The obsessive-compulsive disorder (OCD) is a disorder more severe and disabling anxiety. In these people there is what is known as thought-action fusion: they equate thoughts with actions.
People who have anxiety disorders and need hospitalization often have this disorder, just like those who need psychosurgery.
Symptoms of Obsessive Compulsive Disorder
Obsessions are images or intrusive thoughts without meaning that are tried to avoid or eliminate .
- The most common are:
- Sexual content.
- Aggressive impulses.
- Need for symmetry.
- Worries about the body.
What is Obsessive-Compulsive Disorder?
Actions or thoughts that are used to suppress obsessions. They are believed to reduce stress or prevent a negative event. In addition, they may be magical or illogical, unrelated to obsession.
Compulsions can be:
- Behavioral: check, wash hands, arrange, order, review, rituals …
- Mental: counting, praying …
Many people with OCD continually wash their hands or make revisions, which gives them a sense of security and control.
The checks are used to prevent imaginary disasters. They can be logical – like checking that the door has not been left open or the gas – or illogical – like counting to 100 to avoid a disaster.
Depending on the type of obsession, there are more or other types of compulsions:
- There are more rituals of testing in sexual obsessions.
- In obsessions for symmetry, repetition of rituals occurs more.
- In the obsessions for pollution are given more rituals of washing.
Causes of Obsessive Compulsive Disorder
It is possible that the tendency to develop anxiety from having compulsive thoughts may have the same biological and psychological precursors as anxiety in general.
For it to develop, it will be necessary for a person to have certain biological and psychological factors.
In the first place, repetitive thoughts may be regulated by the hypothetical brain circuit.
People with OCD are more likely to have first-degree relatives who also have the same disorder.
In cases where OCD develops during adolescence, there is a stronger relationship of genetic factors than in cases in which it develops into adulthood.
For evolutionary psychology, moderate versions of OCD may have evolutionary advantages. For example, health, hygiene, or enemy reviews.
One hypothesis is that people with OCD learn that some thoughts are unacceptable or dangerous, as they might happen in reality.
They may develop during childhood the thought-action fusion, excessive responsibility or feelings of guilt.
The rapid onset of OCD in children and adolescents could be caused by a syndrome linked to Group A of streptococcal infections (PANDAS) or caused by immunological reactions to other pathogens (PANS).
Brain studies of people with OCD have shown that they have different activity patterns than people without OCD.
The different functioning of a particular region, the striatum, could be causing the disorder.
Differences in other parts of the brain and deregulation of neurotransmitters, especially serotonin and dopamine, may also contribute to OCD.
Independent studies have found unusual dopamine and serotonin activity in various regions of the brain in people with OCD: dopaminergic hyperfunction in the prefrontal cortex and dopaminergic hypofunction in the basal ganglia.
Deregulation of glutamate has also been recently studied, although its role in the disorder is not well understood.
Diagnostic criteria according to DSM-IV
- A) It is fulfilled for obsessions and compulsions:
- Recurrent, persistent thoughts, impulses, or images that are experienced at some point in the disorder as intrusive and inappropriate, and cause significant anxiety or discomfort.
- Thoughts, impulses or images are not reduced to simple over-worries about real-life problems.
- The person tries to ignore or suppress these thoughts, impulses or images, or tries to neutralize them by other thoughts or acts.
- The person recognizes that these thoughts, impulses or obsessive images are the product of his mind (and do not come as taxes in the insertion of thought).
- B) At some point in the course of the disorder the person has recognized that these obsessions or compulsions are excessive or irrational. Note: this point is not applicable in children.
- C) Obsessions or compulsions cause significant clinical discomfort, represent a waste of time (more than one hour a day) or interfere markedly with the individual’s daily routine, work relationships or social life.
- D) If there is another disorder, the content of obsessions or compulsions is not limited to it (eg, food worries in an eating disorder).
- E) The disorder is not due to the direct physiological effects of a substance or a medical illness.
With little awareness of illness: if for most of the time in the current episode, the individual does not recognize that obsessions or compulsions are excessive or irrational.
OCD is often confused with obsessive-compulsive personality disorder (TOCP).
Its main differences are:
- The TOCP is egodistonic, the person does not suffer from having the disorder and considers it part of their self-image.
- OCD is egodistonic, the person does not consider it part of their self-image and causes discomfort.
- While people with OCD are not aware of anything abnormal, people with OCD are aware that their behavior is not rational.
- On the other hand, OCD is distinct from behaviors such as addiction to gambling or eating disorders. People with these disorders experience some pleasure from doing those activities, while people with OCD do not feel pleasure.
OCD affects 2.3% of people at some time in their lives.
Symptoms usually occur before age 35 and half of people develop the disorder before age 20.
Behavioral therapy, cognitive-behavioral therapy and medication are the first-line treatments for OCD.
Behavioral and cognitive behavioral therapy
Exposure prevention is used in these therapies.
It is a technique by which the person is systematically exposed to the stimuli until it becomes habitable.
For this, any maneuver that is related to the execution of the external or cognitive ritual will be blocked. At first the blockade will be done for short periods of time and then for progressively longer periods.
For this technique to work, the person has to collaborate and take responsibility for:
To think that obsessions are irrational.
