OBSESSIVE-COMPULSIVE DISORDER: SYMPTOMS, CAUSES - ARTE - 2025

The obsessive-compulsive disorder (OCD) is the most severe and disabling anxiety disorder. In these people there is what is known as thought-action fusion: thoughts are equated with actions.

People who have anxiety disorders and need hospitalization often have this disorder, as do those who need psychosurgery. If you have it, in addition to the typical symptoms of this disorder, you may experience panic attacks, generalized anxiety or major depression.

Symptoms

Obsessions

Obsessions are nonsense intrusive thoughts or images that you try to avoid or eliminate. The most commons are:

• Contamination.
• Sexual content.
• Aggressive urges
• Need for symmetry.
• Body concerns.

Compulsions

Actions or thoughts that are used to suppress obsessions. They are believed to decrease stress or prevent a negative event. In addition, they may be magical or illogical, unrelated to the obsession. Compulsions can be:

• Behavioral: checking, washing hands, fixing, ordering, checking, rituals…
• Mental: count, pray…

Many people with OCD continually wash their hands or do checkups, which gives them a sense of security and control. The checks help them avoid imaginary disasters. They can be logical - such as checking that the door or gas has not been left open - or illogical - such as counting to 100 to avoid a disaster.

Depending on the type of obsession, there are more one or other types of compulsions:

• In sexual obsessions there are more checking rituals.
• In obsessions with symmetry there is more repetition of rituals.
• In obsessions with pollution, washing rituals are more common.

Causes

It is possible that the tendency to develop compulsive thinking anxiety may have the same biological and psychological precursors as anxiety in general.

For it to develop, it will be necessary for a person to have certain biological and psychological factors.

Biological factors

First, repetitive thoughts may be regulated by the hypothetical brain circuitry. People with OCD are more likely to have first-degree relatives who also have the same disorder.

In cases where OCD develops during adolescence, there is a stronger relationship of genetic factors than in cases where it develops in adulthood.

Social factors

For evolutionary psychology, moderate versions of OCD could have evolutionary advantages. For example, health, hygiene or enemy checks.

One hypothesis is that people with OCD learn that some thoughts are unacceptable or dangerous, as they could actually happen. Thought-action fusion, excessive responsibility, or feelings of guilt may develop during childhood.

Infections

The rapid onset of OCD in children and adolescents could be caused by a syndrome connected to Group A streptococcal infections (PANDAS) or caused by immunological reactions to other pathogens (PANS).

Pathophysiology

Brain studies of people with OCD have shown that they have different activity patterns than people without OCD. The different functioning of a particular region, the striatum, could be causing the disorder.

Differences in other parts of the brain and dysregulation of neurotransmitters, especially serotonin and dopamine, could also contribute to OCD.

Independent studies have found unusual dopamine and serotonin activity in various brain regions of people with OCD: dopaminergic hyperfunction in the prefrontal cortex and dopaminergic hypofunction in the basal ganglia.

Glutamate dysregulation has also been studied recently, although its role in the disorder is not well understood.

Diagnosis

Diagnostic criteria according to DSM-IV

A) It is fulfilled for obsessions and compulsions:

1. Recurring and persistent thoughts, impulses, or images that are experienced at some point in the disorder as intrusive and inappropriate, causing significant anxiety or discomfort.
2. Thoughts, impulses, or images are not just excessive worries about real-life problems.
3. The person tries to ignore or suppress these thoughts, impulses or images, or tries to neutralize them through other thoughts or actions.
4. The person recognizes that these obsessive thoughts, impulses or images are the product of his mind (and are not imposed as in the insertion of thought).

B) At some point in the course of the disorder, the person has recognized that these obsessions or compulsions are excessive or irrational. Note: this point is not applicable in children.

C) Obsessions or compulsions cause significant clinical discomfort, represent a waste of time (they involve more than one hour a day) or interfere markedly with the individual's daily routine, work relationships or social life.

D) If there is another disorder, the content of the obsessions or compulsions is not limited to it (for example, worries about food in an eating disorder).

