Download Obsessive-compulsive disorder (OCD) is a psychiatric disorder

People often wonder what exactly is Obsessive-compulsive disorder. A good
scenario that would help understand this is best looked at from an early age. I will briefly
describe a daily routine of a little girl that I use to know back in grade school. She often
wake up and go to the bathroom and wash her hands but still having the feeling that they
still weren't clean. When she would get to school, she had a hard time opening doors,
thinking that she would be getting severe germs. During homework sessions she would
always be turning things in late knowing that she thinks there are still mistakes. Or during
her exam she would sit there and erase over and over because she thinks there is still
mistakes, to the point that she is ripping through the paper.
Obsessive-compulsive disorder (OCD) is a psychiatric disorder, specifically, an
anxiety disorder. OCD is manifested in a variety of forms, but is most commonly
characterized by a subject's obsessive drive to perform a particular task or set of tasks,
compulsions commonly termed rituals. OCD should also not be confused with OCPD, the
similarly named but notably different obsessive-compulsive personality disorder, which
psychiatric guidelines define as a personality characteristic rather than an anxiety
disorder.
The phrase "obsessive-compulsive" has worked its way into the English
terminology, and is often used in an offhand sense to describe someone who is
meticulous or absorbed in a cause. It is also important to distinguish OCD from other
types of anxiety, including the routine tension and stress that appear throughout life. A
person who shows signs of infatuation or fixation with a subject/object, or displays traits
such as perfectionism, is not necessarily suffering from OCD.
Symptoms and prevalence
Modern research has revealed that OCD is much more common than previously
thought. An estimated 2-3% of the population of the United States is thought to have
OCD or display OCD-like symptoms. Because of the condition's personal nature, and the
lingering stigma that surrounds it, there may be many unaccounted-for OCD sufferers,
and the actual percentages could be even higher.
The typical OCD sufferer performs tasks (or compulsions) to seek relief from
obsessions. To others, these tasks may appear simple and unnecessary. But for the
sufferer, such tasks can feel critically important, and must be performed in particular
ways for fear of dire consequences and to stop the stress from building up. Examples of
these tasks: repeatedly checking that one's parked car has been locked before leaving it;
turning lights on and off a set number of times before exiting a room; repeatedly washing
hands at regular intervals throughout the day. (Source: Edna B. & Clark)
OCD rituals are often bound up with intricate detail — detail that may seem
arbitrary to outsiders. Smokers with OCD, for instance, may argue with themselves that
quitting cigarettes is possible only on the 13th or 27th of a month, and only when they are
in possession of four cigarettes at noon. Another symptom of the disease is fear of
contamination; some sufferers may fear the presence of human body secretion such as
saliva, sweat, tears or mucus, or excretions such as urine or feces. Some OCD sufferers
even fear the soap they're using is contaminated.(Source: Mineka)
Obsessions are thoughts and ideas that the sufferer cannot stop thinking about.
Common OCD obsessions include fears of acquiring disease, getting hurt, or causing
harm to someone. Obsessions are typically automatic, frequent, distressing, and difficult
to control or put an end to by themselves. People with OCD who obsess over hurting
themselves or others are actually less likely to do so than the average person.
Compulsions refer to actions that the person performs, usually repeatedly, in an
attempt to make the obsession go away (Source: Rachman). For an OCD sufferer who
obsesses about germs or contamination, for example, these compulsions often involve
repeated cleansing or meticulous avoidance of trash and mess. Most of the time the
actions become so regular that it is not a noticeable problem. Common compulsions
include excessive washing and cleaning; checking; hoarding; repetitive actions such as
touching, counting, arranging and ordering; and other ritualistic behaviors that the person
feels will lessen the chances of provoking an obsession (Source: Rachman). Compulsions
can be observable — washing, for instance — but they can also be mental rituals such as
repeating words or phrases, or counting.
Most OCD sufferers are aware that such thoughts and behavior are not rational,
but feel bound to comply with them to fend off fears of panic or dread. Because sufferers
are consciously aware of this irrationality but feel helpless to push it away, OCD is often
regarded as one of the most vexing and frustrating of the major anxiety disorders (Source:
Rapaort).
People who suffer from the separate and unrelated condition obsessive
compulsive personality disorder are not aware of anything abnormal with them; they will
readily explain why their actions are rational, and it is usually impossible to convince
them otherwise. People who suffer with OCPD tend to derive pleasure from their
obsessions or compulsions. Those with OCD do not derive pleasure but are ridden with
anxiety. This is a significant difference between these disorders.
Equally frequent, these rationalizations do not apply to the overall behavior, but to
each instance individually; for example, a person compulsively checking their front door
may argue that the time taken and stress caused by one more check of the front door is
considerably less than the time and stress associated with being robbed, and thus the
check is the better option. In practice, after that check, the individual is still not sure, and
it is still better in terms of time and stress to do one more check, and this reasoning can
continue as long as necessary. Not all OCD sufferers engage in compulsive behavior.
