How to Manage Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) [अनियंत्रित जुनूनी विकार] is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent that it induces distress or impairs general function. As indicated by the disorder’s name, the primary symptoms of OCD are obsessions and compulsions. Obsessions are persistent unwanted thoughts, mental images, or urges that generate feelings of anxiety, disgust, or discomfort. Common obsessions include fear of contamination, obsession with symmetry, and intrusive thoughts about religion, sex, and harm. Compulsions are repeated actions or routines that occur in response to obsessions. People with OCD tend to be overly clean, repeatedly count objects, and seek reassurance to avoid making a mistake. 

What is Obsessive Compulsive Disorder?

Obsessive compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress. You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior — the vicious cycle of OCD.

Obsessive Compulsive Disorder Symptoms

Obsessive Compulsive Disorder usually includes both obsessions and compulsions. But it’s also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social, school, or work functioning.

Obsession symptoms

OCD obsessions are repeated, persistent and unwanted thoughts urge, or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you’re trying to think of or do other things.

Obsessions often have themes to them, such as:

• Fear of contamination or dirt,
• Doubting and having difficulty tolerating uncertainty,
• Needing things orderly and symmetrical,
• Aggressive or horrific thoughts about losing control and harming yourself or others, and
• Unwanted thoughts, including aggression, or sexual or religious subjects.

Examples of obsession symptoms include:

• Fear of being contaminated by touching objects others have touched,
• Doubts that you’ve locked the door or turned off the stove,
• Intense stress when objects aren’t orderly or facing a certain way,
• Images of driving your car into a crowd of people,
• Thoughts about shouting obscenities or acting inappropriately in public,
• Unpleasant sexual images, and
• Avoidance of situations that can trigger obsessions, such as shaking hands.

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may only temporarily relieve anxiety.

You may make up rules or rituals to follow that help control your anxiety when you’re having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they’re intended to fix.

As with obsessions, compulsions typically have themes, such as:

• Washing and cleaning,
• Checking,
• Counting,
• Orderliness,
• Following a strict routine, and
• Demanding reassurance.

Examples of compulsion symptoms include:

• Hand-washing until your skin becomes raw,
• Checking doors repeatedly to make sure they’re locked,
• Checking the stove repeatedly to make sure it’s off,
• Counting in certain patterns,
• Silently repeating a prayer, word, or phrase, and
• Arranging your canned goods to face the same way.

Severity varies

OCD usually begins in the teen or young adult years, but it can start in childhood. Symptoms usually begin gradually and tend to vary in severity throughout life. The types of obsessions and compulsions you experience can also change over time. Symptoms generally worsen when you experience greater stress. OCD, usually considered a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.

Obsessive Compulsive Disorder among Children

Approximately 1–2% of children are affected by OCD. Obsessive compulsive disorder symptoms tend to develop more frequently in children 10–14 years of age, with males displaying symptoms at an earlier age, and at a more severe level than females. In children, symptoms can be grouped into at least four types, including sporadic and tic-related OCD.

Associated conditions

People with OCD may be diagnosed with other conditions as well, such as:

• Obsessive compulsive personality disorder,
• Major depressive disorder,
• Bipolar disorder,
• Generalized anxiety disorder,
• Anorexia nervosa,
• Social anxiety disorder,
• Bulimia nervosa,
• Tourette syndrome,
• Transformation obsession,
• ASD,
• ADHD,
• Dermatillomania,
• Body dysmorphic disorder, and
• Trichotillomania. 

More than 50% of people with OCD experience suicidal tendencies, and 15% have attempted suicide. Depression, anxiety, and prior suicide attempts increase the risk of future suicide attempts.

It has been found that between 18 and 34% of females are currently experiencing or will experience OCD in their lifetime. Of that 18-34%, 7% are likely to have an eating disorder. Fewer than 5% of males have OCD and an eating disorder.

Obsessive Compulsive Disorder Causes

The cause of OCD is unknown. Both environmental and genetic factors are believed to play a role. Risk factors include a history of Adverse Childhood Experiences or other stress-inducing events.

Drug-induced OCD

Some medications and other drugs, such as methamphetamine or cocaine, can induce obsessive-compulsive disorder (OCD) in people without previous symptoms.

Some atypical antipsychotics (second-generation antipsychotics) such as olanzapine (Zyprexa) and clozapine (Clozaril) can induce OCD in people, particularly individuals with schizophrenia.

Genetics

There appear to be some genetic components of OCD causation, with identical twins more often affected than fraternal twins. Furthermore, individuals with OCD are more likely to have first-degree family members exhibiting the same disorders than matched controls. In cases in which OCD develops during childhood, there is a much stronger familial link in the disorder than in cases in which OCD develops later in adulthood. In general, genetic factors account for 45–65% of the variability in OCD symptoms in children diagnosed with the disorder. 

Research has found there to be a genetic correlation between anorexia nervosa and OCD, suggesting a strong etiology. First and second-hand relatives of probands with OCD have a greater risk of developing anorexia nervosa as genetic relatedness increases.

Brain structure and functioning

Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between OCD symptoms and abnormalities in certain brain areas, but such a connection is unclear. 