E) The disorder is not due to the direct physiological effects of a substance or a general medical condition.

Specify if:

With little awareness of illness: if during most of the time of the current episode, the individual does not recognize that the obsessions or compulsions are excessive or irrational.

Differential diagnosis

OCD is often confused with obsessive compulsive personality disorder (OCD). Their main differences are:

• OCPD is egodistonic, the person does not suffer from having the disorder and considers it part of their self-image.
• OCD is egodistonic, the person does not consider it part of their self-image and causes them discomfort.
• While people with OCD are not aware of anything abnormal, people with OCD are aware that their behavior is not rational.

On the other hand, OCD is different from behaviors such as gambling addiction or eating disorders. People with these disorders experience some pleasure from doing these activities, while people with OCD feel no pleasure.

epidemiology

OCD affects 2.3% of people at some point in their lives.

Symptoms usually occur before the age of 35 and half of people develop the disorder before the age of 20.

Treatments

Behavioral therapy, cognitive-behavioral therapy, and medication are the first-line treatments for OCD.

Behavioral and cognitive behavioral therapy

Exposure with response prevention is used in these therapies. It is a technique by which the person is systematically exposed to stimuli until they become accustomed.

To do this, any maneuver that is related to the execution of the external or cognitive ritual will be blocked. At first the block will be done for short periods of time and then for progressively longer periods.

For this technique to work, the person has to collaborate and take responsibility for:

• Thinking that obsessions are irrational.
• Determine to overcome the problem.
• Accept that you are having the obsessions and don't try to reject them.
• Find other ways to eliminate anxiety.

There are several modalities:

• Live exhibition: the feared situation is dealt with in a real way, starting with medium levels of anxiety.
• Exposure in imagination: the dreaded situation is faced in the imagination.

Within the cognitive treatment, specific interventions would be carried out in:

• Examine the validity of beliefs through discussion.
• Overestimation of the importance of thoughts with behavioral experiments or thought records.
• The excessive responsibility attributed to the patient.
• Perfectionism
• Exaggerated interpretation of threats.

Finally, it is advisable to work on relapse prevention, teaching the steps to follow in case of one:

• Keep calm.
• Be aware that you have an obsession.
• Do not give importance to the obsession.
• Do not make compulsions, neutralizations or avoidance.
• Practice the exposition.
• Apply risk estimation techniques, attribution of responsibility…
• Identify what you did when things were going well and what you stopped doing.
• Perceive relapse as an opportunity for improvement.

Medication

Medication as treatment includes selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, particularly clomipramine. SSRIs are a second line of treatment for people with moderate or severe impairment.

Atypical antipsychotics such as quetiapine have also been helpful in treating OCD alongside SSRIs. However, these drugs are poorly tolerated and have metabolic side effects. None of the atypical antipsychotics appear to be helpful when used alone.

Procedures

Electroconvulsive therapy (ECT) has been found to be effective in some severe and refractory cases.

Surgery may be used as a last resort in people who do not improve with other treatments. In this procedure, a surgical injury is made to the cingulate cortex. In one study, 30% of the participants benefited from the procedure.

Children

Cognitive-behavioral therapy can be effective in reducing OCD rituals in children and adolescents. Family involvement, observing and reporting, is a key component for successful treatment.

Although the causes of OCD in younger ages can range from abnormalities to psychological concerns, stressful events such as bullying or deaths in close family members can contribute to developing OCD.

Tips for People with OCD

Refocus attention

When you have obsessive thoughts, try to focus your attention on something else. You can exercise, take a walk, listen to music, read, play a video game, make a call…

The important thing is to do something you enjoy for 10-15 minutes to forget the obsession and prevent the compulsive response.

Write down your obsessive thoughts or worries

When you start to have an obsession, write down all your thoughts or compulsions. Keep writing until the obsession stops, even if you keep writing the same things.

Writing will help you see how repetitive your obsessions are, and will even help them lose their power.

