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OCD is characterised by a combination of obsessive thoughts which the individual manages by compulsive behaviour. Fears may be around contamination or safety and can come in different forms. Causes are as yet uncertain but treatment is widely available.

Introduction

OCD affects approximately one percent of the population in the USA; that amounts to just over two million people.
It is equally prevalent among men and women (although possibly more common in women) and is generally first experienced in late teens/young adulthood. Sadly, about half of cases tend to be severe; it is less common for OCD to be "mild". Obsessional thoughts are actually quite common in the general population - a recent study showed that up to 80 percent of the population experience intrusive thoughts. The difference in the intensity and frequency of the obsessions and how people interpret and deal with the thought that is the issue.

Obsessive Compulsive Disorder is an anxiety disorder that has two key components: obsessions and compulsions. Obsessions are intrusive and unwanted and thoughts that distress the person. The person with OCD becomes "besieged" by their obsessive thoughts - "Obsession’ comes from the Latin word ‘obsidere’ which means ‘to besiege’. These thoughts are unwanted and unwelcome and cause considerable distress and so the person develops strategies to manage them. 

Compulsions are behaviors that the person feels compelled to carry out repeatedly, despite them becoming so time consuming, disruptive of daily living, and as really having no usual function, although they feel purposeful and meaningful to the person. Compulsions serve to remove the anxiety but only temporarily: they initially make the person feel safer or reassured but this effect is short-lived. This might include: 

  • Fear of contamination from the outside world - washing hands applying a certain rule or routine to the process.
  • Fear of being vulnerable so checking doors and windows are locked a certain number of times.

It may even be 'unfounded' in that they don't know what is worrying them but they need to perform certain actions to feel calm again. they may be overt - that which could be observed by another person; or covert or cognitive - which might be counting or substituting a thought with another, for example. 

Types of Obsession

Fear of causing or failing to prevent harm

  • This might be worrying that you have caused harm to someone by your carelessness, action or inaction.

Intrusive thoughts, images, and impulses

  • These are often very disturbing, violent thoughts or images of yourself doing something unpleasant to someone and may cause you to feel you are a dangerous person.

  • Thoughts that are very much at odds with your religious beliefs.

  • Thoughts that your relationship is doomed in some way.

  • Thoughts of a sexual nature, often inappropriate or of a societal “taboo”, such as rape.

Fear of contamination

  • Contact or physical contamination thoughts focus on you in some way being tainted or sullied by something you have touched or been exposed to, such as dirt or bacteria, and worrying that you might transmit this in some way.

  • Mental contamination – here you might experience uncomfortable feelings but not by actual physical contact with something. So for example, feeling dirty after remembering a certain event. Mental contamination tends to develop after physical contamination.

Fears and worries related to order or symmetry

  • Fears that things need to be in order/clean/in the right place to avoid something bad happening.

While people can recognize that their fears may be irrational, they still feel compelled to carry out certain actions. 

Causes of OCD

There are a number of different causes that have been proposed for OCD. However, despite considerable research, scientists have not so far been able to identify a definitive cause for OCD. Some theories include:

  • Biological factors such as different brain activity/areas of the brain being activated.
  • PANDASPediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection
  • Genetic Factors - Studies suggest that someone with OCD is perhaps four times more likely to have another family member with OCD than someone who does not.
  • Chemical Imbalance - OCD has been considered from the perspective of biochemical imbalance, and in particular the neurotransmitter, serotonin.
  • Psychological Explanations - Behavioral, Cognitive and Psychoanalytic Theories
  • Mental Health issues such as depression
  • Life Stressors

Diagnosis of OCD

In the past, sufferers of OCD would often go undiagnosed for years, in part owing to lack of knowledge about the condition, but also because people tended to be highly secretive about their difficulties owing to a strong sense of embarrassment, guilt and even shame about their condition. As a result, people would often wait an average of 10–15 years between symptoms developing and seeking help and so delayed diagnosis was very much an issue.

Fortunately, owing to increased understanding and awareness, people are getting diagnosed much sooner, even if that is sometimes unofficially or self-diagnosis. OCD is diagnosed through interview, self report measures such as the Obsessive Compulsive Interview (OCI) and by using the criteria set out in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition)

 

Treatment

Treatment for most anxiety disorders consists of two possible elements: psychological therapy and medication. 

  • Psychological therapies: the therapy with the strongest evidence base is Cognitive-Behavioral Therapy or CBT. This works by focusing on how your thoughts affect how you feel and behave and looks to challenge dysfunctional thoughts and understand core self-beliefs (the assumptions we have about ourselves and others as well as the world around us) to change behavior. Exposure and Response Prevention (ERP) is a form of CBT which looks to enable you to confront your obsessions and prevent compulsions. 
  • Medication: the first point of call with medication tends to be to prescribe an anti-depressant, often of the SSRI (Specific Serotonin Re-uptake Inhibitor) variety. 
  • Deep brain stimulation is a highly experimental and somewhat controversial treatment currently under investigation as a treatment option for OCD; however research remains inconclusive.

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