What Is Obsessive-Compulsive Disorder?

He Obsessive-compulsive disorder (OCD) is the most serious and disabling anxiety disorder. In these people there is what is known as thought-action fusion: they equate thoughts with actions.

In this article I will explain your symptoms, causes, diagnosis, available treatments and much more.

People who have anxiety disorders and need hospitalization often have this disorder, just like those who need psychosurgery.

If you have it, in addition to the typical symptoms of this disorder, you may experience:

• Panic attacks .
• Generalized anxiety .
• Major depression .

Symptoms of Obsessive Compulsive Disorder

Obsessions

Obsessions are images or Intrusive thoughts Meaningless that they try to avoid or eliminate.

The most common are:

• Contamination.
• Sexual content.
• Aggressive impulses.
• Need for symmetry.
• Worries about the body.

Compulsions

Actions or thoughts that are used to suppress obsessions. They are believed to reduce stress or prevent a negative event. In addition, they may be magical or illogical, unrelated to obsession.

Compulsions can be:

• Behavioral: check, wash hands, arrange, order, review, rituals...
• Mental: counting, praying...

Many people with OCD continually wash their hands or make revisions, which gives them a sense of security and control.

The checks are used to prevent imaginary disasters. They can be logical - like checking that the door has not been left open or the gas - or illogical - like counting to 100 to avoid a disaster.

Depending on the Type of obsession , There are more or other types of compulsions:

• There are more rituals of testing in sexual obsessions.
• In obsessions for symmetry, repetition of rituals occurs more.
• In the obsessions for pollution are given more rituals of washing.

Causes of Obsessive Compulsive Disorder

It is possible that the tendency to develop anxiety from having compulsive thoughts may have the same biological and psychological precursors as anxiety in general.

For it to develop, it will be necessary for a person to have certain biological and psychological factors.

Biological factors

In the first place, repetitive thoughts may be regulated by the hypothetical brain circuit.

People with OCD are more likely to have first-degree relatives who also have the same disorder.

In cases where OCD develops during adolescence, there is a stronger relationship of genetic factors than in cases where it develops into adulthood.

Social factors

For the Evolutionary Psychology , Moderate versions of OCD may have evolutionary advantages. For example, health, hygiene, or enemy reviews.

One hypothesis is that people with OCD learn that some thoughts are unacceptable or dangerous, as they might happen in reality.

They may develop during childhood the thought-action fusion, excessive responsibility or feelings of guilt.

Infections

The rapid onset of OCD in children and adolescents could be caused by a syndrome linked to Group A of streptococcal infections (PANDAS) or caused by immunological reactions to other pathogens (PANS).

Pathophysiology

Brain studies of people with OCD have shown that they have different activity patterns than people without OCD.

The different functioning of a particular region, the striatum, could be causing the disorder.

Differences in other parts of the brain and the deregulation of neurotransmitters, especially Serotonin Y Dopamine , Could also contribute to OCD.

Independent studies have found unusual dopamine and serotonin activity in various regions of the brain in people with OCD: dopaminergic hyperfunction in the prefrontal cortex and dopaminergic hypofunction in the Basal ganglia .

Deregulation of glutamate has also been recently studied, although its role in the disorder is not well understood.

Diagnosis

Diagnostic criteria according to DSM-IV

A) It is fulfilled for obsessions and compulsions:

1. Recurrent, persistent thoughts, impulses, or images that are experienced at some point in the disorder as intrusive and inappropriate, and cause significant anxiety or discomfort.
2. Thoughts, impulses or images are not reduced to simple over-worries about real-life problems.
3. The person tries to ignore or suppress these thoughts, impulses or images, or tries to neutralize them by other thoughts or acts.
4. The person recognizes that these thoughts, impulses or obsessive images are the product of his mind (and do not come as taxes in the insertion of thought).

B) At some point in the course of the disorder the person has recognized that these obsessions or compulsions are excessive or irrational. Note: this point is not applicable in children.

