THE word “obsessed” is passed around lightly by the general public; however, few appreciate the gravity of obsessive compulsive disorder. Even though we might label people as obsessed, it is important to realise that many of us have obsessive traits, but it only becomes a disorder if there is associated social and occupational dysfunction.
Obsessive compulsive disorder (OCD) is characterised by obsessions which are recurrent intrusive thoughts and compulsions that are repetitive behaviours carried out to compensate for and to relieve the anxiety associated with the obsessions.
The obsessions and compulsions cause marked distress and are time-consuming, lasting at least greater than one hour per day. In addition to the anxiety and fear that typically accompanies OCD, sufferers may spend hours performing such compulsions every day. In such situations, it can be hard for the person to fulfil their work, family, or social roles.
In some cases, these behaviours can also cause adverse physical symptoms. For example, people who obsessively wash their hands with antibacterial soap and hot water can make their skin red and raw with dermatitis.
SIGNS AND SYMPTOMS
Common obsessions include the following:
• Doubting one’s memory or perception;
• Need for order or symmetry;
• Unwanted, intrusive sexual/aggressive thoughts
Common compulsions include the following:
• Cleaning or washing;
• Checking things (for example locks, stove, iron, safety of children);
• Counting or repeating actions a certain number of times or until it “feels right”;
• Arranging objects;
• Touching or tapping objects;
• Confessing or seeking reassurance;
• List making.
OCD has a strong genetic influence increasingly found in family members of the affected. Imbalance in brain chemicals and infections with certain bacteria known as streptococcus have also been implicated.
Patients with OCD may suffer from associated psychiatric disorders such as anxiety and major depression. Suicide ideations and attempts are also major concerns that deserve attention. OCD symptoms can interact negatively with interpersonal relationships, and families can become involved with the illness in a counterproductive way.
OCD can be diagnosed through a formal evaluation by a psychiatrist who will take a comprehensive history and do a physical exam. Part of the evaluation will include baseline blood investigations and neuroimaging in the form of a computerised tomography (CT) scan or magnetic resonance imaging (MRI) of the brain with the intention of trying to rule out any medical causes of the symptoms.
The mainstays of treatment of OCD are as follows:
• Serotonergic antidepressant medications;
• Particular forms of behaviour therapy (exposure and response prevention and some forms of cognitive behavioural therapy [CBT]);
• Education and family interventions;
• Neurosurgery (anterior capsulotomy, or deep brain stimulation in extremely refractory cases.
Exposure and response prevention is the core of behaviour therapy, which is employed to great effectiveness in the treatment of this disorder. The patient rank orders OCD situations he or she perceives as threatening, and then the patient is systematically exposed to symptom triggers of gradually increasing intensity, while the individual is to suppress his or her usual ritualised response. This is generally challenging and often quite distressing for the patient, but when effectively done, it promotes unlearning of the strong link that has existed between having an urge and giving into the urge.
Relaxation techniques in the form of deep breathing and progressive muscle relaxation have also shown to be beneficial in many patients.
OCD is a chronic disorder with frequent relapses and remissions, and can be quite frustrating for both the patient and family. However, a significant number experience good response to treatment. A certain percentage of patients may have disabling, treatment-resistant symptoms. A small subgroup of these patients may be candidates for neurosurgical intervention.
Dr Ashish Sarangi MBBS is a resident in psychiatry at the University Hospital of the West Indies. He may be contacted via email at firstname.lastname@example.org