Anticipate compulsions

By anticipating the urge to perform the compulsions before they arise, you can alleviate them. If, for example, your compulsion is to check that the door has been closed, try to be attentive when you close the door and pay attention.

Create a mental note from an image or say "the door is closed" or "you can see that the door is closed."

When the urge to check if the door is closed arises, it will be easy for you to think that it is simply an obsessive thought, because you will remember that you have closed the door.

Create a worry period

Instead of trying to suppress obsessions or compulsions, develop the habit of programming them.

Pick one or two 10-minute periods each day that you dedicate to obsessions. Choose the time and place, so that they are not close to when you go to sleep.

During the worry period, focus only on obsessions, urges, or negative thoughts. Don't try to correct them.

At the end of your period, relax, let the obsessive thoughts go, and get back to your daily activities. When thoughts come back to you during the day, postpone them to your worry period.

Practice relaxation techniques

Although stress does not cause OCD, a stressful event can lead to heritable OCD or make obsessive-compulsive behaviors more severe. Techniques like yoga, deep breathing, progressive muscle relaxation, or meditation can reduce anxiety symptoms.

Try to practice a technique for 15-30 minutes a day. Here you can learn some of them.

Adopt a healthy diet

Complex carbohydrates such as whole grains, fruits and vegetables stabilize blood sugar and increase serotonin, a neurotransmitter with calming effects.

Exercise regularly

Exercise reduces anxiety and helps control OCD symptoms by focusing attention elsewhere when obsessive thoughts and compulsions arise.

Try to do aerobic exercise for at least 30 minutes a day.

Avoid alcohol and nicotine

Alcohol temporarily reduces anxiety and worries, although it increases them when not consumed.

The same goes for tobacco: although they seem relaxing, they are a powerful stimulant, leading to higher levels of anxiety.

Sleep enough

Anxiety and worry can lead to insomnia and vice versa. When you are rested, it is easier to maintain emotional balance, key to coping with anxiety.

Visit this article for some tips on how to sleep better.

Helping People with OCD

If a family member or friend has OCD, the most important thing is to educate yourself about the disorder. Share that knowledge with that person and make him see that he can get help. Simply seeing that the disorder is treatable can boost your motivation.

Also, you can follow these tips:

• Avoid making negative comments - they can make OCD worse. A supportive and relaxed environment can enhance treatment.
• Don't be angry or ask her to stop doing the rituals - pressure to avoid them will only make symptoms worse.
• Try to be as patient as possible: each patient needs to overcome their problems at their own pace.
• Try to keep family life as normal as possible. Make a pact so that OCD does not influence family well-being.
• Communicate clearly and directly.
• Use humor: of course a situation is funny if the patient also finds it funny. Use humor if your family member doesn't bother with it.

Complications

People with OCD may have additional problems:

• Inability to work or perform social activities.
• Problematic personal relationships.
• Low quality of life.
• Anxiety disorders.
• Depression.
• Eating disorders.
• Suicidal thoughts or behaviors.
• Alcohol or other substance abuse.

References

1. Diagnostic and statistical manual of mental disorders: DSM-5 (5 ed.). Washington: American Psychiatric Publishing. 2013. pp. 237–242. ISBN 9780890425558.
2. Fenske JN, Schwenk TL (August 2009). "Obsessive compulsive disorder: diagnosis and management". Am Fam Physician 80 (3): 239–45. PMID 19621834.
3. Boyd MA (2007). Psychiatric Nursing. Lippincott Williams & Wilkins. p. 418. ISBN 0-397-55178-9.
4. Quick Reference to the Diagnostic Criteria from DSM-IV-TR. Arlington, VA: American Psychiatric Association, 2000.
5. Huppert & Roth: (2003) Treating Obsessive-Compulsive Disorder with Exposure and Response Prevention. The Behavior Analyst Today, 4 (1), 66-70 BAO.
6. D'Alessandro TM (2009). "Factors influencing the onset of childhood obsessive compulsive disorder." Pediatr Nurs 35 (1): 43–6. PMID 19378573.