C) Obsessions or compulsions cause significant clinical discomfort, represent a waste of time (more than one hour a day) or interfere markedly with the individual's daily routine, work relationships or social life.

D) If there is another disorder, the content of obsessions or compulsions is not limited to it (eg, food worries in an eating disorder).

E) The disorder is not due to the direct physiological effects of a substance or a medical illness.

Specify if:

With little awareness of illness: if for most of the time in the current episode, the individual does not recognize that obsessions or compulsions are excessive or irrational.

Differential diagnosis

OCD is often confused with Obsessive compulsive disorder of personality (TOCP).

Its main differences are:

• The TOCP is egodistonic, the person does not suffer from having the disorder and considers it part of their self-image.
• OCD is egodistonic, the person does not consider it part of their self-image and causes discomfort.
• While people with OCD are not aware of anything abnormal, people with OCD are aware that their behavior is not rational.

On the other hand, OCD is different from behaviors such as Addiction to gambling Or eating disorders. People with these disorders experience some pleasure from doing those activities, while people with OCD do not feel pleasure.

Epidemiology

OCD affects 2.3% of people at some point in their lives.

Symptoms usually occur before age 35 and half of people develop the disorder before age 20.

Treatments

Behavioral therapy, Cognitive-behavioral therapy And medication are the first-line treatments for OCD.

Behavioral and cognitive behavioral therapy

Exposure prevention is used in these therapies.

It is a technique by which the person is systematically exposed to the stimuli until it becomes habitable.

For this, any maneuver that is related to the execution of the external or cognitive ritual will be blocked. At first the blockade will be done for short periods of time and then for progressively longer periods.

For this technique to work, the person has to collaborate and take responsibility for:

• To think that obsessions are irrational.
• Determined to overcome the problem.
• Accept that you are having obsessions and do not try to reject them.
• Find other ways to eliminate anxiety.

There are several modalities:

• Live exposure: the real feared situation is addressed, starting with average levels of anxiety.
• Exposure in imagination: confronts the situation feared in the imagination.

Within the cognitive treatment, specific interventions would be performed in:

• Examine the validity of beliefs through discussion.
• Overestimation of the importance of thoughts with behavioral experiments or records of thoughts.
• The excessive responsibility attributed to the patient.
• Perfectionism .
• Exaggerated interpretation of threats.

Finally, it is advisable to work on relapse prevention, teaching the steps to follow in case of:

• Keep calm.
• Be aware that you have an obsession.
• Do not give importance to obsession.
• Do not make compulsions, neutralizations or invitations.
• Practice the exhibition.
• Apply the techniques of risk estimation, attribution of responsibility...
• Identify what you were doing when things went well and what you did not do.
• To perceive relapse as an opportunity for improvement.

Procedures

Electroconvulsive therapy (ECT) has been found to be effective in some severe and refractory cases.

Surgery can be used as a last resort in people who do not improve with other treatments. In this procedure, a surgical lesion is made in the cingulate cortex. In one study, 30% of participants benefited from the procedure.

Children

Cognitive-behavioral therapy can be effective in reducing OCD rituals in children and adolescents.

Family involvement, observing and reporting, is a key component of treatment success.

Although the causes of OCD at younger ages can range from abnormalities to psychological concerns, stressful events Like bullying Or deaths of close relatives can contribute to developing OCD.

Tips for people with OCD

Controlling Obsessive Thoughts and Compulsive Behaviors

• Refocus attention

When you have obsessive thoughts, try to focus attention on something else.

You can exercise, take a walk, listen to music, read, play a video game, make a call...

The important thing is to do something you enjoy for 10-15 minutes to forget the obsession and prevent the compulsive response.

• Write your obsessive thoughts or concerns

When you begin to have some obsession, write all your thoughts or compulsions.

Keep writing until the obsession stops, even if you keep writing the same things.

Writing will help you see how repetitive your obsessions are, and even help them lose their power.

