care provider will talk in detail and ask you questions regarding your thoughts, behaviour patterns and feelings. You may be required to answer questions about your symptoms, their severity and history.

Your doctor will determine if your symptoms and condition fall under OCD and suggest appropriate treatment.

What treatment modalities are available for management of the disorder?

Treatment for obsessive-compulsive disorder is not guaranteed and may not always lead to complete recovery. However, it is highly beneficial in bringing symptoms under control so that you can carry out your daily activities without much interference. OCD is generally treated with psychotherapy, medication, or a combination of both.

Psychotherapy – Cognitive behaviour therapy (CBT) is effective in treating OCD. It helps you to retrain your thoughts, reactions and behaviour to reduce anxiety and compulsive behaviour. A type of CBT known as exposure and response prevention involves gradually exposing the patient to his/her obsession and learning new ways to deal with anxiety.

Medication – Most commonly prescribed medicines for OCD are anti-anxiety medications and antidepressants. Some of these medicines may cause side effects like headache, nausea or difficulty in sleeping, and you should consult your doctor if you face any side effects.

Some people respond better to cognitive behaviour therapy, while others do better with medication, or a combination of the two. Consult your doctor about the best treatment mode for you.

 What are the known complications in management of the disorder?

Diagnosis of obsessive-compulsive disorder can sometimes be difficult to diagnose as the symptoms overlap with other mental disorders like depression, schizophrenia, and anxiety disorder. It is important that you discuss your condition freely with your doctor and undergo all tests for proper diagnosis and treatment.

What precautions or steps are necessary to stay healthy and happy during the treatment?

Dealing with OCD can be challenging but you can cope with your condition by staying focused on recovery, seeking routine support from your healthcare provider and other people with similar condition, and making efforts to control stress and time better.

How can you prevent the disorder from happening or recurring?

Though there is no concrete method to ensure prevention of OCD, getting treatment for it at the earliest can prevent the condition from deteriorating further.

As a caregiver, how can you support and help the patient cope with the disorder?

It might seem the right thing to take on some of the compulsive actions on part of the patient as an attempt to share the load, but this might not be the right approach. Protecting the fears of a person with OCD by carrying out their compulsive actions is counter-productive because it is not a solution to the underlying problem.

As a caregiver, you can support the patient in many ways like helping them cope with the embarrassment they might feel about their condition. Encourage the patient to seek support and treatment from healthcare specialists.


Sources:

“Obsessive-Compulsive Disorder, OCD,” National Institute of Mental Health, https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

“Obsessive-compulsive disorder (OCD)” https://www.mayoclinic.com/health/obsessive-compulsive-disorder/DS00189

“Obsessive compulsive disorder (OCD),” NHS.UK, https://www.nhs.uk/Conditions/Obsessive-compulsive disorder/Pages/Introduction.aspx