Obsessive-compulsive disorder is an anxiety disorder in which a person suffers from persistent unwanted thoughts, obsessions and compulsions. The OCD sufferer performs rituals such as hand washing, light checking, counting, and excessive cleaning in the hope of decreasing the obsessive thoughts. The obsessions and compulsions related to obsessive- compulsive disorder often cause the sufferers to have difficulty keeping a job, relating to other people, or even performing routine tasks such as washing dishes, driving a car or talking on the telephone.
According to Mental Health America, “The obsessions experienced by the OCD sufferer are thoughts, images or impulses that occur repeatedly. The person does not want to have these ideas, finds them disturbing and intrusive and, usually, recognizes that they really don’t make sense. Obsessions are accompanied by uncomfortable feelings such as fear, disgust or doubt”. The most common obsessions include the fear of germs, causing harm to others, a need to keep order, distorted thoughts about one’s body, religious concerns, unreasonable sexual urges, and a need to confess. According to a study by Fontenelle, Soares and others, many OCD sufferers also exhibit a hyper-attachment to family members and inanimate objects, resulting in hoarding activities and empathy towards others which is greater than community controls. Compulsions can take on many forms. The fear of germs may cause excessive hand washing and the inability to touch objects with one’s hands. Other compulsions which the OCD sufferer performs in an attempt to relieve the obsessive thoughts include checking door and window locks repeatedly, flipping light switches on and off countless times, counting, arranging and rearranging objects and skin picking. Although these behaviors provide temporary relief to the sufferer, if the compulsions are allowed to continue unchecked, they become more time consuming and eventually require more time to produce the required stress relief. The average age of onset for OCD is 19 years, although a large percentage of people develop the disorder between the ages of 9 and 13. It is very rare to develop OCD over the age of 30. It is more common in males than in females. According to Medicine Net, “The diagnosis of OCD has been described in medicine for at least the past 100 years. Statistics on the number of people in the United States who have OCD range from 1% - 2%.The frequency with which it occurs and the symptoms which it presents are remarkably similar, regardless of the culture of the sufferer.”
A wide variety of other mental health disorders are associated with obsessive-compulsive disorder. People with OCD often exhibit other disorders such as muscle tics (Tourette’s disorder), anorexia and other eating disorders, body dysmorphic disorder, depression, anxiety, and hypochondriasis (the fear of having a disease). Obsessive compulsive personality disorder is also common in people with OCD. It is characterized by extreme perfectionism in which sufferers feel the need to control their environment and the people around them.
Scientists are unsure of the exact causes of obsessive-compulsive disorder, although several factors seem to contribute to a persons’ likelihood of developing the disease. An imbalance of serotonin in the brain and a family history of the illness are the most common causes of OCD. In years past, scientists attributed a person’s upbringing to the development of OCD. Due to recent research in the area of brain function, it is no longer believed this is the case. Certain abnormal brain patterns have been associated with obsessive-compulsive disorder. According to Science News, “Scientists have discovered that people with OCD and their close family members show under-activation of brain areas responsible for stopping habitual behavior. This is the first time that scientists have associated functional changes in the brain with familial risk for the disorder.” Science News also reported that Dr. Samuel Chamberlain at the University of Cambridge’s Department of Psychiatry used functional magnetic resonance imaging to measure brain activity of OCD patients and their families during a series of decision making tests. The tests focused on brain activity in the lateral orbitalfrontal cortex. This is the area of the brain associated with decision making and behavior. Dr. Chamberlain was able to conclude that “impaired function in the brain areas controlling flexible behavior probably predisposes people to developing rigid symptoms that are characteristic of OCD”. A tendency to exhibit OCD symptoms is also related to distinctive patterns in brain structure. According to Science Daily, “Certain genes may pose a risk for OCD by influencing brain structure, such as the amount and location of grey matter in the brain, which in turn may impact upon an individual’s ability to perform mental tasks.” Science News reported that researchers at Cambridge University devised a test which measured the ability to stop repetitive behaviors. Participants were told to press a left or right button as quickly as possible, and stopping the action when a buzzer sounded. The OCD sufferers and their immediate families took a longer period of time to stop the repetitive behavior than the control group. This was directly connected to a decrease in grey matter in the areas of the brain directly associated with suppressing responses and habits. A study by Carmona, Bassas and others discovered that children diagnosed with OCD showed a 5.93% reduction of gray matter n the brain compared to the control group. Science News noted that although brain function and structure in patients with OCD is different from non-sufferers, it is unclear why some family members which have similar brain structures never develop symptoms, while others struggle with the disease. Further studies of genetics may provide information on the specific genes which contribute to the development of OCD and how they are passed on from parent to child.