• Anticipate compulsions

By anticipating the urge to perform compulsions before they arise, you can make them relieved.

If, for example, your compulsion is to check that the door has been closed, try to be alert when you close the door and pay attention.

Create a mental note from an image or say"the door is closed"or"you can see that the door is closed".

When the urgency to check if the door is closed appears to be easy to think is simply an obsessive thought, because you will remember that you have closed the door.

• Create a period of concern

Instead of trying to suppress obsessions or compulsions, he develops the habit of programming them.

Choose one or two periods of 10 minutes each day that you devote to obsessions. Choose the time and place, so that they are not close to bedtime.

During the period of concern, focus only on obsessions, urgencies or negative thoughts. Do not try to correct them.

At the end of the period, relax, let go of obsessive thoughts and go back to doing your daily activities.

When thoughts come back to you during the day, postpone them to your worrying period.

• Practice relaxation techniques

Although stress does not cause OCD, a stressful event can lead to heritable OCD or obsessive-compulsive behavior.

Techniques such as yoga, deep breathing, progressive muscle relaxation or meditation can reduce the symptoms of anxiety.

Try to practice a technique for 15-30 minutes a day.

Here you can learn some of them .

• Adopt a healthy diet

Complex carbohydrates such as whole grains, fruits and vegetables stabilize blood sugar and increase serotonin, a neurotransmitter with calming effects.

• Exercise regularly

The exercise Reduces anxiety And helps control the symptoms of OCD by focusing attention on something else when obsessive thoughts and compulsions arise.

Try to do aerobic exercise for at least 30 minutes a day.

• Avoid alcohol and nicotine

Alcohol temporarily reduces anxiety and worry, although it increases when it is not consumed.

The same goes for tobacco: although they seem soothing, they are a powerful stimulant, leading to higher levels of anxiety.

• Sleep enough

Anxiety and worry can lead to insomnia and vice versa.

When you are rested, it is easier to maintain emotional balance, key to coping with anxiety.

Visit this article To receive some tips on how to sleep better.

Helping people with OCD

If a family member or friend has OCD, the most important thing is to educate yourself about the disorder.

Share that knowledge with that person and let him see that you can get help. Simply seeing that the disorder can be treated can increase your motivation.

Also, you can follow these tips:

• Avoid making negative comments: they can make OCD worse. A supportive and relaxed environment can improve treatment.
• Do not get angry or ask to stop doing the rituals: the pressure to avoid them will only worsen the symptoms.
• Try to be as patient as you can: each patient needs to overcome their problems at their own pace.
• Try to keep family life as normal as possible. Make a pact so that OCD does not influence family well-being.
• Communicate clearly and directly.
• Use humor: of course a situation is funny if the patient also finds it funny. Use humor if your family member does not bother with it.

Complications

People with OCD may have additional problems:

• Inability to work or perform social activities.
• Problematic personal relationships.
• Low quality of life.
• Anxiety disorders .
• Depression .
• Eating Disorders .
• Suicidal thoughts or behaviors .
• Abuse of alcohol or other substances.

References

1. Diagnostic and statistical manual of mental disorders: DSM-5 (5 ed.). Washington: American Psychiatric Publishing. 2013. pp. 237-242. ISBN 9780890425558.
2. Fenske JN, Schwenk TL (August 2009). "Obsessive compulsive disorder: diagnosis and management". Am Fam Physician 80 (3): 239-45. PMID 19621834.
3. Grant JE (14 August 2014). "Clinical practice: Obsessive-compulsive disorder." The New England Journal of Medicine 371 (7): 646-53. Doi: 101056 / NEJMcp1402176. PMID 25119610.
4. Goodman, WK; Grice, DE; Lapidus, KA; Coffey, BJ (September 2014). "Obsessive-compulsive disorder." The Psychiatric Clinics of North America 37 (3): 257-67. Doi: 10.1016 / j.psc.2014.06.004. PMID 25150561.
5. Bynum, W.F.; Porter, Roy; Shepherd, Michael (1985). "Obsessional Disorders: A Conceptual History. Terminological and Classificatory Issues." The anatomy of madness: essays in the history of psychiatry. London: Routledge. Pp. 166-187. ISBN 9780415323826.
6. Doron G, Szepsenwol O, Karp E, Gal N (2013). "Obsessing About Intimate Relationships: Testing the Double-Relationship Hypothesis Vulnerability". Journal of Behavior Therapy and Experimental Psychiatry 44 (4): 433-440. Doi: 10.1016 / j.jbtep.2013.05.003. PMID 23792752.
7. Weisman M.M., Bland R.C., Canino G.J., Greenwald S., Hwu H.G., Lee C.K. Et al. (1994). "The cross national epidemiology of obsessive-compulsive disorder". Journal of Clinical Psychiatry 55: 5-10.
8. Boyd MA (2007). Psychiatric Nursing. Lippincott Williams & Wilkins. P. 418. ISBN 0-397-55178-9.
9. Chen YW, Dilsaver SC (1995). "Comorbidity for obsessive-compulsive disorder in bipolar and unipolar disorders". Psychiatry Research 59 (1-2): 57-64. Doi: 10.1016 / 0165-1781 (95) 02752-1. PMID 8771221.
10. Paterson JL, Reynolds AC, Ferguson SA, Dawson D (2013). "Sleep and obsessive-compulsive disorder (OCD)." Sleep Medicine Reviews 17 (6): 465-74. Doi: 101016 / j.smrv.2012.12.002. PMID 23499210.
11. Moretto, Germana, Pasquini Massimo, et al.:"What every psychiatrist should know about PANDAS: a review". Department of Psychiatric Sciences and Psychological Medicine,"Sapienza"University of Rome. In: Clinical Practice and Epidemiology in Mental Health 2008.
12. Wu K, Hanna GL, Rosenberg DR, Arnold PD (2012). "The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder". Pharmacology Biochemistry and Behavior 100 (4): 726-735. Doi: 10.1016 / j.pbb.2011.10.007. PMC 3437220. PMID 22024159.
13. Kim KW, Lee DY (2002). "Obsessive-Compulsive Disorder Associated With a Left Orbitofrontal Infarct." Journal of Neuropsychiatry and Clinical Neurosciences 14 (1): 88-89. Doi: 10.1176 / appi.neuropsych.14.1.88. PMID 11884667.
14. Quick Reference to the Diagnostic Criteria from DSM-IV-TR. Arlington, VA: American Psychiatric Association, 2000.
15. Aardema, F. & O'Connor. (2003). Seeing white bears that are not there: Inference processes in obsessions. Journal of Cognitive Psychotherapy, 17, 23-37.
16. Huppert & Roth: (2003) Treating Obsessive-Compulsive Disorder with Exposure and Response Prevention. The Behavior Analyst Today, 4 (1), 66-70 BAO.
17. Fineberg NA, Brown A, Reghunandanan S, Pampaloni I (2012). "Evidence-based pharmacotherapy of obsessive-compulsive disorder". The International Journal of Neuropsychopharmacology 15 (8): 1173-91. Doi: 10.1017 / S1461145711001829. PMID 22226028.
18. Surgical Procedures for Obsessive-Compulsive Disorder, by M. Jahn and M. Williams, Ph.D. BrainPhysics OCD Resource, Accessed 6 July 2008.
19. D'Alessandro TM (2009). "Factors influencing the onset of childhood obsessive compulsive disorder". Pediatr Nurs 35 (1): 43-6. PMID 19378573.
20. Berrios G E (1989). "Obsessive Compulsive Disorder: Its Conceptual History in France during the 19th Century". Comprehensive Psychiatry 30: 283-95. Doi: 10.1016 / 0010-440x (89) 90052-7.
21. Image source.