Some people with OCD have areas of unusually high activity in their brain, or low levels of the chemical serotonin, which is a neurotransmitter that some nerve cells use to communicate with each other, and is thought to be involved in regulating many functions, influencing emotions, mood, memory, and sleep.

Autoimmune

A controversial hypothesis is that some cases of rapid onset of OCD in children and adolescents may be caused by a syndrome connected to Group A streptococcal infections (GABHS), known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). OCD and tic disorders are hypothesized to arise in a subset of children as a result of a post-streptococcal autoimmune process. 

A review of studies examining anti-basal ganglia antibodies in OCD found an increased risk of having anti-basal ganglia antibodies in those with OCD versus the general population.

Environment

OCD may be more common in people who have been bullied, abused, or neglected, and it sometimes starts after a significant life event, such as childbirth or bereavement. It has been reported in some studies that there is a connection between childhood trauma and obsessive compulsive symptoms. More research is needed to understand this relationship better.

Obsessive Compulsive Disorder Diagnosis

Formal diagnosis may be performed by a psychologist, psychiatrist, clinical social worker, or other licensed mental health professional. OCD, like other mental and behavioral health disorders, cannot be diagnosed by a medical exam. Nor are there any medical exams that can predict if one will fall victim to such illnesses.

To be diagnosed with OCD, a person must have obsessions, compulsions, or both, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM notes that there are multiple characteristics that can turn obsessions and compulsions from normalized behavior to “clinically significant”. There have to be recurring and strong thoughts or impulsive that intrude on the day-to-day lives of the patients and cause noticeable levels of anxiousness.

Differential diagnosis of Obsessive Compulsive Disorder

OCD is often confused with the separate condition obsessive compulsive personality disorder (OCPD). OCD is egodystonic, meaning that the disorder is incompatible with the individual’s self-concept. As egodystonic disorders go against a person’s self-concept, they tend to cause much distress. OCPD, on the other hand, is egosyntonic, marked by the person’s acceptance that the characteristics and behaviors displayed as a result are compatible with their self-image, or are otherwise appropriate, correct, or reasonable.

As a result, people with OCD are often aware that their behavior is not rational, and are unhappy about their obsessions, but nevertheless, feel compelled by them. By contrast, people with OCPD are not aware of anything abnormal; they will readily explain why their actions are rational. It is usually impossible to convince them otherwise, and they tend to derive pleasure from their obsessions or compulsions.

Obsessive Compulsive Disorder Management

Cognitive behavioral therapy (CBT) and psychotropic medications are the first-line treatments for OCD.

Therapy for Obsessive Compulsive Disorder

The specific CBT technique used is called exposure and response prevention (ERP), which involves teaching the person to deliberately come into contact with situations that trigger obsessive thoughts and fears (exposure), without carrying out the usual compulsive acts associated with the obsession (response prevention).

This technique causes patients to gradually learn to tolerate the discomfort and anxiety associated with not performing their compulsions. For many patients, ERP is the add-on treatment of choice when selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) medication does not effectively treat OCD symptoms, or vice versa, for individuals who begin treatment with psychotherapy. Modalities differ in ERP treatment but both virtual reality-based as well as unguided computer-assisted treatment programs have shown effective results in treatment programs.

Medication for Obsessive Compulsive Disorder

The medications most frequently used to treat OCD are antidepressants, including:

• Selective serotonin reuptake inhibitors (SSRIs), and
• Serotonin-norepinephrine reuptake inhibitors (SNRIs). 

Sertraline and fluoxetine are effective in treating OCD in children and adolescents.

SSRIs help people with OCD by inhibiting the reabsorption of serotonin by the nerve cells after they carry messages from neurons to synapses; thus, more serotonin is available to pass further messages between nearby nerve cells.

Second-line treatment for Obsessive Compulsive Disorder

SSRIs are a second-line treatment for adult OCD with mild functional impairment, and a first-line treatment for those with moderate or severe impairment. In children, SSRIs can be considered as a second-line therapy in those with moderate to severe impairment, with close monitoring for psychiatric adverse effects.

Patients treated with SSRIs are about twice as likely to respond to treatment as are those treated with a placebo, so this treatment is qualified as efficacious. Efficacy has been demonstrated in short-term (6–24 weeks) treatment trials and in discontinuation trials with durations of 28–52 weeks.

Procedures for Obsessive Compulsive Disorder

Electroconvulsive therapy (ECT) has been found to have effectiveness in some severe and refractory cases. Transcranial magnetic stimulation has been shown to provide therapeutic benefits in alleviating symptoms.

Children

Therapeutic treatment may be effective in reducing ritual behaviors of OCD for children and adolescents. Similar to the treatment of adults with OCD, cognitive behavioral therapy stands as an effective and validated first line of treatment of OCD in children. 

Although the known causes of OCD in younger age groups range from brain abnormalities to psychological preoccupations, life stress such as bullying and traumatic familial deaths may also contribute to childhood cases of OCD. Acknowledging these stressors can play a role in treating the disorder.

Siddha Remedies for Obsessive Compulsive Disorder

1. Siddha Preventive Measures

Reference: https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder