OCD

OCD is a chronic, life-long mental health condition in which a person experiences uncontrollable and recurring distressing and intrusive thoughts or obsessions and/or engages in repetitive behaviors or compulsions. The symptoms are time consuming and cause significant distress or interfere with daily life. It is categorized under anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Treatment aims to help people manage their symptoms and improve their quality of life.

The exact cause of OCD remains unclear, but a combination of genetic, brain structure and function, behavioral, cognitive, and environmental factors may contribute.

• Family studies suggest a hereditary component, with first-degree relatives of affected individuals having a higher risk.
• Differences in brain structure and function, particularly in the basal ganglia and frontal lobes, have been associated with OCD. These differences impact the ability to control behavior and emotional responses. They have also been found to play a key role in obsessive thoughts, compulsive behaviors and associated fear and anxiety.
• Stressful childhood trauma, and streptococcal infections can exacerbate or precipitate the onset in predisposed individuals.

Obsessions: These are recurrent and persistent unwanted thoughts, images, or urges that cause significant distress or anxiety. Examples include:

• fears of contamination
• unwanted aggressive thoughts about the self or others
• unwanted or forbidden sexual thoughts or images
• fears of making mistakes or forgetting
• fears of losing or misplacing something
• fears of losing control over one’s behavior
• the need for symmetry

Compulsions: Repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or based on rigid rules. Examples include:

• excessive or ritualized hand washing, showering, brushing teeth or toileting
• repetitive cleaning of household objects
• compulsive checking, arranging or ordering
• repetitive checking of locks, switches and appliances or doors
• constantly seeking approval or reassurance
• rituals related to counting, or repeating
• praying or repeating words silently

The compulsive behaviors are often undertaken in an attempt to reduce the distress associated with the obsessions or to prevent a feared event or situation, although these behaviors or mental acts are not connected in a realistic way to the feared event. People with OCD may attempt to avoid situations that trigger their symptoms or use substances to cope.

Importantly, not all repeated thoughts are obsessions and not all habits are compulsions. The difference is that in people with obsessive and compulsive disorder, they know their obsessions and compulsions are excessive but are unable to control them and spend more than an hour each day with these feelings and behaviors which significantly interferes with daily life.

• Some people with obsessive and compulsive disorder develop a tic disorder involving repetitive movements or sounds.
• Many people with OCD recognize their behaviors make no sense, but children do not and fear that something terrible will happen if they don’t perform their compulsive rituals.

The diagnosis is clinical, based on a detailed patient history, symptoms and psychiatric evaluation including medical and mental health history. A diagnosis requires the presence of obsessional thoughts and/or compulsions that are time consuming (more than one hour per day), cause significant distress and impair work or social functioning. It’s important to differentiate OCD from other disorders that can have similar symptoms.

• Medication therapy: Selective Serotonin Reuptake Inhibitors (SSRIs), a specific type of antidepressants, are the first-line treatment, including fluoxetine, fluvoxamine, sertraline, and paroxetine. For those who don’t respond, clomipramine, a tricyclic antidepressant, may be effective.
• Cognitive Behavioral Therapy (CBT): Exposure and response prevention (ERP) is a specific form of CBT that has been found effective for OCD.
• Deep Brain Stimulation (DBS): Reserved for severe, treatment-resistant cases.
• Psychoeducation: It’s essential to educate patients about the nature of the disorder, treatment options, and the importance of adhering to therapy.

Your Mercie Health and Wellness mental health professional will develop a customized treatment plan that addresses your needs, and preferences. They will work with you to decide which treatment options are best for you and explain the risks and benefits of each option.

While there is no cure, with appropriate treatment, many individuals with OCD can achieve significant symptom relief. However, some might continue to experience residual symptoms. Early diagnosis and intervention often lead to better outcomes.

Research into OCD is ongoing, with new findings in genetics, neuroimaging, and treatment approaches. As our understanding of the brain and behavior evolves, it’s anticipated that more targeted interventions will be developed to benefit those with OCD.

Obsessive Compulsive Disorder is a complex psychiatric condition with multifactorial origins. Accurate diagnosis and comprehensive treatment can offer substantial relief to individuals affected by this disorder.