What You Should Know About Obsessive Compulsive Disorder (OCD)

What is OCD?

Obsessive-compulsive disorder (OCD) causes intrusive thoughts that make a person feel like they must carry out unwanted, recurring behaviors. OCD may appear in the form of obsessions like unwelcome but persistent thoughts, impulses, or images. This mental condition will typically involve compulsions—here, a person carries out repetitive behaviors they feel pressured to perform.

People with OCD will usually carry out these unwanted behaviors to produce a feeling of relief. These repeated practices, however, produce a sense of discomfort and can be very disruptive to daily life.

OCD V OCPD

Obsessive-compulsive disorder is categorized under obsessive-compulsive and related disorders. These behaviors are not voluntary and are often the impulsive result of distressing thoughts. 

A person with obsessive-compulsive traits will not always display these behaviors all day long; however, the symptoms occupy at least one hour or more of a person’s day. OCD traits occur after feeling a persistent urge to act.

Obsessive-compulsive behaviors come in the form of obsessions or compulsions that cause a person to act in a certain manner. They are an unwelcome part of daily living.

In contrast, obsessive-compulsive personality disorder is a condition of personality. People with OCPD have personalities that are dominated by perfectionist traits. A person with this disorder will often obsess over orderliness and detail. It isn’t uncommon for people with this disorder to plan out every moment of their day to avoid idle time.

While people with OCD often feel distressed at the behaviors they feel forced to exhibit, a person with OCPD will usually believe in the merits of his/her personality traits. OCPD behaviors are accepted as a way of life. The affected person may not feel like they have a problem that needs to be changed.

Statistics

Obsessive-compulsive disorder is a common condition affecting men and women alike. Children and adolescents are also known to exhibit the common compulsions and obsessions of this disorder.

Most people will begin to show signs of this disease by ages 19-29¹. Around 2.2 million adults², or 1% of the American population, live with obsessive-compulsive disorder.

  1. Obsessive–compulsive disorder (2020)

  2. Anxiety disorders - facts & statistics | Anxiety & Depression Association of America

Symptoms

A person with OCD will display signs of overt compulsions or obsessions. Obsessive behaviors come in the form of unpleasant thoughts, images, or urges—these unwanted urges usually lead to anxiety. Compulsions are performed to reduce this anxiety.

Obsessive behaviors are seen where:

  • A person is considerably frightened of germs or contaminated surfaces/exposure

  • Distressing thoughts about sex or bodily harm frequently appear

  • There is an excessive fixation on religion

  • Thoughts on aggressive behavior towards self or others are common

  • There is a preoccupation with getting objects in perfect order

  • There is considerable fear of losing/forgetting something

  • There is uncertainty about losing self-control

Compulsive traits may appear in the following settings¹:

  • When a person engages in excessive self-cleaning

  • Where an individual carries out persistent mental rituals or prayers

  • In situations where things are required to be placed in a specific arrangement

  • Where a person compulsively checks items such as the door or oven to avoid accidents

  • In situations where a person carries out uncontrollable counting

  • Where a person hoards objects for their real or imagined value

Causes

Obsessive-compulsive disorder in children or adults is often marked by persistent and unreasonable behaviors. Experts remain at a loss to pinpoint the exact causes of these traits that many struggles to manage.

A few theories however exist to explain the factors responsible for the disorder. According to the National Institutes of Health, the following are likely causes of OCD:

Genetic factors

Studies have established a link between heredity and the development of obsessive-compulsive symptoms.

In particular, people with a first-degree relative¹ (i.e a parent, sibling, or child) living with OCD are at higher risk of acquiring similar traits. 

This risk is often higher if the relative started to show signs of OCD as a child or teenager². Identical twins will usually share symptoms of this disorder where one displays traits of OCD¹.

Research is inconclusive on the genes or gene sets that may encourage the appearance of obsessive compulsive features.

Biology

A person with OCD may live with abnormalities in the brain that cause the behaviors linked to this disorder².

The prefrontal cortex—responsible for cognitive processes like attention and impulse control—is one section of the brain associated with OCD. Likewise, subcortical (deeper) brain structures that affect mood, thought, and social functions can play a role in obsessive-compulsive traits.

Environmental factors

The environment a person is exposed to can increase the odds of acquiring OCD. Negative experiences such as birth complications can contribute to a child’s risk of OCD. Similarly, living through stressful or traumatic events can cause obsessive-compulsive symptoms to appear².

There are cases where OCD may develop from infection. Children can begin to show signs of this disorder after a streptococcal infection known to cause pneumonia, skin infections, and other disorders. When OCD develops from this infection, the condition is classified under Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)².

