What Is Obsessive Compulsive Disorder?

Obsessive-compulsive disorder, also known as OCD is a mental illness that can affect people of any age, gender or nationality. It is nothing to be ashamed of or embarrassed about. As the name suggests, the affected individual will have obsessive and compulsive thoughts going on in their minds. 

Symptoms mostly start during the puberty phase, but they can also occur in adulthood.

According to NHS statistics, 12 out of 1000 people are affected by OCD in the UK and it accounts for around 750,000 people. 

Overview 

Obsessive-compulsive disorder is a mental disorder where the patient suffers from a cycle of obsessions and compulsions. It affects around 2% of the population and it can lead to impairment in social or personal life.^¹,² These thoughts bring anxiety to the minds of the affected individuals.

Obsessions are unwanted or intrusive thoughts, desires and fears. These can be fear of germs, aggressive or harmful thoughts about self or others, forbidden thoughts about sex or religion and wanting things to be in perfect order. 

Compulsions are the urges that an individual feels due to obsessive thoughts. These can be excessive hygiene measures, arranging things in a specified manner, repeatedly checking things and compulsive counting.

Causes of obsessive compulsive disorder 

Scientists are still not sure what causes obsessive-compulsive disorder, but they suspect some causes for this mental health condition. Brain scan shows increased activity in the areas of the brain dealing with strong emotions and their response. Serotonin, a chemical which helps in transmitting information from one part of the brain to another is found in abnormal levels in OCD patients. These are a few factors that are suspected to cause OCD:^{¹,³,⁴,⁵}

• Genetics: OCD symptoms are mostly found to be genetic in nature. Research studies suggest that people who have first-degree relatives such as a parent, sibling or child suffering from obsessive-compulsive disorder are more likely to be affected. Also, if that relative suffered from OCD symptoms in childhood or teenage years, then the chances of getting affected are increased
• Brain: Brain scans have shown some abnormalities in certain areas of the brain in people suffering from OCD. These changes are also observed in other brain disorders such as Parkinson's disease, Tourette syndrome and epilepsy

There is still not much research regarding how these abnormalities cause OCD symptoms in individuals.

• Stress: Few cases of OCD are found to be related to stressful conditions in life. Bullying or facing any kind of abuse can be a cause of OCD
• PANDAS syndrome: PANDAS stands for Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Sometimes, kids get OCD symptoms after a streptococcal infection. Streptococcal infections can cause strep throat or scarlet fever

Signs and symptoms of obsessive compulsive disorder 

OCD symptoms include obsessions, compulsions or both. Everyone feels little obsessions for some things, but when these obsessions are consuming excessive time or energy and start interfering with daily life, they might be due to obsessive-compulsive disorder.^²,⁶ 

Obsession symptoms

Obsessions are repeated, unwanted thoughts or urges that keep coming to the mind of OCD-affected individuals. These thoughts might give them a sense of anxiety. Sometimes, these obsessions interfere with daily life. Some of the obsessions that are identified as OCD symptoms are:

• Fear of getting dirty by touching some object
• Re-checking the door locks 
• Re-checking if appliances are switched off 
• Desire to keep things in an organised manner 
• Unpleasant sexual desires 
• Fear of harming self or others 
• Excessive thinking about offending God 
• Excessive thinking about partners' flaws or qualities 
• Excessive thoughts about death 

Compulsion symptoms 

Compulsions are repetitive behaviours that give us the urge to perform some activity. These acts can give temporary relief from the anxiety caused due to obsessions. Some compulsive actions recognised with OCD are:

• Excessive hand washing 
• Excessive cleaning of the house or objects 
• Repeated tapping, touching or blinking
• Checking doors repeatedly to make sure they are locked 
• Checking appliances repeatedly to make sure they are switched off 
• Performing tasks to make sure they end on specific 'safe' numbers 
• Arranging products in a specified manner only 
• Checking on things again and again

Management and treatment for obsessive compulsive disorder 

If you or anyone you know shows OCD symptoms, contact your GP. Mental health is often neglected and not taken seriously. But, if the treatment is not availed, symptoms might worsen. 

GP or healthcare provider might ask questions like 

• Do you get the urge to clean things or your hands a lot
• Do you check things or door locks repetitively
• Do you like to keep things in a specific manner
• Are you bothered by the mess of things in any room
• Do you get any intrusive thoughts and get bothered
• Do these symptoms interfere with your daily tasks

OCD is classified into three levels depending on the severity of the symptoms.

• Mild functional impairment: As the name suggests, the symptoms are mild at this stage. Obsessive thoughts and compulsive behaviour take up around one hour of the day
• Moderate functional impairment: As the name suggests, the symptoms are moderate at this stage. Obsessive thoughts and compulsive behaviour consume around one to three hours of the day
• Severe functional impairment: As the name suggests, the symptoms are severe in this stage. They impact daily tasks to large a extent. Obsessive thoughts and compulsive behaviour consume more than three hours of the day

When OCD is confirmed, doctors might prescribe medications or therapy for relieving symptoms. If these don't work, transcranial magnetic stimulation (TMS) might be tried.^{¹,², ⁵},^⁸

Therapies for OCD: There are different types of therapies for OCD treatment. A psychologist, a mental health expert provides these psychotherapy sessions. 

• Cognitive Behavioural Therapy (CBT): CBT can be quite helpful for patients with mild OCD symptoms. These sessions help the individual recognise self-thoughts and emotions. These sessions will prevent harmful thoughts from clouding the mind and replace the harmful habits with healthier choices
• Exposure and Response Prevention (ERP): This therapy is a part of CBT. In this, the therapist will expose the patient to some stressful situation where they would do something compulsive. The therapist will prevent them from compulsive behaviour. For example, if a person has an obsession about dirty things, he/she will be asked to touch something dirty. And then they will be prevented from washing their hands and see that nothing adverse happened. This makes the person face reality
• Acceptance and Commitment Therapy (ACT): In this therapy, patients will be asked to accept their obsessive thoughts as plain thoughts. This will give them the power to live a healthy life

Medications for OCD: Antidepressants can be beneficial for OCD patients too. These medications alter the level of serotonin in the brain, thus relieving OCD symptoms to some extent. serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are often used for the treatment of symptoms. High dose of this medication is given to OCD patients compared to depression patients. Medications might start showing their effects in 8-12 weeks' time.

Deep brain stimulation (DBS): Patients who are above 18 years of age and don't respond to medications and CBT are referred for DBS. In this, electrodes are implanted in certain areas of the brain. These electrodes will pass electrical impulses which help in altering the abnormal impulses. 

• Transcranial magnetic stimulation (TMS): 

Patients in the age group 22-68 years old are given this if other treatment options fail. In this, magnetic fields are used to stimulate the nerve cells of the brain. An electromagnetic coil is placed near the forehead. This delivers the magnetic impulse to the nerve cells.

DBS and TMS are complex procedures and they must be  discussed with the treating professional.

FAQs

How is obsessive-compulsive disorder diagnosed? 

GP or healthcare specialists will ask questions about symptoms and how much they affect daily life. If the thoughts and compulsions take up to one hour a day, it is categorised as mild functional impairment. If these thoughts consume around one to three hours a day, they are categorised as moderate functional impairment. And if the symptoms consume more than three hours a day, they are categorised as severe functional impairment.

Can obsessive compulsive disorder be prevented? 

OCD can't be prevented, but early diagnosis might reduce the symptoms and make life easy to live. There are many therapies and medications available to reduce anxiety.

What is the difference between OCD and OCPD? 

Obsessive Compulsive Disorder (OCD) is a mental health condition where a patient suffers from unwanted, repetitive and intrusive thoughts. 

Obsessive Compulsive Personality Disorder (OCPD) is a personality disorder where a patient suffers from the urge to make everything perfect and in proper order.⁷ 

Who is are at risk of obsessive compulsive disorder? 

People whose first-degree relatives have OCD, especially those who developed symptoms in their childhood or teenage are at more risk of developing this disorder. Individuals who have suffered any abuse or trauma, especially in childhood, are also at risk of developing OCD.

How common is obsessive compulsive disorder? 

According to the NHS statistics, every 12 out of 1000 people in the UK are affected by this disorder.

When should I see a doctor? 

If you feel you are suffering from OCD and the symptoms interfere  with your everyday tasks, it is better to see a doctor. 

Summary 

Obsessive-compulsive disorder is a mental health disorder where an individual suffers from obsessions, compulsions or both. Obsessions are unwanted, repetitive or intrusive thoughts causing anxiety. Compulsions are the urges to perform any task caused due to obsessive thoughts. Sometimes, assigned females at birth get OCD symptoms during pregnancy or post-delivery. They start feeling anxiety over things such as whether the baby is breathing or not, whether the baby's toys or bottles are clean or not etc. 

Scientists are still researching the exact cause of this disorder, but stress, genetics, brain function and PANDAS syndrome are thought to be the reason behind OCD symptoms.

There are three levels of this disorder depending on the severity of the OCD symptoms - mild, moderate and severe functional impairment. 

Psychotherapy and medications are the treatment options available. Cognitive behavioural therapy, exposure and response prevention, and acceptance and commitment therapy can be beneficial. Antidepressant medications such as serotonin reuptake inhibitors and selective serotonin reuptake inhibitors are given to patients in higher doses compared to depression patients. 

If these options don't work, then deep brain stimulation or transcranial magnetic stimulation can be tried. These have some pros and cons, so careful discussion needs to be done. 

There are many support groups available to help OCD patients such as OCD Action and OCD-UK. This disorder is nothing to be ashamed of.