Obsessive-compulsive disorder

Individuals with OCD may have symptoms of obsessions, compulsions, or both. Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Compulsions are repetitive behaviors in response to obsessive thoughts. Some of the symptoms of OCD are discussed below:

Symptoms of Obsession

• Fear of contamination or germs
• Unnatural need to be clean and tidy
• Forbidden thoughts involving sex, religion, etc.
• Aggressive thoughts toward others or oneself
• Wanting to have everything aligned and in perfect symmetry
• Impulsive behavior
• A need to know or remember everything
• Inability to throw something out due to fear of losing or forgetting something important
• Excessive concern about one’s partner, their flaws, and qualities

Symptoms of Compulsions

• Excessive desire to be clean, including excessive showering, bathing, and tooth-brushing
• Washing hands excessively or in a specific manner
• Repeating body movements such as tapping, touching, blinking, biting nails, or rhythmic neck movements
• Desire for things to be arranged in a particular, precise way
• Repeatedly checking on things, for example, if the door is locked or if the oven is off
• Compulsive counting

OCD is not just about keeping things clean and tidy. Listen to our experts discuss how OCD can affect your life.

OCD is multifactorial, and an inability to cope with uncertainty, an increased sense of responsibility along with overthinking can predispose individuals to obsessive-compulsive habits. Though the exact cause of OCD remains unknown, certain risk factors can increase the chances of developing OCD.

There is an array of factors that can lead to obsessive-compulsive disorder. OCD is characterized by obsessive and compulsive thoughts, and the risk factors can include:

• Genetic mutations: Research shows that there is a genetic predisposition to the development of OCD. Mutations in certain genes have been linked to OCD.
• Family history: Children with parents or siblings who have OCD are at a higher risk for developing OCD themselves. Research has shown the risk is as high as 45% to 65% in children and 27% to 45% in adults.
• Environmental factors: Childhood trauma and obsessive-compulsive symptoms are interlinked. Studies show that the development of OCD symptoms can be due to trauma during childhood; however, more research is needed to understand this relationship better.
• Brain structure: There is some connection between OCD symptoms and abnormalities in certain areas of the brain, but it is not clear. It is hypothesized that problems in communication between the front part of the brain and deeper structures of the brain are attributed to OCD.
• Streptococcal infections: Certain studies have shown that earlier onset of OCD is seen after a Streptococcal infection known as PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections).

Diagnosis of any mental health condition can be tricky; it mainly relies on physical examination and psychological evaluation. Steps to help diagnose OCD may include:

1. Screening for OCD
   • NICE guidelines: According to studies, the recently launched NICE guideline recommends six screening questions, which include:
     • Do you wash or clean a lot?
     • Do you check things a lot?
     • Is there any thought that keeps bothering you that you would like to get rid of but can’t?
     • Do your daily activities take a long time to finish?
     • Are you concerned about orderliness or symmetry?
     • Do these problems trouble you?
   • Yale-Brown Obsessive-Compulsive Scale (Y-BOCS): It is the most widely accepted tool to screen for OCD. The Y-BOCS rates on a scale from 0 to 40 (40 being the most severe symptomatology). It ranks the individual based on severity:
     • The time occupied by obsessive thoughts and compulsions
     • The interference of obsessive thoughts
     • The distress of obsessive thoughts
     • Resistance against obsessions
     • Degree of control over obsessive thoughts
     • The time occupied by compulsive behavior
     • The interference of compulsive behavior
     • The distress associated with compulsive behavior
     • Resistance against compulsive behavior
     • Degree of control over compulsive behaviors
2. Physical exam: This is done to help rule out other problems that could be causing the symptoms and to check for any related complications.
3. Psychological evaluation: This includes discussing your thoughts, feelings, symptoms, and behavior patterns. Recognition of obsessive-compulsive disorder may require direct questions. Your doctor may also use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
4. Lab tests: These are done to check for co-morbidities and other conditions and may include:
   • Complete blood count (CBC)
   • Thyroid function test
   • Screening for alcohol and drugs

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There is no way to predict or prevent OCD as the exact cause is unknown. However, OCD might be linked to problems during pregnancy, so it is important to take care of yourself while pregnant.

Even though OCD cannot be prevented, early diagnosis and treatment are key to managing the effects of symptoms on quality of life.

