Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder.

What is Obsessive Compulsive Disorder?

What is Obsessive Compulsive Disorder

Obsessive compulsive disorder, also called OCD, is one of the most serious anxiety disorders . It is characterized by continuous and persistent obsessive thoughts, which provoke in the patient, restlessness, fear and worry. In addition, repetitive acts of a compulsive nature appear, with which it is sought to reduce anxiety.

“Obsessive Compulsive Disorder (OCD) is a serious anxiety disorder.”

The acronym TOC , short for Obsessive Compulsive Disorder, has become popular and often evoke laughing images, such as the film “Best Impossible” by Jack Nicholson, or the more recent “OCD TOC” of Spanish nationality, starring Paco de León. Nothing is further from the truth, OCD is a very serious anxiety disorder, which severely limits the life of the patient and which is certainly not fun for those who suffer from it.

Jack Nicholson in the movie “Better Impossible” is a patient with OCD.

OCD is characterized by two fundamental elements: obsessive thoughts and compulsive acts.

Obsessive Thoughts.

Obsessive thoughts: Sometimes they are also called intrusive because they are ideas that enter the subject’s mind as an intruder, against the subject’s will. These ideas appear on a recurring basis and cause a persistent feeling of anxiety in the patient.

This anxiety can be experienced as fear, as the sensation of impending misfortune, as restlessness or restlessness, as apprehension or fear of some disease or as constant worry.

Obsessive thoughts are the basis of the disease. The OCD patient lives constantly surrounded by thoughts that assail his mind, against his will, causing him enormous restlessness and anxiety.

These obsessive thoughts can have a varied nature. The most frequent are ideas, which provoke fear of being contaminated with germs and contracting diseases. The fear that the subject himself or his closest people may suffer some misfortune is also frequent.

Sometimes it is the need to have all the objects perfectly ordered and controlled. Obsessive thoughts can appear as constant doubts about daily activities (closing a door or a faucet) that force them to perform countless checks. Regardless of their nature, these obsessive thoughts have something in common: the enormous anxiety and anguish they cause in the patient.

Compulsive acts.

The patient, who experiences great anxiety, associated with his obsessive thoughts, is forced to perform acts or activities in a repetitive and compulsive way.

The purpose of these repetitive acts, also called rituals, is to try to reduce the level of anxiety.

These feelings of anxiety force the patient to perform repetitive and methodical acts to try to neutralize the danger by which he feels threatened. These compulsive rituals can be acts like repeatedly washing hands, lining up objects to the millimeter, performing endless counts, or exhaustively repeating phrases.

We can get an approximate idea of ​​the intensity of the anguish associated with obsessions, seeing, for example, a subject with fear of being contaminated with any germ, spends hours and hours in the sink, rubbing his hands repeatedly over and over again, until eroding skin and injure their hands.

In movies like “The Aviator” this fear of contamination and the compulsive need to wash until they bleed are described quite well.

OCD sufferer with compulsive order rituals.

OCD epidemiology.

OCD is a disorder that can appear at any age, although it often appears in childhood or adolescence. Cases have been described in 5-year-old children , although it is more common to appear over ten years of age.

It affects both sexes equally and is a very common disease. According to the WHO, it is the fifth psychiatric disease by number of affected patients.

“OCD is a very disabling disease and usually entails a very low quality of life for those affected.”

OCD is frequently associated with depressive disorders . More than 60% of OCD patients experience depression at some point in their life.

Regarding the prevalence of the disease, the figures are highly variable. Some studies have focused only on clinical pictures. Others have included subclinical cases and finely some studies have focused on patients with obsessive compulsive symptoms, but who do not meet the criteria to be diagnosed with OCD.

Figures from TOC in Spain.

A study carried out in 2011, in Catalonia, by the Rovira i Virgili University studied a sample of children between 8 and 12 years old, analyzing the data in three categories: clinical OCD, subclinical OCD and compulsive obsessive symptomatology.

The results obtained were:
– Clinical OCD: It had a prevalence of 0.8%.
– Subclinical OCD: The prevalence figure rose to 1.5%.
– OC symptoms: Depending on the severity of the symptoms, the figures vary from 5% to 30%. Of these patients, at least 30% continued to present symptoms after three years of follow-up.

It should be noted that subclinical OCD is more frequent in males until adolescence, while in later ages it is more frequent in females.

One of the most relevant aspects of this research was the corroboration of a well-known fact: the association of OCD with other psychological disorders.

“The association of OCD with other mental disorders is 85%.”

The most common problems associated with OCD were:

– Generalized anxiety .
– Separation anxiety.
– Depression .
– Social phobia .
– ADHD.