Risk factors for OCD

Stress

For many living with obsessive-compulsive disorder, symptoms are usually traceable to a stressful or traumatizing period in life. 

However, it remains unclear whether stress is a direct cause of OCD, or if these difficult periods simply worsen the disorder.

Stress can trigger harmful, obsessive, functional impairment in people living with psychiatric conditions. The same effects may be observed in healthy people constantly faced with strain.

Reports place stressful life events around six to 12 months before signs of OCD begin to appear³. 

Stressful events can cause a sudden emergence of OCD symptoms. When stress is the primary cause of OCD, a person will not require a family history of the condition before showing signs of the disorder³.

Personality

Personality or temperament are not established causes of OCD. However, different personality types have been associated with this disorder. They include traits like hoarding and indecisiveness. People that strive for perfectionism have been known to fit the profile for obsessive traits. 

History of abuse

There is already established evidence that childhood abuse worsens the risk of developing physical or mental health challenges late in life. Early research points to higher chances of OCD in cases where physical, emotional, and sexual abuse or neglect were present in childhood⁴. 

Brain trauma

Traumatic head injury can impact the brain’s circuitry. A person who has suffered brain trauma may develop several complications—OCD being a likely consequence.

This disorder may emerge following impact to the neural circuits, environmental stressors, and the rehabilitation process following the injury. 

Other mental health disorders associated with OCD

Body dysmorphic disorder

BDD is an obsessive preoccupation with flaws in appearance. This fixation is often enough to be distressing to daily life. 

It is linked with OCD because body dysmorphic disorder is often categorized as a type of obsessive condition. 

Both conditions involve repetitive behaviors like continuously checking the mirror to critique features. Also, symptoms of BDD and OCD commonly begin early, usually around adolescence.

OCD, however, covers any number of obsessions—contamination, religion, etc. BDD is focused solely on perceived shortcomings in physical appearance. 

Depressive disorder

OCD and depression are co-occurring disorders. Depression may develop from having to cope with unwanted thoughts and behaviors regularly.

People with OCD are reported to display symptoms that mirror depression. This includes trouble feeling pleasure, struggles with sadness, a decrease in sex drive, and appetite and sleep disturbance. There are even rare cases where OCD and depression begin at the same time.

When a person lives with depression and OCD, care has to be taken during treatment. Living with the former can negatively impact the effects of treatment methods like therapy when managing OCD⁵. 

Autism spectrum disorder

There are common overlaps between OCD and autism spectrum disorder. Both conditions can involve compulsive or obsessive behaviors. These behaviors are often repetitive and can form a part of daily routine.

However, while these similarities are present, it should be noted that a person with autism will often carry out repetitive behaviors to soothe themselves or cope with overwhelming stimuli in their environment. In contrast, OCD compulsive traits are usually distressing and unwanted. 

Generalized anxiety disorder

At the core of both conditions, GAD⁶ and OCD involve excessive amounts of worry over various situations. However, the nature of these worries is different.

While GAD often follows worries on everyday issues like bill payment, work duties, school responsibilities, etc.—OCD anxiety is usually reserved for worries about dirt contamination, losing an object of perceived sentimental value, religious impurity, etc.

Also, people with GAD do not display the compulsive behaviors commonly found in OCD. Uncontrollable traits like handwashing or praying are limited to OCD.

Diagnosis

To qualify as a case of obsessive-compulsive disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) stipulates that a person must meet several conditions⁷.

First, the obsessions and compulsions displayed in a case must cause extreme discomfort or functional impairment that affects the quality of life. 

This is to avoid confusing every unwanted thought or repetitive behavior as an automatic symptom of OCD.

Likewise, if a person shows obsessive traits or common compulsions, these behaviors should not result from other mental disorders. 

Obsessive traits will not meet the requirements of OCD if they are derived from the effects of a drug or other substance. 

To qualify as obsessive-compulsive disorder, the DSM-5 specifies the following⁷:

  • Obsessive behaviors are marked by recurrent thoughts and impulses. These impulses must be unwanted at the time of occurrence and should cause distress

  • There should be attempts to suppress these impulses by moving to act. This action will usually lead to a compulsive response to manage the distress

  • Compulsive traits are usually the result of obsessive thoughts. They may include repetitive behaviors such as handwashing and mental acts like praying or repeating words silently. 

  • The compulsive behaviors are usually carried out as a way to manage anxiety. They are, however, an excessive response

An OCD diagnosis will also require that a person spend considerable time out of the day managing these obsessions or compulsions. At least one hour daily should be dedicated to managing these traits⁷.

Prevention

In some cases, it is possible to prevent symptoms of OCD from worsening or emerging at all. People at high risk of this disorder may go through psychoeducation to understand their obsessive traits. 