OCD is primarily diagnosed through a combination of interviews and a physical examination to determine if there is an underlying illness which could cause symptoms similar to OCD. Many people with OCD also have other mental health problems which need to be addressed to properly treat the symptoms of OCD. The Yale-Brown Compulsive scale is widely used by psychiatrists to measure the severity of the patient’s obsessive-compulsive disorder and formulate a plan for treatment. As medical science advances, MRI scans and genetic testing may provide another avenue for diagnosis.
Obsessive-compulsive disorder is a difficult disease to treat, especially since there are other illnesses within the spectrum of OCD and many patients have multiple symptoms. The most common treatment is cognitive behavior therapy combined with selective serotonin re-uptake inhibitors. Ritual prevention and exposure therapy are the two most commonly used cognitive behavior therapies. According to Medicine Net, “Ritual prevention involves a mental health professional helping the OCD sufferer to endure longer and longer periods of resisting the urge to engage in compulsive behaviors. Exposure therapy is the process by which the individual with OCD is put in touch with situations that tend to increase the person’s urge to engage in compulsions, then helping him or her resist that urge. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving that are often associated with the anxiety involved with OCD”. A study by Simpson, Foa and others examined the importance of cognitive-behavioral therapy. The study states, “Most OCD patients who have received an adequate SRI trial continue to have clinically significant OCD symptoms.” The results of the study stated, “Augmentation of SRI pharmacotherapy with exposure and ritual prevention is an effective strategy for reducing symptoms. However, 17 sessions were not sufficient to help most of these patients achieve minimal symptoms.” Patients with OCD struggle with the disease for most of their life, although periods of stress and illness can increase the severity of the symptoms.
Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat OCD. In people diagnosed with OCD, the level of serotonin in the brain is below normal levels. Serotonin is a neurochemical which carries messages across brain synapses where neurons are connected to each other. According to Medicine Net, SSRIs increase the amount of serotonin in the brain by selectively blocking serotonin reuptake at brain synapses. The reuptake of serotonin normally causes the production of serotonin to cease. The increase in the serotonin levels caused by the selective serotonin reuptake inhibitors enable cells that may have been deactivated by OCD to be reactivated, which in turn decreases the symptoms of OCD. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox) and escitalopram (Lexapro). The side effects of SSRIs are mild and include nausea, sleepiness or insomnia, headaches, agitation and diarrhea. Some patients also experience tremors. Most of these side effects disappear within the first few weeks of use. . A serious side effect of SSRIs is serotonergic syndrome. Although it is very rare, symptoms include heart arrhythmia, seizures, and high fevers.
As safer medications become available and scientists learn more about how the brain functions, the prognosis for sufferers of obsessive-compulsive disorder is more promising than ever before. A combination of the correct medications along with a consistent plan of therapy can help OCD sufferers function normally.
Cited References
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Obsessive compulsive disorder linked to brain activity [online article]. In: Science daily. c2008 [cited 2009 June 22]. Available from: http://www.sciencedaily.com/releases/2008/07/080717140456.htm.
Pattern associated with genetic risk of obsessive compulsive disorder [online article]. 2007. In: Science daily. c2009 [cited 2009 June 26]. Available from: http://www.sciencedaily.com/releases/2007/11/071126114002.htm.
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