Disorders

Obsessive Compulsive Disorder

Some people have gestures or habits to make them feel better such as rubbing the nose, tugging the ears, or scratching the head. These are OK if done in moderation and may be removed any time. What’s worrying is when these actions are done repeatedly and uncontrollably. It may qualify as obsessive-compulsive disorder (OCD).

Obsessive-compulsive disorder is characterized by thoughts and behaviors that are recurring and seemingly unstoppable. The repetitive thoughts urges, or images are the obsessions while the actions done to satisfy these three are the compulsions. People who suffer from OCD are aware of what they do; yet, they cannot control it.

OCD can affect anyone, but is usually diagnosed at the age of 19 or earlier for boys. A study shows that 2-3% of the world population is affected by this disorder. The causes are still unknown, but if a person has any of the following, he or she may be at risk:

  1. Immediate relative who suffers from the disorder, especially if it was developed during childhood or teenage years
  2. Abnormalities in the brain such as different frontal cortex and subcortical structures
  3. Physical or sexual abuse or trauma

Signs and Symptoms

Some of the signs and symptoms that a person is suffering from this disorder are 1) frequent cleaning or washing as he or she is worried about being contaminated or contaminating someone else; 2) persistent checking of doors, locks, or stove as the person wants to ensure safety; 3) periodic counting or repeating of phrases to check his or her memory and perception; 4) incessant arranging and rearranging of objects because he or she has a strong inclination for symmetry. These actions do not necessarily make them feel better, but they get instant yet brief relief from their obsessive thoughts.

Aside from the actions mentioned above, persons suffering from OCD have other psychiatric and physical symptoms. Some experience anxiety and depression, tic disorder, eating disorder, and impulse control disorder among others. Physically, the person may have skin eruptions caused by excessive washing, hair loss because of too much hair pulling or combing, and other skin lesions due to overindulgent skin picking.

Because other psychological and psychiatric abnormalities may coexist in a patient with OCD, diagnosis proves to be a challenge. Hence, the American Psychological Association (APA) has provided screening questions to identify people with OCD clearly. An example of which is identifying the individuals involved in the fear. A person with OCD would usually involve another person in his or her fear, e.g. fear of contaminating someone else; a person with depression is mainly focused on himself or herself such as feeling guilty for previous actions.

Treatments

Despite the seemingly irremediable case of having the disorder, treatments and therapies are available to alleviate the persistent urge and hence the compulsive acts. Medicine-wise, the patients, may be given SRI or SSRI. These stand for serotonin reuptake inhibitor and selective serotonin reuptake inhibitor respectively. Clomipramine, fluoxetine, fluvoxamine, and sertraline are the most common prescriptions for these patients. People with OCD are believed to be lacking serotonin; hence, these medications are prescribed. They help the brain provide enough neurotransmitter serotonin. Antipsychotic medicines are also prescribed if the both SRIs and SSRIs do not improve the patient’s condition.

In prescribing drugs, doctors opt for augmentation instead of replacement, as the latter may take longer to exhibit positive effect. Augmentation means increasing dosage or prescribing another medication to be taken along with the existing one.

Along with the medication, psychotherapy is also recommended for patients with this disorder. Cognitive behavior therapy and habit reversal training are the most common. The former teaches how thoughts and behavior are interrelated and promotes stress management and problem-solving skills. For example, if a patient does not want to sit on public chairs for fear of germs, the therapist may ask him or her to sit on one repeatedly. This will be done until the patient learns to resist the urge to clean the chair thoroughly before using it. The latter, on the other hand, is helpful for tic disorders as it fosters tic awareness and teaches how to respond to these tics. This training has three stages: first, identification of the behavior and the urge for doing the behavior; second, devising competing for action for that conduct; and third, relaxing to diminish the behavior that was replaced.

Family and the people around the patient are also encouraged to act accordingly when the person is around. Some of the recommended actions are:

  • Not arguing with the patient about his or her behavior. The person is aware that what he or she is doing is nonsense, but that person cannot control the actions. Hence, arguments are not helpful.
  • Not avoiding things that trigger anxiety. Patients must be taught how to cope with them instead.
  • Being prepared for sudden onsets of the disorder. It may happen anytime regardless of the mood in the environment.
  • Joining family counseling or asking for support from other people who experienced the same things. Their experiences and experts’ advice help a lot.
  • Celebrating small victories.

Another treatment doctors use for such disorder is deep brain stimulation (DBS) although it is not regarded as a cure. Instead, it reduces or treats the symptoms of OCD. DBS is done by placing a thin strip of the metal electrode where needed. It is then attached to a pulse generator that is implanted below the collarbone. A programming computer will then be placed near the pulse generator and adjusted according to the needs of the patient. This process changes the abnormal brain activity by delivering constant pulses of electrical charge until normal brain rhythm is achieved. This treatment takes time, however, for the optimal results to be visible. Hence, the patient opting for this should be committed to long-term treatment. Also, this option is only for patients who have not responded positively to medicines and psychotherapy.

For all the above mentioned treatments and therapies, one thing is incontestable: consistency. Not being able to finish treatments may result in worse signs and symptoms. However, it should be noted that, according to a study, only about 10% completely recover from OCD with the help of treatments. Nevertheless, 50% show improvement. Therefore, a patient must be assisted and encouraged not to stop trying.