Obsessive-compulsive disorder

Symptoms Of Obsessive-Compulsive Disorder (OCD)

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

• Not able to throw something out because of fear of losing or forgetting something important 

• Excessive concern about one’s partner, the partner’s flaws, and qualities.

Symptoms of compulsions

• Excessive desire to be clean with excessive showering, bathing, tooth-brushing, etc

• Washing hands excessively or in a certain way

• Repeating body movements like tapping, touching, or blinking, biting nails, rhythmic neck movements

• Wanting things 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 talk about how OCD can affect your life.
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Causes Of Obsessive-Compulsive Disorder (OCD)

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

Risk Factors For Obsessive-Compulsive Disorder (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:

1. Genetic mutations

Research shows that there is a genetic predisposition to the development of OCD. Mutations (changes) in certain genes have been linked to OCD.

2. 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.

3. 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.

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4. 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.

5. 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 Obsessive-Compulsive Disorder (OCD)

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

A. NICE guidelines: According to studies, the recently launched NICE guideline recommends six screening questions, that 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?

B. 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 of 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

It 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. Also, your doctor may 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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Prevention Of Obsessive-Compulsive Disorder (OCD)

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 can not be prevented, early diagnosis and treatment is the key to managing the effect of symptoms on quality of life.

Specialist To Visit

OCD is a behavioral disorder that needs the right diagnosis and treatment. Doctors that can help with this include:

• Psychiatrist
• Psychologist
• Internal medicine specialist
  
  

A psychiatrist is a medical practitioner specializing in the diagnosis and treatment of mental illness. A psychologist is a medical professional who treats mental disorders primarily with talk therapy. An internal medicine specialist diagnoses and treats conditions related to the internal organs of the body.

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Treatment Of Obsessive-Compulsive Disorder (OCD)

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

Cognitive behavioral therapy (CBT)

CBT is a type of talk therapy. The most used form of CBT in the management of obsessive-compulsive disorder is exposure and response prevention (ERP). During this, the individuals are exposed to feared situations or images that focus on their obsessions. However, it can evoke anxiety in some cases.

Medications

A class of medications used to treat OCD is known as selective serotonin reuptake inhibitors (SSRIs), typically used to treat depression. Research suggests that SSRIs and SRI like clomipramine are recommended as first-line agents for drug treatment. The best 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

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Neurosurgical treatment 

Surgical procedures like gamma ventral capsulotomy can be very effective for patients who do not respond to typical treatments. Deep brain stimulation, which involves an implanted device in the brain, has data to support its efficacy. However, it is still highly invasive and complex to manage.

Newer advancements

A. Immunological therapies: Immunomodulatory therapy represents a new field, however, more research is required on this front. Some drugs used are:

• Celecoxib
• Nonspecific nonsteroidal anti-inflammatory drugs 

B. Pharmacogenetics: It studies how a person's genes respond to medications. Currently, several pharmacogenetic approaches have been conducted on the association between candidate genes with OCD and drug response.

C. Psychotherapy: Recent advances have been made that focus on positive reinforcement, rather than asking the patient to face their fears, as in CBT, they include:

• Rational emotive therapy: This therapy uses developed danger ideation reduction therapy (DIRT). It focuses on not undergoing exposure for patients with contamination fears.
• Third-wave therapies: This therapy uses mindfulness in OCD, which teaches individuals to focus on the world around them rather than their internal dialogue.

Home care For Obsessive-Compulsive Disorder (OCD)

Management of OCD is not a one-time thing but a daily effort. Maintaining a healthy lifestyle can help tackle OCD symptoms better. Apart from this, there are certain supplements and herbs that can provide some relief from the symptoms of OCD. They include:

Add the essential supplements

• Vitamin D: Studies suggest that Vitamin D has a neuroprotective effect and vitamin D deficiency is associated with numerous neuropsychiatric diseases that include autism, major depressive disorder, schizophrenia, and OCD.

• Vitamin B12, folic acid, and homocysteine: Studies have investigated the association between OCD and vitamin B12, folic acid, and homocysteine levels in adult and child-adolescent patients.

• Selenium: It is an antioxidant, research shows that decreased selenium levels are found in individuals with OCD.

• Zinc: it is an antioxidant trace element that is required for many processes such as gene expression, protein synthesis, and enzymatic catalysis. Zinc is essential for the normal functioning of the nervous system.

• N-acetyl cysteine (NAC): Studies show that a patient with SSRI-refractory OCD showed there was a significant improvement in their symptoms by taking NAC.

• Glycine: Glycine is an amino acid that is associated with learning and memory. Glycine has the potential to make OCD symptoms better.

• Myoinositol (MI): It is used in the treatment of psychiatric disorders. High amounts of MI have been found in fruits, grains, nuts, and beans.

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Try herbal remedies

A few herbal remedies are known for their effectiveness in managing OCDs. However, it is important to consult your health care provider before trying any of these:

• St John’s wort (SJW): It is derived from a plant and has been used for centuries as a traditional medicine to treat depression. SJW can be used for OCD due to its antidepressant effects. 

