Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects millions of people worldwide. The main feature of obsessive-compulsive disorder is the occurrence of recurrent obsessions or compulsions that consume a large amount of time, causing significant suffering and difficulties in daily functioning. Find out what are the basic features of this disorder and how can OCD be effectively treated?
What is obsessive-compulsive disorder?
Obsessive-compulsive disorder, also known as OCD (from obsessive-compulsive disorder), is a mental disorder characterized by two main elements: obsession and compulsion. It was also formerly called obsessive-compulsive neurosis, but modern medical terminology prefers the term “obsessive-compulsive disorder.”
Obsessions, compulsions. Obsessive-compulsive neurosis
Obsessions are persistent thoughts, impulses or imaginings that are perceived as intrusive or inappropriate, e.g. a religious person may have persistent blasphemous thoughts or a mother may experience thoughts of harming her child. It is worth remembering that obsessive thoughts occur as a normal phenomenon, occurring in almost 90% of people. What makes the difference is the duration of the symptoms, its intensity and the suffering experienced.
Obsessions
- obsessions can occur in the form of intrusive thoughts, impulses, images that cause severe anxiety or stress,
- are not worries, related to real problems in daily life,
- a person with this disorder tries to ignore, suppress or neutralize the occurrence of obsessions.
Compulsions are repetitive behaviors that can be overt or covert.
Overt compulsions include washing hands, controlling, organizing, arranging objects in a certain order, among others. Implicit and covert compulsions are mental acts such as praying, counting or repeating words. The purpose of these behaviors is to reduce anxiety; after performing a compulsion, there is short-term relief from experiencing anxiety.
Compulsions (obsessions)
- repetitive behaviors or acts of the mind, a person feels compelled to undertake compulsions (they are compulsive in nature) as a result of the appearance of obsessions,
- certain behaviors are intended to reduce stress, prevent events, prepare in some way, e.g. a person who has blasphemous intrusive thoughts goes to church every day to minimize his anxiety.
Obsessive-compulsive disorder – examples
To better understand how obsessive-compulsive disorder manifests itself in everyday life, it is useful to look at specific examples of obsessions and compulsions. Keep in mind that OCD can take many forms, and the following examples are only some of the possible manifestations of this disorder.
Cleanliness obsessions and cleaning compulsions
One of the most common manifestations of OCD are obsessions about dirt and bacteria. A person experiencing such obsessions may:
- Feel fear of germs, bacteria or viruses
- Be afraid of chemical or biological contamination
- Fear of getting sick or infecting others
- Compulsions arise in response to these obsessions, such as:
- Excessive hand washing, often to the point of damaging the skin
- Washing the body, hair or teeth repeatedly
- Avoiding places perceived as “dirty” (such as public restrooms)
- Using paper towels to touch doorknobs
Obsessions with order and symmetry
Many people with OCD experience the need to keep things in a certain order or symmetry. This can include:
- Compulsive ordering of objects according to specific patterns
- The need to arrange things symmetrically
- Repetition of activities until the “right feel” is achieved
Obsessions about safety and checking
Another common OCD pattern is related to security:
- Obsessive fear of burglary or fire
- Concern for the safety of loved ones
- Compulsive checking of locks, windows, gas stoves, irons
- Repeatedly returning home to make sure everything is safe
Obsessions with counting and magical thinking
Some people with OCD engage in obsessive counting or magical thinking:
- Counting specific objects or repeating actions a certain number of times
- Believing that certain numbers are “safe” or “dangerous”
- Performing rituals to “prevent” misfortune
Religious obsessions (scrupulosity)
Religious people may experience obsessions related to morality and religion:
- Excessive worry about committing sin
- Compulsive recitation of prayers or performance of religious practices
- Constantly seeking reassurances about moral issues
Symptoms of obsessive-compulsive neurosis
Obsessive compulsive neurosis, is also known as obsessive-compulsive disorder, is a type of anxiety disorder that is characterized by experiencing obsessive thoughts, or uncontrollable, recurring thoughts that can be bothersome and difficult to ignore. In response to these obsessive thoughts, people with obsessive-compulsive neurosis also experience compulsions, or repetitive behaviors that they engage in to relieve the anxiety associated with the obsessions.
Obsessive-compulsive disorder – causes
The causes of the development of obsessive-compulsive disorder are not yet fully understood, but scientific research points to a complex background of the disorder.
Genetic factors
Studies confirm that genetic factors play an important role in the development of OCD, accounting for about 40% of the explained variance. This means that people whose relatives suffer from obsessive-compulsive disorder may be more susceptible to developing the disorder. However, this is not a simple mechanism of inheritance of a single gene, but rather a complex interaction of multiple genes.
Environmental factors
The environment plays an equally important role in the development of OCD, accounting for about 50% of the explained variance. Potential risk factors in this category include:
Neurobiological disorders
Modern research also points to the role of dysfunction in specific areas of the brain and imbalances in neurotransmitters, particularly serotonin. Brain imaging techniques have revealed differences in the activity and structure of specific brain regions in people with OCD compared to healthy individuals.
