Overview
Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions). To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing/cleaning, checking on things, and mental acts like (counting) or other activities, can significantly interfere with a person’s daily activities and social interactions.
Many people without OCD have distressing thoughts or repetitive behaviors. However, these do not typically disrupt daily life. For people with OCD, thoughts are persistent and intrusive, and behaviors are rigid. Not performing the behaviors commonly causes great distress, often attached to a specific fear of dire consequences (to self or loved ones) if the behaviors are not completed. Many people with OCD know or suspect their obsessional thoughts are not realistic; others may think they could be true. Even if they know their intrusive thoughts are not realistic, people with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions.
What's it like to live with OCD?
Although many people experience minor obsessions (such as worrying about leaving the gas on, or if the door is locked) and compulsions (such as avoiding the cracks in the pavement), these don't significantly interfere with daily life, or are short-lived.
If you experience OCD, it's likely that your obsessions and compulsions will have a big impact on how you live your life:
Disruption to your day-to-day life. Repeating compulsions can take up a lot of time, and you might avoid certain situations that trigger your OCD. This can mean that you're not able to go to work, see family and friends, eat out or even go outside. Obsessive thoughts can make it hard to concentrate and leave you feeling exhausted.
Impact on your relationships. You may feel that you have to hide your OCD from people close to you – or your doubts and anxieties about a relationship may make it too difficult to continue.
Feeling ashamed or lonely. You may feel ashamed of your obsessive thoughts, or worry that they can't be treated. You might want to hide this part of you from other people, and find it hard to be around people or to go outside. This can make you feel isolated and lonely.
Feeling anxious. You may find that your obsessions and compulsions are making you feel anxious and stressed. For example, some people feel that they have to carry out their compulsions so frequently that they have little control over them.
OCD - Symptoms
Obsessive-compulsive disorder usually includes both obsessions and compulsions.
But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social, school or work functioning.
Obsession symptoms
OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you're trying to think of or do other things.
Obsessions often have themes to them, such as:
Fear of contamination or dirt
Doubting and having difficulty tolerating uncertainty
Needing things orderly and symmetrical
Aggressive or horrific thoughts about losing control and harming yourself or others
Unwanted thoughts, including aggression, or sexual or religious subjects
Examples of obsession signs and symptoms include:
Fear of being contaminated by touching objects others have touched
Doubts that you've locked the door or turned off the stove
Intense stress when objects aren't orderly or facing a certain way
Images of driving your car into a crowd of people
Thoughts about shouting obscenities or acting inappropriately in public
Unpleasant sexual images
Avoidance of situations that can trigger obsessions, such as shaking hands
Compulsion symptoms
OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.
You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they're intended to fix.
As with obsessions, compulsions typically have themes, such as:
Washing and cleaning
Checking
Counting
Orderliness
Following a strict routine
Demanding reassurance
Examples of compulsion signs and symptoms include:
Hand-washing until your skin becomes raw
Checking doors repeatedly to make sure they're locked
Checking the stove repeatedly to make sure it's off
Counting in certain patterns
Silently repeating a prayer, word or phrase
Arranging your canned goods to face the same way
Treatment
Patients with OCD who receive appropriate treatment commonly experience increased quality of life and improved functioning. Treatment may improve an individual's ability to function at school and work, develop and enjoy relationships, and pursue leisure activities.
Cognitive Behavioral Therapy
One effective treatment is a type of cognitive-behavioral therapy (CBT) known as exposure and response prevention (ERP). During treatment sessions, patients are exposed to feared situations or images that focus on their obsessions. Although it is standard to start with those that only lead to mild or moderate symptoms, initially the treatment often causes increased anxiety. Patients are instructed to avoid performing their usual compulsive behaviors (known as response prevention). By staying in a feared situation without anything terrible happening, patients learn that their fearful thoughts are just thoughts. People learn that they can cope with their thoughts without relying on ritualistic behaviors, and their anxiety decreases over time. Using evidence-based guidelines, therapists and patients typically collaborate to develop an exposure plan that gradually moves from lower anxiety situations to higher anxiety situations. Exposures are performed both in treatment sessions and at home. Some people with OCD may not agree to participate in CBT because of the initial anxiety it evokes, but it is the most powerful tool available for treating many types of OCD.
Medication
A class of medications known as selective serotonin reuptake inhibitors (SSRIs), typically used to treat depression, can also be effective in the treatment of OCD. The SSRI dosage used to treat OCD is often higher than that used to treat depression. Patients who do not respond to one SSRI medication sometimes respond to another. The maximum benefit usually takes six to twelve weeks or longer to be fully visible. Patients with mild to moderate OCD symptoms are typically treated with either CBT or medication depending on patient preference, the patient’s cognitive abilities and level of insight, the presence or absence of associated psychiatric conditions, and treatment availability. The best treatment of OCD is a combination of CBT and SSRIs, especially if OCD symptoms are severe.
Neurosurgical treatment
Some newer studies show that gamma ventral capsulotomy, a surgical procedure, can be very effective for patients who do not respond to typical treatments and are very impaired, but it is underused due to historical prejudice and its invasiveness.
Deep brain stimulation, which involves an implanted device in the brain, has data to support efficacy and does not permanently destroy brain tissue as done in a capsulotomy. However, it is still highly invasive and complex to manage, and there are limited providers and hospital systems trained to offer this treatment and, able to provide the long-term support needed by DBS patients.
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REFERENCE: NHS, MAYOCLINIC.EDU, OCDUK,MIND
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