Children diagnosed with OCD presented a significant decrease in their academic performance. Children who also have tic tend to have a more unfavorable evolution.

Obsessive Compulsive Disorder: Causes.

Despite the numerous studies carried out, it has not been possible to establish a single cause responsible for the disease, although different factors that may influence its genesis have been described.

“The origin of OCD is multifactorial.”

Let’s look at the main factors involved in the origin of OCD:

Genetic factors.

Twin studies have revealed that OCD occurs in a significantly higher proportion (almost double) in monozygotic twins. The genes involved in the disorder are not known.

Biological factors.

Imaging studies with brain markers have seen a possible abnormality in the frontal lobe and the basal brain ganglia. Some recent studies have observed an increase in gray matter in the lenticular nuclei.

This fact contrasts with what is observed in patients with anxiety disorders of another class, where what there is is a decrease in the gray matter in these brain nuclei.

Brain abnormalities can be possible causes of OCD.

Environmental and educational factors. 

It is quite common for parents of patients with OCD to have very rigid and controlling personalities and have given their children an excessively upright and harsh upbringing. This attitude of the parents causes in the child a loss of confidence and an increase in insecurity and anxiety.

Biochemical factors.

Some neurotransmitters such as serotonin could be involved in the origin of OCD. Serotonin deficiency could imply a slowdown in the transfer of interneuronal information, a fact proven in patients with OCD.

Pathological factors.

Recently, cases of OCD associated with celiac disease have been described. Some patients improve on a gluten-free diet.

   Other factors

  • Rare cases of induced or produced OCD have been described in a wide variety of situations:
  • Carbon monoxide poisoning.
  • Allergic reaction to wasp sting.
  • Tumors
  • Postviral encephalitis.
  • Sydeham Korea.
  • At least 50% of patients with Prader-Willy syndrome develop OCD.
  • Streptococcal infection: Some children develop very sudden onset of OCD. The picture appears after suffering an infection by group A beta-hemolytic streptococcus, which affects the basal ganglia of the brain. A syndrome known as PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) has been described. It is associated with the sudden onset of OCD and the presence of tics in children before puberty. It has a severe course and can be associated with infantile hyperactivity.

Obsessive Compulsive Disorder: Symptoms.

Obsessive Compulsive Disorder Symptoms.

The symptoms of OCD are derived from its two main components: obsessions and rituals (compulsive acts).

Obsessive symptoms:

Depending on the nature of their obsessions, various types of OCD patients are described. In general, each type of obsession is associated with a specific type of ritual to neutralize anxiety.

  •  Washers obsessed with spreading germs by touching objects. They often wear gloves and spend much of the day with hand-washing rituals.
  •  Verifiers : Live obsessed checking again and again if they have made certain acts such as closing the gas, the car doors or floor, turn off the light, etc. If they do not carry out the checks they are sure that a misfortune will happen to themselves or a close family member.
  •  Hypochondriacs obsessed with all kinds of diseases. They spend the day checking their vital signs over and over again.
  • Computers that are obsessed with order. Everything must be arranged and arranged perfectly and often symmetrically.
  • Numerals who spend the day adding and subtracting numbers. They look for an outcome that is meaningful and reassuring for them.
  • Perfectionists : they worry about insignificant details. They are very self-demanding, they have the need to perform perfect tasks. They try to keep all the objects in perfect order.

Obsessive compulsive patient belonging to the numeral type.

  • Superstitious: They live dominated by magical and irrational thinking. They think that negative thoughts or certain actions can cause some misfortune.
  • Compulsivequestioners : they spend the whole day asking themselves or those around them about anything insignificant, absurd or trivial.
  • Doubtfuland indecisive: They have great intolerance to uncertainty. Everything generates doubts, they are not capable of making decisions. They need to have absolute certainty in order to lessen their distress.

Rituals in OCD.

To neutralize anxiety, the patient needs to perform his rituals that are long and repetitive. Because of this, they waste a lot of time and are late for their obligations (school, work, appointments …) creating serious family and work problems.

“Rituals are repetitive and capricious behaviors. They must always carry them out in the same way, in order to reduce the anxiety caused by obsessions ”.

The origin of the rituals is the primitive “magical thinking” of our ancestors. It is based on the “magical” belief that performing the ritual will prevent some misfortune from happening.

The patient can recognize the absurdity of his obsessions and the rituals with which he tries to neutralize the anxiety, but nevertheless he has to end up completing the compulsive rituals. The obsessive patient derives no pleasure from performing his ritual acts. He only achieves a slight decrease in his anxiety, for which he is forced to repeat the acts over and over again.