• Milk thistle: It is a medicinal plant, which is grown in the Mediterranean and Persian regions. Studies suggest that it has a positive effect on OCD symptoms.

• Valerian root: It is a perennial plant, which was used as a perfume. The research found that valerian extract was effective in OCD treatment.

• Curcumin: It is an active constituent of turmeric. It has multiple benefits, along with a positive effect on neuropsychiatric disorders. Although no human studies examine the benefits of curcumin in OCD treatment.

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• Borage: It is a traditional Persian plant, which has anxiolytic and sedative effects comparable to diazepam and also antidepressant effects. It can have a placebo effect in OCD treatment. 
  
  

Complications Of Obsessive-Compulsive Disorder (OCD)

OCD goes undetected for a long time, due to the stigma and taboo around mental health conditions. It is generally neglected thinking it’s just behavioral. This can lead to complications like:

• Poor quality of life: Studies show that the quality of life in OCD patients is significantly impaired compared to that in the general population as OCD hampers an individual’s ability to enjoy life.

• Skin problems: Excessive hand washing can make the skin dry and cause dermatitis (inflammation of the skin).

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• Social isolation: OCD often leads to self-isolation. Managing obsessions and compulsions can be tiring, which often leads to avoiding other people and potential triggers. Studies show that self-isolation, due to OCD can lead to depression, anxiety, and loneliness.

• Difficulty in maintaining relationships: Individuals with OCD are possessive and insecure around romantic relationships leading to doubts, and discomfort. They eventually end up hurting the relationship.

• Problems with daily activities: Individuals spend way too much time trying to make or do things right, due to their repetitive nature. This makes it difficult for them to concentrate on work or school.

• Suicidal tendency: Studies have shown that individuals with OCD have other co-morbid disorders like depression and anxiety, which can lead to suicidal thoughts and behavior.

Alternative Therapies For Obsessive-Compulsive Disorder (OCD)

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

1. Mindfulness

It involves making a special effort to give your full attention to what is happening in the present moment, to what’s happening in your body, your mind, or your surroundings. Studies show that practicing mindfulness along with CBT and medications can help manage mild to moderate cases of OCD. 

2. Hypnotherapy

Hypnotherapy is a type of complementary therapy that uses hypnosis, which is an altered state of consciousness. Hypnosis is widely promoted as a treatment for anxiety, however, it may not be the best option for the treatment of OCD.

3. Cognitive analytic therapy (CAT)

CAT focuses on an individual's relationships. It is used in individuals living with depression, anxiety, or eating problems, who tend to self-harm, and with personal or relationship problems. CAT may help someone with OCD, but only to a certain extent.

4. Eye movement desensitization 

This is a newer form of therapy that specifically focuses to help people with difficult traumatic memories. EMDR combines talking to a therapist about traumatic experiences with a technique where you make rapid rhythmic eye movements while recalling traumatic events to help you process them. Individuals with OCD can be considered for this therapy if they do not respond to CBT. 

5. Interpersonal therapy (IPT)

This therapy focuses on relationships with other people and how your thoughts, feelings, and behavior are affected by your relationships. However, there is little evidence that this therapy can work for individuals with OCD. 

6. Dialectical behavior therapy (DBT)

This therapy is an extension of CBT, that helps individuals experiencing borderline personality disorder. At this time there is little evidence to suggest it can help treat OCD any more than CBT. 

7. Emotional freedom technique (EFT)

This therapy is commonly known as psychological acupressure, which aims to release emotional blockages within the body’s energy system. 

Living With Obsessive-Compulsive Disorder (OCD)

Having OCD or dealing with a family member or a friend can be challenging. It takes constant effort to keep a check on the 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 a task as you are trapped in your thoughts and emotions. Maintaining a healthy lifestyle by getting good quality sleep, eating healthy food, exercising, and spending time with others can help with overall mental health. Other important things include:

• Learning as much as you can about obsessive-compulsive disorder
• Knowing what triggers you and avoiding them
• Focusing on your recovery goals
• Joining support groups to understand how others with OCD are dealing with it
• Finding outlets to release all the tension and energy healthily
• Constantly reminding and motivating yourself
• Keeping yourself busy 

Things to do if your loved ones have OCD

Taking care of someone with OCD is a daily chore. They need daily affirmations and motivation. Other ways by which you can help someone with OCD inside:

• Constantly communicating with them
• Creating a supportive environment
• Recognizing and appreciating their efforts
• Helping them with their medications and therapies
• Keeping their daily routine normal
• sensitively setting limits for them
• Avoiding comparisons

OCD in children: Tips for parents

Parents generally keep on following the rituals to help their children feel less distressed. Unfortunately, this can unintentionally reinforce a child's symptoms of obsessive-compulsive disorder (OCD). Things to do if your child has OCD:

• Not performing a specific routine demanded by their child
• Not changing your behavior to accommodate your child's demands
• Trying not to excessively reassure your child
• Taking a consistent approach to help your child with OCD
• Not comparing them with other children
• Giving your child rewards and brief praise provide on their achievements

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

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