The treatment for OCD mainly focuses on improving the quality of life and managing symptoms to facilitate daily activities. It primarily consists of the following:

• Cognitive Behavioral Therapy (CBT): CBT is a type of talk therapy. The most commonly used form of CBT in the management of obsessive-compulsive disorder is exposure and response prevention (ERP). During this process, individuals are exposed to feared situations or images that focus on their obsessions, which can evoke anxiety in some cases.
• Medications: A class of medications used to treat OCD is known as selective serotonin reuptake inhibitors (SSRIs), which are typically used to treat depression. Research suggests that SSRIs and serotonin reuptake inhibitors like clomipramine are recommended as first-line agents for drug treatment. The most effective treatment for severe symptoms of OCD is a combination of CBT and SSRIs. The U.S. Food and Drug Administration (FDA)-approved SSRIs for the management of OCD include:
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline
• Neurosurgical Treatment: Surgical procedures such as gamma ventral capsulotomy can be very effective for patients who do not respond to standard treatments. Deep brain stimulation, which involves an implanted device in the brain, has data supporting its efficacy; however, it remains highly invasive and complex to manage.
• Newer Advancements:
  • Immunological Therapies: Immunomodulatory therapy represents a new field; however, more research is required. Some drugs used include:
    • Celecoxib
    • Nonspecific nonsteroidal anti-inflammatory drugs
  • Pharmacogenetics: This field studies how a person's genes respond to medications. Several pharmacogenetic approaches have been conducted on the association between candidate genes, OCD, and drug response.
  • Psychotherapy: Recent advances focus on positive reinforcement rather than asking patients to face their fears, as in CBT. These include:
    • Rational Emotive Therapy: This therapy utilizes developed danger ideation reduction therapy (DIRT), focusing on avoiding exposure for patients with contamination fears.
    • Third-Wave Therapies: These therapies incorporate mindfulness in OCD, teaching individuals to focus on the world around them rather than their internal dialogue.

Management of OCD is not a one-time effort but a daily commitment. Maintaining a healthy lifestyle can help alleviate OCD symptoms more effectively. Additionally, certain supplements and herbs may provide relief from OCD symptoms. They include:

• Vitamin D: Studies suggest that Vitamin D has a neuroprotective effect, and its deficiency is associated with various neuropsychiatric disorders, including autism, major depressive disorder, schizophrenia, and OCD.
• Vitamin B12, Folic Acid, and Homocysteine: Research has investigated the association between OCD and levels of vitamin B12, folic acid, and homocysteine in both adult and child-adolescent patients.
• Selenium: As an antioxidant, decreased selenium levels have been observed in individuals with OCD.
• Zinc: This antioxidant trace element is essential for many biological processes such as gene expression, protein synthesis, and enzymatic catalysis. Zinc is crucial for the normal functioning of the nervous system.
• N-acetyl Cysteine (NAC): Studies indicate that patients with SSRI-refractory OCD showed significant improvement in symptoms when taking NAC.
• Glycine: An amino acid associated with learning and memory, glycine has the potential to improve OCD symptoms.
• Myoinositol (MI): Used in the treatment of psychiatric disorders, high amounts of MI can be found in fruits, grains, nuts, and beans.

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Try herbal remedies. A few herbal remedies are recognized for their effectiveness in managing OCD. However, it is important to consult your healthcare provider before trying any of these:

• St John’s Wort (SJW): Derived from a plant, SJW has been used for centuries as a traditional medicine to treat depression and can be beneficial for OCD due to its antidepressant effects.
• Milk Thistle: A medicinal plant grown in the Mediterranean and Persian regions, studies suggest it positively affects OCD symptoms.
• Valerian Root: This perennial plant, historically used as a perfume, has been found effective in treating OCD through valerian extract.
• Curcumin: An active constituent of turmeric, curcumin has multiple benefits, including a positive effect on neuropsychiatric disorders. However, no human studies have specifically examined its benefits for OCD treatment.
• Borage: A traditional Persian plant with anxiolytic and sedative effects comparable to diazepam, borage also exhibits antidepressant properties and may have a placebo effect in OCD treatment.

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OCD goes undetected for a long time due to the stigma and taboo surrounding mental health conditions. It is generally neglected, often perceived as merely behavioral. This can lead to several complications, including:

• Poor quality of life: Studies show that the quality of life in OCD patients is significantly impaired compared to that of the general population, as OCD hampers an individual’s ability to enjoy life.
• Skin problems: Excessive hand washing can lead to dry skin and dermatitis (inflammation of the skin).
• Social isolation: OCD often results in self-isolation. Managing obsessions and compulsions can be exhausting, which often leads to avoiding other people and potential triggers. Studies indicate that self-isolation due to OCD can result in depression, anxiety, and loneliness.
• Difficulty in maintaining relationships: Individuals with OCD may exhibit possessiveness and insecurity in romantic relationships, leading to doubts and discomfort, ultimately harming the relationship.
• Problems with daily activities: Individuals may spend excessive time trying to perform tasks perfectly due to their repetitive nature, making it difficult to concentrate on work or school.
• Suicidal tendency: Research has shown that individuals with OCD often have co-morbid disorders such as depression and anxiety, which can lead to suicidal thoughts and behavior.

Management of OCD requires continuous efforts. Along with CBT and medications, there are a few alternative therapies that have shown promising results. They include:

• Mindfulness: This involves making a special effort to give your full attention to what is happening in the present moment, including your body, mind, or surroundings. Studies show that practicing mindfulness along with CBT and medications can help manage mild to moderate cases of OCD.
• Hypnotherapy: Hypnotherapy is a type of complementary therapy that uses hypnosis, an altered state of consciousness. While hypnosis is widely promoted as a treatment for anxiety, it may not be the best option for treating OCD.
• Cognitive Analytic Therapy (CAT): CAT focuses on an individual's relationships and is used for individuals living with depression, anxiety, or eating problems, who tend to self-harm, and with personal or relationship issues. CAT may help someone with OCD, but only to a certain extent.
• Eye Movement Desensitization and Reprocessing (EMDR): This newer form of therapy specifically helps people with difficult traumatic memories. EMDR combines talking to a therapist about traumatic experiences with a technique involving rapid rhythmic eye movements while recalling traumatic events to aid processing. Individuals with OCD may be considered for this therapy if they do not respond to CBT.
• Interpersonal Therapy (IPT): This therapy focuses on relationships with others and how your thoughts, feelings, and behavior are influenced by these relationships. However, there is little evidence that this therapy is effective for individuals with OCD.
• Dialectical Behavior Therapy (DBT): This therapy is an extension of CBT that assists individuals experiencing borderline personality disorder. Currently, there is little evidence to suggest it can treat OCD more effectively than CBT.
• Emotional Freedom Technique (EFT): Commonly known as psychological acupressure, this therapy aims to release emotional blockages within the body’s energy system.

Having OCD or dealing with a family member or a friend can be challenging. It takes constant effort to monitor symptoms, behaviors, and emotions. Here are a few tips that can help:

Things to do if you have OCD

Living with OCD can be quite demanding as you may feel trapped in your thoughts and emotions. Maintaining a healthy lifestyle by getting quality sleep, eating nutritious food, exercising, and spending time with others can enhance overall mental health. Other important strategies include:

• Learning as much as you can about obsessive-compulsive disorder
• Identifying your triggers and avoiding them
• Focusing on your recovery goals
• Joining support groups to understand how others with OCD cope
• Finding healthy outlets to release tension and energy
• Consistently reminding and motivating yourself
• Keeping yourself engaged

Things to do if your loved ones have OCD

Taking care of someone with OCD can be a daily challenge. They require constant affirmations and motivation. Other ways you can support someone with OCD include:

• Maintaining open communication
• Creating a supportive environment
• Recognizing and appreciating their efforts
• Assisting with their medications and therapies
• Keeping their daily routine as normal as possible
• Sensitively setting limits
• Avoiding comparisons

OCD in children: Tips for parents

Parents often follow rituals to help their children feel less distressed. Unfortunately, this can unintentionally reinforce a child's OCD symptoms. Here are some strategies if your child has OCD:

• Avoid performing specific routines demanded by your child
• Do not change your behavior to accommodate your child's demands
• Try not to excessively reassure your child
• Take a consistent approach to help your child with OCD
• Avoid comparing them with other children
• Provide rewards and brief praise for their achievements

Note: If you experience OCD symptoms, seek treatment and be open about it with your child.

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