OBSESSIVE COMPULSIVE DISORDERS
Obsessive-Compulsive Disorder (OCD) is a chronic disorder whereby a person has uncontrollable, reoccurring thoughts (obsessions) and behaviours (compulsions) that he or she feels the urge to repeat over and over.
People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.
Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:
- Fear of germs or contamination
- Unwanted forbidden or taboo thoughts involving sex, religion, and harm
- Aggressive thoughts towards others or self
- Having things symmetrical or in a perfect order
Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:
- Excessive cleaning and/or handwashing
- Ordering and arranging things in a particular, precise way
- Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
- Compulsive counting
Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:
- Can't control his or her thoughts or behaviours, even when those thoughts or behaviours are recognised as excessive
- Spends at least 1 hour a day on these thoughts or behaviours
- Doesn’t get pleasure when performing the behaviours or rituals, but may feel brief relief from the anxiety the thoughts cause
- Experiences significant problems in their daily life due to these thoughts or behaviours
Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognise that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary.
OCD is a common disorder that affects adults, adolescents, and children. Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen.
The causes of OCD are unknown, but risk factors include:
Twin and family studies have shown that people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. The risk is higher if the first-degree relative developed OCD as a child or teen.
Brain Structure and Functioning
Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear. Research is still underway.
People who have experienced abuse (physical or sexual) in childhood or other trauma are at an increased risk for developing OCD.
In some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).
Treatments and Therapies
OCD is typically treated with medication, psychotherapy or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.
Serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms. Examples of medications that have been proven effective in both adults and children with OCD include clomipramine , which is a member of an older class of “tricyclic” antidepressants, and several newer “selective serotonin reuptake inhibitors” (SSRIs), including:
SRIs often require higher daily doses in the treatment of OCD than of depression, and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.
Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP) is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication. Often it is helpful to engage in therapy to support the changes that need to be made; changes in our thinking, feelings and behaviour.
There are several advantages of therapy and in particular CBT. It is a therapy that predominantly looks at the ‘here and now’ – the problem today rather than looking too far back into history or childhood. It helps the client to understand the origin of the perceived threat and this ‘informs’ the pre-frontal cortex (the part of the brain that deals with logic, inference, problem solving and planning). By challenging the client’s beliefs the amygdala is dampened down (the part of the brain that gives the rough and ready immediate responses that are not always appropriate). In addition new coping strategies for dealing with anxiety can be learned and the client can begin to enjoy a new life with reduced or normal levels of anxiety.
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