- Determined to overcome the problem.
- Accept that you are having obsessions and do not try to reject them.
- Find other ways to eliminate anxiety.
There are several modalities:
- Live exposure: the real feared situation is addressed, starting with average levels of anxiety.
- Exposure in imagination: confronts the situation feared in the imagination.
Within the cognitive treatment, specific interventions would be performed in:
- Examine the validity of beliefs through discussion.
- Overestimation of the importance of thoughts with behavioral experiments or records of thoughts.
- The excessive responsibility attributed to the patient.
- Perfectionism .
- Exaggerated interpretation of threats.
Finally, it is advisable to work on relapse prevention, teaching the steps to follow in case of:
- Keep calm.
- Be aware that you have an obsession.
- Do not give importance to obsession.
- Do not make compulsions, neutralizations or avoidance.
- Practice the exhibition.
- Apply the techniques of risk estimation, attribution of responsibility …
- Identify what you were doing when things went well and what you did not do.
- To perceive relapse as an opportunity for improvement.
Medication as treatment includes selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, in particular clomipramine.
SSRIs are a second line of treatment for people with moderate or severe impairment.
Atypical antipsychotics such as quetiapine have also been useful in treating OCD along with SSRIs. However, these drugs are poorly tolerated and have metabolic side effects. None of the atypical antipsychotics appear to be useful when used alone.
Electroconvulsive therapy (ECT) has been found to be effective in some severe and refractory cases.
Surgery can be used as a last resort in people who do not improve with other treatments. In this procedure, a surgical lesion is made in the cingulate cortex. In one study, 30% of participants benefited from the procedure.
Cognitive-behavioral therapy can be effective in reducing OCD rituals in children and adolescents.
Family involvement, observing and reporting, is a key component of treatment success.
Although the causes of OCD in younger ages can range from abnormalities to psychological concerns, stressful events such as bullying or deaths of close relatives can contribute to developing OCD.
Tips for people with OCD
Controlling Obsessive Thoughts and Compulsive Behaviors
- Refocus attention
When you have obsessive thoughts, try to focus attention on something else.
You can exercise, take a walk, listen to music, read, play a video game, make a call …
The important thing is to do something you enjoy for 10-15 minutes to forget the obsession and prevent the compulsive response.
- Write your obsessive thoughts or concerns
When you begin to have some obsession, write all your thoughts or compulsions.
Keep writing until the obsession stops, even if you keep writing the same things.
Writing will help you see how repetitive your obsessions are, and even help them lose their power.
- Anticipate compulsions
By anticipating the urge to perform compulsions before they arise, you can make them relieved.
If, for example, your compulsion is to check that the door has been closed, try to be alert when you close the door and pay attention.
Create a mental note from an image or say “the door is closed” or “you can see that the door is closed”.
When the urgency to check if the door is closed appears to be easy to think is simply an obsessive thought, because you will remember that you have closed the door.
- Create a period of concern
Instead of trying to suppress obsessions or compulsions, he develops the habit of programming them.
Choose one or two periods of 10 minutes each day that you devote to obsessions. Choose the time and place, so that they are not close to bedtime.
During the period of concern, focus only on obsessions, urgencies or negative thoughts. Do not try to correct them.
At the end of the period, relax, let go of obsessive thoughts and go back to doing your daily activities.
When thoughts come back to you during the day, postpone them to your worrying period.
- Practice relaxation techniques
Although stress does not cause OCD, a stressful event can lead to heritable OCD or obsessive-compulsive behavior.
Techniques such as yoga, deep breathing, progressive muscle relaxation or meditation can reduce the symptoms of anxiety.
Try to practice a technique for 15-30 minutes a day.
Here you can learn some of them.
- Adopt a healthy diet
Complex carbohydrates such as whole grains, fruits and vegetables stabilize blood sugar and increase serotonin, a neurotransmitter with calming effects.
- Exercise regularly
Exercise reduces anxiety and helps control the symptoms of OCD by focusing attention on something else when obsessive thoughts and compulsions arise.
Try to do aerobic exercise for at least 30 minutes a day.
- Avoid alcohol and nicotine
Alcohol temporarily reduces anxiety and worry, although it increases when it is not consumed.
The same goes for tobacco: although they seem soothing, they are a powerful stimulant, leading to higher levels of anxiety.
- Sleep enough
Anxiety and worry can lead to insomnia and vice versa.
When you are rested, it is easier to maintain emotional balance, key to coping with anxiety.
Helping people with OCD
- If a family member or friend has OCD, the most important thing is to educate yourself about the disorder.
- Share that knowledge with that person and let him see that you can get help. Simply seeing that the disorder can be treated can increase your motivation.
- Also, you can follow these tips:
- Avoid making negative comments: they can make OCD worse. A supportive and relaxed environment can improve treatment.
- Do not get angry or ask to stop doing the rituals: the pressure to avoid them will only worsen the symptoms.
- Try to be as patient as you can: each patient needs to overcome their problems at their own pace.
- Try to keep family life as normal as possible. Make a pact so that OCD does not influence family well-being.
- Communicate clearly and directly.
- Use humor: of course a situation is funny if the patient also finds it funny. Use humor if your family member does not bother with it.