Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

In Obsessive-Compulsive Disorder (OCD), a person’s thoughts, images, or urges (obsessions) are recurrent and distressing. As a result, they feel compelled to perform mental or behavioral acts (compulsions) in response, either to an obsession or to the rules they believe must be applied rigidly. OCD usually begins in infancy or adolescence, lasts for the rest of a person’s life, and severely impairs their ability to function.

Intense anxiety can result from obsessive thoughts, frequent recurrences, and persistent. Compulsive behaviors or mental acts performed in reaction to an obsession can help prevent or alleviate anxiety. The patient learns to distinguish between excessive or unreasonable obsessions and compulsions with time. As a result of these OCD characteristics, a person’s daily life can be disrupted by the disorder’s symptoms.

Diagnostic Criteria

An individual’s thoughts, desires, or ideas are classified as obsessive if they are frequently and persistently experienced as intrusive and undesired at some point throughout the disturbance and if they produce significant concern or distress in most individuals. Consequently, an attempt is made by the individual to deny, repress, or negate these ideas, urges, or pictures (Toro-Martínez, 2014).

Examples of compulsions include hand washing, ordering, checking, and mental acts like praying, counting, and quietly repeating words. Anxiety, stress, and other dreaded events and situations can be avoided by engaging in certain actions and mental acts. However, these behaviors and mental acts may be excessive or unrelated to the intended effect (Toro-Martínez, 2014).

In other cases, the obsessions or compulsions require more than an hour a day to carry out or cause clinically substantial distress or impairment in crucial aspects of daily life. In other words, the symptoms of OCD cannot be explained by the physiological effects of a drug (such as heroin or a prescription drug) or by another medical disease (Toro-Martínez, 2014).

Epidemiology

In the United States, 2-3% of people will have OCD at some point in their lives (Team, 2022). Childhood and early adulthood are two distinct periods when OCD can begin to manifest itself. Only 15 percent of instances begin beyond 35, and two-thirds begin before 25. Most cases begin in early adolescence or childhood. There is an earlier beginning and a more severe course in males. Before seeking help, symptoms may last for years, and those afflicted often suffer alone. About 15% of individuals see their condition deteriorate, whereas 5% see bouts of improvement in between each deterioration (Team, 2022).

Causes

Genetic models

The concordance rate between monozygotic and dizygotic twins is higher. OCD and Tourette’s syndrome are more common in first-degree relatives (Chacon et al., 2018). As a result, there may be a link between OCD and Tourette’s syndrome in some families with Tourette’s syndrome. This would imply that OCD and Tourette’s syndrome are two manifestations of identical central hereditary defects (Chacon et al., 2018).

Behavioral Models

OCD is a two-stage classical instrument conditioning model: When anxiety-inducing ideas are combined with a certain mental stimulus, the consequence is an obsession. Anxiety reduction has been linked to compulsions; thus, they have been encouraged.

Neurobiological models

The pathophysiology of OCD has been linked to hyperactivity in frontal-subcortical thalamic circuits by imaging, pharmacological, and behavioral studies. According to this idea, excessive activity in frontal-subcortical systems is caused by hyperactivity in these circuits, leading to OCD’s behavioral disturbances (Lv et al., 2021).

Treatment

Medication and behavioral treatment are all options for treating OCD. Currently, only SRIs (serotonin reuptake inhibitors) are used to treat depression. These are some of the SRIs used to treat OCD. For instance, clomipramine, the most commonly prescribed medication for bipolar disorder, is the most effective, although slight weight gain and decreased sex drive are associated side effects (Foa et al., 2022). Another example includes Benzodiazepines which can aid with anxiety and insomnia in the beginning. Tricyclics and trazodone may also alleviate the sleeplessness, as well. OCD may respond best to a treatment approach that incorporates both single-agent and multi-agent approaches.

Patients who are unable to withstand behavioral therapy because of their extreme anxiety may benefit most from a combination of medication and therapy. The goal of behavioral treatment is to expose the patient to symptom-inducing situations while preventing obsessive or avoidant behaviors. As a result, the patient’s ability to cope with everyday challenges is improved through progressive desensitization.

Neurosurgery (anterior cingulotomy, capsulotomy, limbic leucotomy) should only be used in extreme circumstances. According to a recent study from Massachusetts General Hospital, cingulotomy helped roughly 30% of severe, refractory OCD individuals. For patients with intractable and severe OCD, anterior capsulotomy, especially with the “double-shot” gamma-knife approach, appears to be promising. At 12 months after the operation, 40% of patients had significantly improved on the clinical global impression scale. However, symptoms often take a while to improve after the operation.

Deep brain stimulation is a relatively new technique reported in Harmsenet al., 2022), but it is still in its early stages of development. It has significantly eased symptoms in many severely affected patients who would otherwise be candidates for neurosurgery. No brain tissue is harmed, it may be titrated for maximal individual benefit, and it is reversible, which are all potential advantages over neurosurgery.

References

Chacon, P., Bernardes, E., Faggian, L., Batistuzzo, M., Moriyama, T., Miguel, E. C., & Polanczyk, G. V. (2018). Obsessive-compulsive symptoms in children with first degree relatives diagnosed with obsessive-compulsive disorder. Revista Brasileira de Psiquiatria, 40(4), 388–393. https://doi.org/10.1590/1516-4446-2017-2321

Foa, E. B., Simpson, H. B., Gallagher, T., Wheaton, M. G., Gershkovich, M., Schmidt, A. B., Huppert, J. D., Imms, P., Campeas, R. B., Cahill, S., DiChiara, C., Tsao, S. D., Puliafico, A., Chazin, D., Asnaani, A., Moore, K., Tyler, J., Steinman, S. A., Sanches-LaCay, A., . . . Rosenfield, D. (2022). Maintenance of Wellness in Patients With Obsessive-Compulsive Disorder Who Discontinue Medication After Exposure/Response Prevention Augmentation. JAMA Psychiatry, 79(3), 193. https://doi.org/10.1001/jamapsychiatry.2021.3997

Harmsen, I. E., Fernandes, F. W., Krauss, J. K., & Lozano, A. M. (2022). Where are we with deep brain stimulation? a review of scientific publications and ongoing research. Stereotactic and Functional Neurosurgery, 1-14.

Lv, Q., Lv, Q., Yin, D., Zhang, C., