Obsessive-Compulsive Disorder: Types, Causes and Treatment

Be it a celebrity or an ordinary person, we often find people around us saying that they have Obsessive-Compulsive Disorder because they like their surroundings clean and organized. This is because of the lack of awareness that people have OCD which makes them assume and form such myths about it.

Understanding Obsessive-Compulsive Disorder

Unwanted and bothersome obsessive thoughts or upsetting images are what characterize obsessive-compulsive disorder (OCD). Compulsive actions are typically displayed in connection with these, either to fight the intrusive thoughts or pictures or to avoid a distressing situation or incident. More specifically, intrusive, recurring thoughts, ideas, or urges that are considered unsettling, inappropriate, or uncontrollable are classified as obsessions by the DSM-5. Individuals with these kinds of obsessions make a conscious effort to minimize or oppose them with different ideas or behaviors.

Compulsions may show up as either secret or openly repetitive actions carried out as prolonged rituals (e.g., repeatedly washing hands, checking, or arranging items in an orderly manner). Obsessions could additionally involve subtle mental practices (such as counting, praying, or repeating specific words aloud). An obsession usually drives a person with OCD to engage in this ritualistic, compulsive behavior, and there are frequently strict guidelines regulating how the compulsive conduct must be carried out. The obsessive activities are carried out in an attempt to avoid or lessen discomfort or to stop a scenario or event that is feared. Because it causes a significant amount of functional impairment and a lower quality of life, it is frequently one of the most harmful mental diseases (Stein et al., 2009).

Obsessive-Compulsive Disorder Criteria (DSM-5)

DSM is a diagnostic manual to assess psychological disorders, according to which a person needs to fit in following criteria to be diagnosed with OCD:

• Obsessions are recurrent and persistent thoughts, urges, or images that cause anxiety or distress during a disturbance. These thoughts are often aimed at preventing or reducing anxiety or distress, but these behaviors or mental acts are not realistically connected to the intended outcome.

• Obsessions can be time-consuming, causing significant distress or impairment in social, occupational, or other areas of functioning.
• They cannot be linked to another medical condition or the physiological effects of a medication.

• The disturbance is not better explained by symptoms of another mental disorder, such as excessive worries, preoccupation with appearance, difficulty discarding possessions, hair pulling, skin picking, stereotypies, ritualized eating behavior, substance-related and addictive disorders, preoccupation with illness, sexual urges or fantasies, impulses, guilty ruminations, thought insertion or delusional preoccupations, or repetitive patterns of behavior.

Types of Obsessive-Compulsive Disorder

OCD is a disorder characterized by various subgroups, including checking, contamination, hoarding, indecisiveness, and just right.

• Hoarding is a common subclinical OCD type, characterized by a persistent tendency to accumulate objects, causing psychological distress and cluttering domestic areas.

• Contamination is a type of OCD characterized by obsessions and compulsions related to both realistic and unrealistic contagions or contaminations.
• Checking is a subtype of OCD characterized by safety-checking compulsions, aiming to prevent obsessive thinking related to damage, leaks, or harm to others or oneself.
• Indecisiveness is defined by longer decision times and increased searches for information, associated with OCD tendencies and symptoms.
• Just right is an OCD subtype characterized by uncomfortable feelings of things not being right, driven to perform actions until the sensation subsides. Not-just-right experiences (NJREs) include perfectionism, ordering, symmetry obsessions, compulsions, indecisiveness, and procrastination. Indecisiveness is linked to procrastination in OCD patients due to the feeling of imperfection in their actions. Ordering and symmetry symptoms cause an unpleasant feeling of lack of harmony and logic, and NJREs are strongly linked to perfectionism.

OCD and Other Mental Health Disorders

Obsessive-compulsive disorder often occurs along with other mood and anxiety problems, just like anxiety disorders. Particularly common is depression, with estimates indicating that between 25 and 50 percent of OCD sufferers may have signed up to 80% of people may have major depressive symptoms at some point in their lives. Considering how persistent and damaging OCD is, it should come as no surprise that many OCD sufferers experience depression in part because of their condition.

OCD most frequently co-occurs with the following disorders:

• PTSD (Post Traumatic Stress Disorder)
• GAD (Generalized Anxiety Disorder)
• Social phobia
• Panic disorder.
• The two personality disorders that OCD sufferers, most frequently have are avoidant and dependent.

Causes of Obsessive-Compulsive Disorder

Though the exact causes of Obsessive-Compulsive Disorder are unclear, there are a few risk factors that add up to this condition:

• Genetics: Research has indicated that there is a greater chance of developing OCD if one has a first-degree family member (parent or sibling) who has the disorder. Although no one gene or combination of genes has been proven to be the cause of OCD, research into the relationship between genes and OCD continues to be studied.
• Brain: Various brain regions, connectivity, and biological functions have all been linked by researchers to thoughts of obsession, compulsive behavior, and the accompanying worries and anxiety. To learn more about the relationship between specific brain regions and symptoms of OCD, research is being pursued.
• Temperament: According to some studies, there is a higher chance of OCD development in individuals who grow up displaying more reserved habits, unpleasant feelings, and signs of worry and depression.
• Trauma: Research has indicated a relationship between childhood trauma and symptoms of obsessive-compulsive disorder.

Can Obsessive-Compulsive Disorder Be Treated?

1. Behavioral and Cognitive Behavioral Therapy

The most effective approach to treating obsessive-compulsive disorders is a behavioral treatment that combines exposure and response prevention. Clients develop a hierarchy of upsetting stimuli and rate them on a scale. They expose themselves to these stimuli repeatedly, avoiding rituals to reduce anxiety. Preventing these rituals helps the client see that the anxiety will dissipate naturally, even if it takes several hours.

Cognitive-behavioral therapy (CBT) has shown promise in treating obsessive-compulsive disorder (OCD), with a majority of clients showing a 50-70% reduction in symptoms and improvement in quality of life. About 50% of clients show significant improvement, while another 25% are moderately improved. About 76% maintain their gains at several-year follow-ups, making it superior to medication. D-cycloserine, a drug known to facilitate the extinction of fear, may decrease the number of exposure and response prevention sessions needed.

However, it has not been shown to be superior to exposure and response prevention therapy. Some researchers suggest that cognitive therapy may enhance extinction and response-prevention treatment, but further improvements are needed to improve the efficacy of these treatments.

2. Medications

Serotonin-affecting medications like clomipramine and fluoxetine have mild to moderate effects on treating OCD. Around 40-60% of clients show a 25-35% reduction in symptoms, while 30-50% do not show significant improvement. In one-third of cases, small doses of certain antipsychotic medications may produce greater improvement.

Medication treatment for OCD has a disadvantage as discontinuing it often leads to high relapse rates. Psychiatrists are now considering neurosurgical techniques for severe, intractable OCD, which may affect 10% of people. To be considered, patients must have severe OCD for at least 5 years and not respond to known treatments. Studies show that 35-45% of these cases respond well to neurosurgery, but many have adverse side effects.