Obsessive-Compulsive Disorder (OCD)

Hi, and welcome to this video on Obsessive-Compulsive Disorder!

Uncontrollable Thoughts

Known as OCD, this mental health disorder is characterized by recurrent, uncontrollable thoughts that are irrational and arise out of different fears. Along with the uncontrollable thoughts are irrational behaviors that arise in response to the thoughts, which temporarily bring some comfort to the individual. The person may know intellectually that the thoughts and behaviors are irrational, but they are unable to control them. A hallmark defining feature is the obsession to perform the behaviors over and over, such as repeated handwashing.

Most often OCD begins in children, teens, and/or young adults, with men being thought to develop symptoms earlier than women. Most people are diagnosed by age nineteen, but diagnosis can range up to age thirty-five.

Some of the fears or mental images that cause a great deal of anxiety include:

• Fear of germs or contamination;
• Unwanted forbidden or taboo thoughts involving sex, religion, or harm;
• Aggressive thoughts towards others or self;
• And/or having things symmetrical or in a perfect order

Common compulsions include:

• Excessive cleaning and/or handwashing;
• Ordering and arranging things in a particular, precise way;
• Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off;
• and/or Compulsive counting

Not all rituals or habits are compulsions (everyone double checks things from time to time), but a person with OCD generally:

• Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive.
• They spend at least 1 hour a day on these thoughts or behaviors.
• There is no pleasure when performing the behaviors or rituals, but the individual may feel brief relief from the anxiety the thoughts caused.
• They experience significant problems in their daily life due to these thoughts or behaviors.

Some people with OCD have a bodily tic, which is a sudden movement they cannot control, such as:

• eye blinking,
• shoulder shrugging,
• facial grimacing,
• or a head or shoulder jerking.

Common vocal tics include:

• repetitive throat-clearing,
• sniffing,
• or grunting sounds.

Symptoms can come and go or worsen over time.

People with OCD may try to avoid situations that trigger the obsessions or compulsions they have.

Patients may also try to self-medicate with drugs or alcohol in hopes of stopping the signs and symptoms of OCD.

Factors Contributing to OCD

Risk factors for OCD fall into three main categories: genetics, environment, brain structure, and functioning.

Genetics

If a first-degree relative (parent, sibling, or child) has OCD, studies show a twenty-five percent higher risk of developing the disorder.

Environment

Childhood trauma has been linked with OCD, and in some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

Brain structure

In anatomy, structure always affects function, and in OCD this may also be the case as frontal cortex changes in the brain have been shown on imaging in people with OCD.

Treatment options include: medication and psychotherapy.

Medications include selective serotonin reuptake inhibitors (SSRIs) and antipsychotic medications. SSRIs need to be given in higher doses in these patients, and can often take up to eight to twelve weeks to see benefits but can give these patients relief from their symptoms. As with any SSRI, the patient should never stop this medication abruptly. Antipsychotic medications have also been known to help patients with OCD. With both of these classes of drugs, the patient should be monitored by their health care provider. These medications work well in addition to psychotherapy.

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (such as habit reversal training), can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP) is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SSRI medication. EX/RP involves spending time in the very situation that triggers compulsions (like touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (such as handwashing).

In 2018, the FDA approved Transcranial Magnetic Stimulation (TMS) as an adjunct in the treatment of OCD in adults. TMS is noninvasive and uses magnetic fields to stimulate nerve cells in the brain.
Though OCD cannot be cured, it can be treated very effectively and active research into treatment modalities continues.

Now let’s test your knowledge with a review question:

Review Question

Which of the following are risk factors for OCD:

1. The patient used alcohol or drugs in the past
2. The patient engaged in risky behavior as a teen
3. The patient may have experienced childhood trauma
4. The patient may have low intelligence

Thanks for watching, and happy studying!