Psychological factors
Some psychological theories suggest that certain thinking patterns and beliefs may increase the risk of developing OCD. This may include excessive responsibility, perfectionism, a tendency to overestimate the importance of thoughts, and the need to control thoughts.
It is important to understand that OCD is rarely due to a single factor – it is usually a combination of multiple genetic, neurobiological and environmental factors.
Obsessive-compulsive disorder – diagnosis
Diagnostic criteria for obsessive-compulsive disorder according to DSM V:
- The presence of obsessions, compulsive intrusive activities, or both. The behaviors or mental activities described are intended to prevent, or reduce the severity of, anxiety, or to prevent certain events or anxiety-provoking situations.
- The behaviors or mental activities are not actually related to what they are supposed to neutralize, but are clearly excessive and can escalate.
- Recurring and entrenched thoughts, impulses or imaginings are experienced as intrusive or inappropriate and cause significant anxiety, or distress, in most people.
- For example, the amount of time spent on symptoms, greater than an hour a day, causes significant clinical distress or difficulty functioning in social, occupational and other important areas. For most people with OCD, symptoms impede daily functioning
- The person makes attempts to ignore or suppress the impulse thoughts described, such as by performing intrusive activities.
- Diagnosing OCD can be difficult due to the complex nature of the disorder. Obsessive-compulsive symptoms are not caused by the physiological effects of substances, such as alcohol or marijuana use or a general medical condition.
General characteristics of OCD sufferers
People who face OCD symptoms most often experience an exaggerated sense of responsibility. They tend to catastrophize and focus on the worst-case scenario. They exhibit perfectionism, high standards, and have a strong need for control – intolerant of any uncertainty and overestimating the impact of thoughts on daily events.
Obsessive-compulsive disorder – a spectrum of problems
The spectrum of obsessive-compulsive disorder includes several intertwining categories. The first includes such features as impulsivity-compulsivity. In both impulsive and compulsive behavior, the patient is unable to delay the behavior or inhibit it. The difference between these traits, however, concerns the underlying mechanism of the actions. Compulsive behavior causes a temporary reduction in discomfort. The goal of impulsive behavior is to provide pleasure.
The second dimension allows for the inclusion of obsessions and compulsions on a continuum. A person suffering from obsessive-compulsive disorder may experience a preponderance of intrusive thoughts, and on the other hand, intrusive activities (often diagnosed in children and adolescents) may predominate.
The third dimension includes traits – good insight, poor insight. Among patients, there is a group that is non-critical of their complaints and symptoms. They have a strong belief in their obsessions and compulsive behavior. Patients may not cope with their symptoms and yet want to maintain rituals, even though they become difficult to break. For example, checking to make sure doors are locked and believing that checking will protect them from potential theft.
Co-occurrence of obsessive-compulsive disorder OCD
Co-occurrence of obsessive-compulsive disorder with other mental disorders is very common. Among the most commonly described are anxiety disorders, depression, neurotic disorders, personality disorders and eating disorders.
Treatment of OCD. CBT cognitive-behavioral psychotherapy
For more severe symptoms of obsessive-compulsive disorder, a psychiatrist may recommend pharmacotherapy to relieve symptoms. In the treatment of obsessive-compulsive disorder, pharmacotherapy can be used alone or in combination with other therapeutic methods. Implementing pharmacological treatment, such as serotonin regulation, can bring relief to the patient’s mental health.
Cognitive-behavioral therapy(CBT) is a form of psychotherapy that has proven effective in treating obsessive-compulsive disorder (OCD). It focuses on changing the thoughts and behaviors associated with OCD, helping patients identify and challenge their negative beliefs and replace them with more realistic ones. The goal of therapy is to distance oneself from intrusive thoughts and accept them as irrelevant to continued functioning. CBT also includes exposure therapy, which involves gradually minimizing compulsive behavior. The best results can be expected when treating OCD by combining cognitive and behavioral techniques.
Cognitive model of obsessive-compulsive disorder
A key cause and sustaining factor in the occurrence of obsessive-compulsive syndrome is the misinterpretation of intrusions that occur. There are many studies saying that the occurrence of intrusions is a common phenomenon, which leads us to believe that the specific way of interpreting them is associated with a strong sense of responsibility for possibly causing harm, harm to oneself or others. This most likely leads to experiencing discomfort and strong anxiety, which in turn triggers the process of compulsive behavior that sustains the existence of the disorder.
Fusion of thought and action
Patients with OCD often equate thought with action. During therapeutic interactions, OCD patients try to separate their own thoughts from their behavior. For example – I had a thought about cheating does not mean I cheated.
The fusion of thought and action can take the following forms:
- Thought = action
- If I think this way, I must do something to prevent it.
- Thinking this way is just as bad as acting.
- The appearance of this thought in my head indicates how bad a person I am.
