Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a mental health condition. OCD patients have frequent unwanted thoughts (obsessions), which lead to repetitive behaviors (compulsions). Typically, treatment for OCD includes a combination of psychotherapy and medication. OCD can occur to anyone. Approximately 50% of those with OCD experience their first symptoms during childhood and adolescence. On average, symptoms tend to emerge around the age of 19.

Symptoms

Obsessions in OCD refer to unwelcome intrusive thoughts or mental images that cause significant anxiety. People with OCD have no control over these thoughts, and most of them are aware that these thoughts are not rational. For example:

• You fear touching objects because of germs or the spreading of germs.
• You are anxious that you may harm yourself or others if you are not careful enough.
• You have intrusive and inappropriate sexual thoughts.
• You fear that you will make a mistake.
• You are preoccupied with morality.
• You crave constant reassurance.
• You are obsessive about orderliness, symmetry, neatness, or perfection. 

Compulsions in OCD drive you to do repetitive actions to relieve your anxiety. You do not like your compulsive behaviors despite them providing temporary relief to your obsessions. For instance:

• You like to arrange objects in a very particular way.
• You take a bath or wash your hands very frequently.
• You collect or hoard things that have no personal or financial value.
• You persistently check on locks, doors, or switches.
• You have rituals associated with numbers, such as doing specific tasks at certain times, counting, or having a strong preference or avoidance of particular numbers. 
• You utter specific words or prayers while doing unrelated activities. 
• You avoid touching objects you think are dirty.

What causes obsessive-compulsive disorder?

The exact cause is unknown, but factors that may contribute to OCD are as follows:

• Heredity: The risk is high if your direct family member has OCD as a child or teenager. 
• Brain changes: People with OCD have different frontal cortex and subcortical structures from others. 
• Pediatric autoimmune neuropsychiatric disorders (PANDAS syndrome): It can occur in children who have had strep throat or scarlet fever. 
• Childhood trauma or adverse life events

Diagnosis

• History taking
• Diagnostic and Statistical Manual of Mental Disorders: DSM-5, which includes criteria as follows:
  
  • You experience obsessions, compulsions, or a combination of both.
  • You devote at least one hour to activities related to your obsessions or compulsions.
  • You have a distress that interferes with school, work, and daily activities. 
  • Your symptoms are not attributable to the influence of substances, alcohol, medications, or any underlying medical condition.
  • Your symptoms are not attributable to another mental health disorder, such as generalized anxiety disorder, an eating disorder, or a body image disorder.

Treatment

• Psychotherapy
  
  • Cognitive behavioral therapy (CBT) can help you recognize your thoughts and emotions and cope with your habits or thoughts of self-harm.
  • Exposure and response prevention (ERP) can help you face your fear and resist the compulsion. For instance, you will touch dirty objects and resist the urge to wash your hands.  
  • Acceptance and commitment therapy (ACT) helps you accept obsessive thoughts as mere thoughts. 
  • Meditation and mindfulness techniques
• Medication for OCD. Medications prescribed for OCD patients are serotonin reuptake inhibitors (SRIs), selective SRIs (SSRIs), and tricyclic antidepressants.
  
• Transcranial magnetic stimulation (TMS). The doctor may recommend TMS if your symptoms are severe and do not improve with other types of treatment.

Having regular treatment is crucial in treating OCD. However, if you notice side effects from OCD medications, inform your doctor immediately.

Complications

• Health problems such as hand washing induced dermatitis.
• Challenges at school, work, or social activities.
• Relationship problems.
• Depression.
• Self-harm or suicide.

Prevention

Obsessive-compulsive disorder is not preventable, but you should seek immediate medical care to prevent OCD from aggravating and interfering with your life quality.

Preparation for your appointment

List any symptoms you have, your recent life changes or severe stresses, your personal and family medical history, medications you have been taking, and questions you would like to ask your doctor.  For example:

• Are my symptoms considered symptoms of OCD?
• What treatments are available and suitable for my symptoms?
• Do I need to take medications?
• What can I do to improve my symptoms? 
• Prepare answers for the questions your doctor may ask. 
  
  • When was your symptom onset? 
  • Do your symptoms come and go?
  • What improves or worsens your symptoms?
  • Do you frequently wash your hands, count, or check things multiple times? 
  • Is there anyone in your family who has a mental health problem?

FAQ

• What is the difference between OCD and OCPD?
  OCPD is a personality disorder characterized by an intense fixation on perfectionism, organization, and control.
  People with OCD generally recognize that their obsessions and compulsions are problematic and acknowledge the need for professional assistance in addressing their condition. However, those with OCPD often do not perceive anything wrong with their behavior and beliefs.