Recent years have seen increased diagnoses of Pure Obsessional OCD, or "Pure O." This
form of OCD is manifested entirely within the mind, and involves obsessive ruminations
triggered by certain thoughts. These mental "snags" can be debilitating, often tying up a
sufferer for hours at a time (Source: Mineka). As of 2004, headway continues to be made
by specialists.
"Pure O" OCD is thought to be the most difficult form of OCD to treat. OCD is
different from behaviors such as gambling addiction and overeating. People with these
disorders typically experience at least some pleasure from their activity; OCD sufferers
do not actively want to perform their compulsive tasks, and experience no tangible
pleasure in doing so. It is believed by many that Pure O OCD is in fact more prevalent
than other types of OCD (Source: Edna & Wilson). In this disorder, the sufferer tries to
"disprove" the anxious thoughts through logic and reasoning, yet in doing so becomes
further entrapped by the obsessions.
OCD is placed in the anxiety class of mental illness, but like many chronic stress
disorders it can lead to depression over time. The constant stress of the condition can
cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of
hopelessness. OCD's effects on day-to-day life — particularly its substantial consumption
of time — can produce difficulties with work, finances and relationships. However, some
people still maintain successful careers and relationships as many do find they can hide or
suppress their obsessive-compulsive behaviour due to feeling unnecessarily ashamed of
this debilitating disorder (Source: Rapaport).
Causes and related disorders
There are many different theories about the cause of obsessive-compulsive
disorder. Some research has discovered a type of size abnormality in different brain
structures. The majority of researchers believe that there is some type of abnormality in
the neurotransmitter serotonin, among other possible psychological or biological
abnormalities; however, it is possible that this activity is the brain's response to OCD, and
not its cause. Recent research has revealed a possible genetic mutation that could be the
cause of OCD (Source: Mineka). Researchers funded by the National Institutes of Health
have found a mutation in the human serotonin transporter gene, hSERT, in unrelated
families with OCD.
A popular explanation for OCD is that offered in the book 'Brain Lock', which
suggests that OCD is caused by the part of the brain that is responsible for translating
complex intentions (e.g., "I will pick up this cup") into fundamental actions (e.g., "move
arm forward, rotate hand 15 degrees, etc.") failing to correctly communicate the chemical
message that an action has been completed (Source: Edna & Wilson). This is perceived
as a feeling of doubt and incompleteness which then leads the individual to attempt to
consciously deconstruct their own prior behavior - a process which induces anxiety in
most people, even those without OCD.
Violence is rare among OCD sufferers, but the disorder is often debilitating and
detrimental to their quality of life. Also, the psychological self-awareness of the
irrationality of the disorder can be painful. For people with severe OCD, it may take
several hours a day to carry out the compulsive acts. To avoid perceived obsession
triggers, they also often avoid certain situations or places altogether.
It has been alleged that sufferers are generally of above-average intelligence, as the very
nature of the disorder forces complicated thinking patterns, but this has never been
supported by clinical data (Source: Rachman).
Some people with OCD also suffer from conditions such as Tourette syndrome,
compulsive skin picking, and other severe conditions. It is also interesting to note that
there is some research demonstrating a link between drug addiction and obsessive
compulsive disorder as well. There is a higher risk of drug addiction among those with
any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety),
but drug addiction among obsessive compulsive patients may serve as a type of
compulsive behavior and not just as a coping mechanism(Source: Rapaport). Depression
is also extremely prevalent among sufferers of OCD. One idea for the high depression
rate among OCD populations was posited by Mineka, Watson and Clark (1998), who
explained that people with OCD (or any other anxiety disorder, for that matter) may feel
depressed because of an "out of control" type of feeling.
Some cases are thought to be caused at least in part by childhood streptococcal
infections and are termed P.A.N.D.A.S. (Pediatric Autoimmune Neuropsychiatric
Disorders Associated with Streptococcal infections). The streptococcal antibodies
become involved in an autoimmune process. OCD in men at least may be partially caused
by low oestrogen levels (entire paragraphcited from “Obsessive-Compulsive Disorders:
The Facts).
Treatment
OCD can be treated with behavioral therapy (BT) or Cognitive therapy (CBT) and
with a variety of medications. According to the Expert Consensus Guidelines for the
Treatment of Obsessive-Compulsive Disorder (Journal of Clinical Psychiatry, 1995, Vol.
54, supplement 4), the treatment of choice for most OCD is behavior therapy or cognitive
behavior therapy. Medications can help make the treatment go faster and easier, but most
experts regard those as clearly the best choice. Medications generally do not produce as
much symptom control as BT/CBT, and symptoms invariably return if the medication is
ever stopped.