A suitable way to prevent OCD is to detect it early. Quick identification of this disorder can lead to early management of obsessive-compulsive symptoms¹.

Family members and loved ones can also play an important role in preventing OCD from worsening. This is through family accommodation. Here, loved ones participate in learning about and overcoming obsessive-compulsive traits¹.

Treatments

Individuals with OCD can learn to manage and control their obsessive-compulsive impulses. To achieve this, a combination of educational, pharmaceutical, or even surgical procedures will be required. In some cases, alternative medicine may provide positive results for treating OCD.

Psychoeducation

Patient literacy on the causes, effects, and treatments available for OCD can provide a deeper understanding of the disorder.

This education may apply to the patient, family members, or other loved ones who often observe obsessive-compulsive traits.

Psychoeducation is carried out by a professional that teaches about stigma and prejudice that might result from OCD behaviors. Also to be taught are the roles family and loved ones can play in worsening or potentially boosting the progress of OCD treatment¹. 

Medication

Pharmacological options are trusted for managing symptoms of OCD. Selective serotonin reuptake inhibitors (SSRIs) are often recommended as a first-line treatment to manage this disorder. 

This medication often impacts serotonin receptors to improve the brain’s supply of serotonin—the ‘feel-good’ hormone. 

SSRIs are commonly used to manage symptoms of anxiety and depression. However, their safety, efficiency, easy tolerance, and low abuse potential make them a choice treatment for OCD traits.

Clomipramine², a tricyclic antidepressant, is a second-line treatment option for OCD in children aged 10 and older³. This medication is approved by the Food and Drug Administration for managing this disorder. 

Therapy

Cognitive-behavioral therapy is the most recognized form of therapy for managing OCD. This treatment helps to pinpoint negative, obsessive thoughts that cause compulsive, repetitive reactions¹.

In particular, exposure and response prevention (ERP)⁴—a sub-group of CBT, is the preferred treatment for OCD.

ERP teaches people to embrace their obsessive thoughts without giving in to the compulsions that would typically satisfy them. 

This form of therapy is done in a safe environment. It instructs on the skills required to control obsessive-compulsive traits.

Non-conventional approaches to OCD

Deep brain stimulation (DBS)⁵

This treatment is a last resort in cases of treatment-resistant OCD. This method is commonly used to manage movement disorders such as Parkinson’s disease and can improve severe symptoms of obsessive-compulsive disorder.

Through DBS, different portions of the brain are stimulated to improve circuitry and connections that impact OCD. This process can help to manage and improve symptoms of obsessive-compulsive behavior. It is a minimally invasive procedure.

Transcranial magnetic stimulation (TMS)

This procedure is a non-invasive treatment for managing obsessive traits. It is an established treatment for major depressive disorder.

TMS⁶ introduces magnetic fields to portions of the brain responsible for the symptoms of obsessive-compulsive disorder. It is believed that targeting these sections will isolate the specific symptoms of OCD, giving the brain a chance to reorient its response to obsessive thoughts.

Transcranial magnetic stimulation can complement treatment to established options like medicine and therapy. 

Coping with OCD

Living with the knowledge that obsessive thoughts can control and take over a significant portion of the day can be difficult. Personal, professional, social, and other interactions may become strained due to this disorder. Also greatly affected is the quality of life when living with OCD.

While treatment options are ongoing, there are different steps to ensure daily life goes on with relative ease.

How to manage OCD symptoms

Learning about the disorder

Researching the different aspects of OCD can be empowering when looking to tackle the disease head-on.

Knowledge about causes, symptoms, effects, etc., can improve the outlook on the disorder. Proper information may also help with managing treatment expectations.

Joining a support group

Anyone that lives with OCD can stand to gain from hearing about other experiences with the disorder. A support group can provide a stigma-free setting to discuss challenges, worries, progress, or simply stories of people living with obsessive-compulsive disorder.

Maintaining a healthy lifestyle

Keeping a healthy outlook and lifestyle can be beneficial to OCD treatment progress. Getting regular exercise, eating healthy, getting adequate sleep, etc.—can have a positive effect on life quality and treatment outcomes.

Doctors & specialists

When to see a doctor

Obsessive-compulsive disorder can be very disruptive to everyday living. It is important to visit a doctor when symptoms of this disorder become distressing enough to interfere with regular activities. 

Which types of doctors/specialists treat OCD?

OCD is a severe condition that can lead to other serious physical and mental health challenges. To get this condition under control, expert, specialized care is required.

A person suspected of having this disorder should consult a mental health professional like a psychiatrist or psychologist for a proper diagnosis and treatment advice.


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