- The appearance of this thought indicates that I can lose control and actually do it.
Characteristic cognitive distortions of OCD
The most important cognitive distortions that occur in people with OCD.
- Dichotomous thinking – “if I make a mistake, it means I’m hopeless”.
- Exaggeration – “I’d better wash again, then I’ll be clean for sure.”
- Catastrophizing – “if I don’t wash again, I will definitely get a dangerous disease”. Personalization – “if my child gets sick, it will be my fault”.
- Magical thinking – “if I don’t go out on the balcony, nothing will happen.”
- Negative labeling – “I’m abnormal, I’m sick”.
- I have to, I should – “I should control everything, I have to check everything”.
How to treat obsessive-compulsive disorder? Behavioral approach
Exposure and response inhibition procedures are the most effective methods of reducing compulsions. The behavioral approach is based on the principle that compulsions that relieve discomfort are subject to negative reinforcement and thus become more likely to occur.
Exposure therapy planning involves identifying anxiety-triggering stimuli and intrusive activities, along with assessing the severity of the anxiety and compulsion to perform the compulsion.
For example, a person who is afraid of germs and uses a series of compulsive behaviors gradually exposes himself to potential germs (e.g., touching a doorknob, the floor) without allowing him to wash his hands.
With regular exposure exercises, the person begins to learn that anxiety is diminishing, becoming accustomed to potential threatening experiences, which, with the help of repetition, begin to not be so scary anymore. There are two types of exposure: real exposure, imaginary exposure.
Habituation
Habituation is the process of reducing or eliminating the response to a repeated stimulus. Often this process used in the treatment of obsessive-compulsive disorder, exposure therapy.
Through the process of habituation, we know that anxiety cannot grow indefinitely, it must eventually begin to diminish. Anxiety can be tamed despite its presence, ignored anxiety fades away like an unused muscle. Habituation helps OCD sufferers gradually reduce their anxiety levels and stop engaging in compulsive behaviors such as washing hands, checking, counting, etc. By repeatedly exposing themselves to the source of their fear or anxiety, deferring compulsive behaviors, patients can experience that anxiety will gradually decrease on its own.
Recognizing OCD in everyday life
It is important to understand the difference between normal habits and OCD symptoms. The main differences are:
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The time spent performing rituals (more than an hour a day with OCD).
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The level of distress associated with obsessive thoughts.
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The degree to which obsessions and compulsions interfere with normal functioning.
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Lack of ability to control obsessive thoughts and compulsive behavior.
Obsessive-compulsive disorder – medications
Pharmacotherapy is an important part of the comprehensive treatment of obsessive-compulsive disorder. Medications are usually prescribed by a psychiatrist after a thorough evaluation of the patient’s condition and individual needs.
Types of medications used to treat OCD
The main drugs used to treat obsessive-compulsive disorder are antidepressants from the selective serotonin reuptake inhibitor (SSRI) group. They work by regulating serotonin levels in the brain, which helps reduce the severity of obsessive-compulsive symptoms. In some cases, other groups of drugs are also used, such as tricyclic antidepressants or anti-anxiety drugs.
What to know about pharmacotherapy for OCD
Each medication may work slightly differently in different people, so it is important to work closely with your doctor during treatment. Neuraxpharm and other pharmaceutical companies provide a variety of drug options that can be tailored to a patient’s individual needs. Remember that the effects of drug treatment may not be felt until after several weeks of regular medication.
Therapy as an adjunct to pharmacotherapy
Medications are often only part of a comprehensive treatment plan. The best results are achieved by combining pharmacotherapy with psychotherapy, especially cognitive-behavioral therapy (CBT), which is considered the most effective therapeutic method for treating OCD. The therapy helps patients develop coping strategies to deal with obsessive thoughts and gradually reduce compulsive behavior.
Summary
Obsessive-compulsive disorder is a complex mental disorder that can significantly affect quality of life. It is characterized by obsessive thoughts that cause anxiety and compulsive behaviors designed to reduce that anxiety. The causes of OCD are multifactorial and include both genetic and environmental factors.
Remember, obsessive-compulsive disorder can be effectively treated. One of the most effective therapies is cognitive-behavioral therapy (CBT). CBT helps people with OCD challenge irrational thoughts and break the cycle of compulsive behavior.
Bibliography:
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Bryńska A., Obsessive-compulsive disorder. Diagnosis, etiology, behavioral-cognitive therapy – a detailed monograph combining theory and practice, including examples of therapeutic conversations and current data on OCD.
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Hyman B.M., Pedrick C., Overcome OCD, or obsessive-compulsive disorder – a practical guide with exercises for patients and therapists, discussing step-by-step methods for managing symptoms.
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Hershfield J., Corboy T., Obsessive-Compulsive Disorder. A guide with exercises based on mindfulness and cognitive-behavioral therapy – second edition updated with the latest therapeutic techniques, including ACT and ER therapy.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7059159/
- https://pubmed.ncbi.nlm.nih.gov/30008679/