The specific technique used in BT/CBT is called Exposure and Ritual Prevention
(also known as Exposure and Response Prevention) or ERP; this involves gradually
learning to tolerate the anxiety associated with not performing the ritual behavior
(Source: Mineka). At first, for example, someone might touch something only very
mildly "contaminated" (such as a tissue that has been touched by another tissue that has
been touched by the end of a toothpick that has touched a book that came from a
"contaminated" location, such as a school.) That is the "exposure." The "ritual
prevention" is not washing. Another example might be leaving the house and checking
the lock only once (exposure) without going back and checking again (ritual prevention).
The person fairly quickly habituates to the (formerly) anxiety-producing situation and
discovers that their anxiety level has dropped considerably; they can then progress to
touching something more "contaminated" or not checking the lock at all — again,
without performing the ritual behavior of washing or checking.
“Pharmacologic treatments include selective serotonin reuptake inhibitors such as
paroxetine (Paxil, Aropax), sertraline (Zoloft), fluoxetine (Prozac), and fluvoxamine
(Luvox) as well as the tricyclic antidepressants, in particular clomipramine (Anafranil).
Other medications like gabapentin (Neurontin), lamotrigine (Lamictal), and the newer
atypical antipsychotics olanzapine (Zyprexa) and risperidone (Risperdal) have also been
found to be useful as adjuncts in the treatment of OCD. Symptoms tend to return,
however, once the drugs are discontinued.” (Cited from Comorbidity of Anxiety and
Unipolar Mood Disorders)
The naturally occurring sugar Inositol has been found in double-blind studies to
be an effective treatment for OCD. It is equal in effectiveness to SSRI's and is virtually
free from side effects. (Source: a summary of research on inositol in treatment of OCD
can be found at
http://www.standardprocess.com/lit/monographs/InositolL9005.pdf#search='inositol%20
OCD')
Recent research has found increasing evidence that opiates may significantly
reduce OCD symptoms, though the addictive property of these drugs likely stands as an
obstacle to their sanctioned approval for OCD treatment. Anecdotal reports suggest that
some OCD sufferers have successfully self-medicated with opiates such as Ultram and
Vicodin, though the off-label use of such painkillers is not encouraged, again because of
their addictive qualities (Source: Rachman).
Hallucinogens, such as psilocybin (an active ingredient in "magic mushrooms")
and LSD, have also shown promise — reducing symptoms for up to several months in
some people. There is an ongoing US FDA-approved study being conducted at the
University of Arizona to determine their effectiveness. Studies have also been done that
show nutrition deficiencies may also be a probable cause for OCD and other mental
disorders. Certain vitamin and mineral supplements may aid in such disorders and
provide the nutrients necessary for proper mental functioning.
Neuropsychiatry
OCD primarily involves the brain regions of the striatum and the cingulate cortex,
especially the striatum. OCD involves several different receptors, mostly H2, M4, nk1,
NMDA, and non-NMDA glutamate receptors. The receptors 5-HT1D, 5-HT2C, and the
mu opioid receptor exert a secondary effect. The H2, M4, nk1, and non-NMDA
glutamate receptors are active in the striatum, whereas the NMDA receptors are active in
the cingulate cortex (Source: Rachman).
The following research information was taken after National Institute of Mental
Health (NIMH) conducted a clinical and after their studies basically stated the following:
The activity of certain receptors is positively correlated to the severity of OCD, whereas
the activity of certain other receptors is negatively correlated to the severity of OCD.
* H2
* M4
* nk1
* non-NMDA glutamate receptors
activity negatively correlated to severity:
* NMDA
* mu opioid
* 5-HT1D
* 5-HT2C
The central dysfunction of OCD involves the receptors nk1, non-NMDA
glutamate receptors, and NMDA, whereas the other receptors exert secondary modulatory
effects. Pharmaceuticals that act directly on those core mechanisms are aprepitant (nk1
antagonist), riluzole (glutamate release inhibitor), and tautomycin (NMDA receptor
sensitizer). The drugs that are popularly used to fight OCD lack efficacy because they do
not act upon the core mechanisms.
Bibliography:
Edna B. Foa & Reid Wilson, Stop Obsessing! How To Overcome Your Obsessions And
Compulsions, Bantam Books, 1st Edition (July 2001), ISBN 0553381172. A self-help
text for OCD patients, clear, precise and practical.
Mineka, S., Watson, D. & Clark, L. A. (1998). "Comorbidity of Anxiety and Unipolar
Mood Disorders." Annu. Rev. Psychol., 49, 377-412. Peer reviewed journal article
offering a possible explanation for the high comorbidity rate of anxiety disorders and
certain mood disorders.
Rachman, Stanley & De Silva, Padmal, Obsessive Compulsive Disorders: The Facts,
Oxford University Press, 2nd edition (January 15, 1998), ISBN 0192628607. Book for
patients and their families. Includes assessment and evaluation, treatment, effect on
family, work, and social life, practical advice, and its relationship to other disorders.
Rapoport, Judith, L. The Boy Who Couldn't Stop Washing : The Experience and
Treatment of Obsessive-Compulsive Disorder (1991), ISBN 0451172027, A highly
readable introduction to OCD, with case histories.