It is necessary to know how to differentiate “the daily manias” that we all have, to a greater or lesser degree, from the rituals of the patient with OCD. The difference is that OCD obsessions create great anxiety, cannot be controlled by patients, force rituals, are persistent and cause a significant alteration in the life of the subject.

Obsessive Compulsive Disorder: Diagnosis.

For the diagnosis of OCD we can use the DSM-5 criteria or the ICD-10 criteria.

  1. a)DSM-5: Presence of obsessive, compulsive or both kinds of symptoms, which cause significant deterioration in the life of the subject and cannot be explained by taking substances or other mental illness.
  2. b)ICD-10: Presence of obsessive, compulsive or both kinds of symptoms, for most of the day, for at least two weeks. Obsessive symptoms must be bothersome and ongoing. The subject recognizes them as his own thoughts and must try to reject at least one of them. Performing the rituals, although it relieves anxiety, should not bring pleasure.

Compulsive cleaning rituals in a patient with OCD.

Diagnosis of childhood OCD.

Early diagnosis is especially important in children, who begin to present some type of obsessive compulsive symptoms. This is not an easy task, because very often, the child tries to hide his symptoms. For this reason, it is important when approaching the diagnosis to be able to count on the help of those who are close to him, such as parents, siblings and teachers.

To assess the degree of severity of the disorder, it may be useful to quantify the symptoms using tests or scales.

The Y-BOCS or Yale-Brown Obsessive Compulsive Scale can serve this purpose. For the child population, the CY-BOCS: Yale-Brown Obsessive Compulsive Scale for Children is preferable.

It is important to investigate the presence of motor or vocal tics, due to the frequent association with OCD. It is also advisable to investigate other compulsive acts such as trichotillomania, (compulsion to pull hair or hair from certain parts of the body) with or without trichophagia (they eat their own hair), onychophagia (habit of biting their nails) or dermatilomania ( compulsion to scratch, scratch and scratch the skin).

For some authors, these cited disorders could be forms of obsessive compulsive disorder. For others, they would be compulsive behaviors associated with in body dysmorphic disorder (formerly called dysmorphophobia).

OCD and famous people.

There are many characters who have confessed to suffering from this disorder: American actress Cameron Díaz, singer Justin Timberlake, actresses Charlize Theron and Jessica Alba, soccer player David Beckham, actors Woody Allen and Harrison Ford, singer Kate Perry.

For some Albert Einstein would be in the group of patients with OCD. Other authors think that he actually suffered from Asperger’s syndrome.

Famous people with OCD

Obsessive Compulsive Disorder: Treatment.

The treatment of OCD is carried out from two aspects:

Treatment with psychotropic drugs.

The prognosis for OCD has improved considerably with the advent of modern antidepressants. The appearance of SSRIs or selective serotonin reuptake inhibitors has changed the prognosis of the disease and improves symptoms in 80% of patients.

The efficacy of these drugs derives from their participation in the metabolism of serotonin, since by inhibiting its neuronal reuptake, it increases the levels of this neurotransmitter in the intersynaptic space.

The main problem is that to be effective in OCD, they must be used at high doses. This has side effects on sexual activity. These drugs cause a delay in ejaculation, difficulty reaching orgasm, and decreased sex drive. In fact some of these drugs are used in the treatment of premature ejaculation.

  • The most widely used SSRIs are fluoxetine (Prozac), paroxetine (Seroxat), sertraline (Besitran), citalopram (Prisdal) and escitalopram (Cipralex).
  • TheSSRIs or selective serotonin and norepinephrine reuptake inhibitors, such as venlafaxine (Vandral) or more specific ones such as mirtazapine (Rexer), are also being used. Psychotropic drugs help 80% of patients reduce their symptoms.
  • To minimize the side effects of the previous drugs, products involved in dopamine metabolism , such as agomelatine (Valdoxan), have been used, but their efficacy has not been proven, since relapses are very high after stopping treatment.

Psychotherapy.

Psychotherapy is helpful in treating OCD. Are used:

  • The behavioral psychotherapy , specifically the  EPR : Exposure and response prevention that helps reduce compulsive rituals.
  •  Cognitive psychotherapy  that can help reduce obsessions.
  • Psychoanalytic psychotherapy is also used to know, through free association and dream analysis, the unconscious psychic mechanisms that cause the appearance of OCD symptoms. The work published in 1909 by Freud is famous “On the subject of a case of obsessive neurosis” on a patient known as ” The man of rats ” where a series of serious obsessive symptoms are analyzed and solved.
  • The therapy focused on emotions (TFE) has proved useful both in treating anxiety and depression, both of which often appear together in patients with OCD.
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Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.

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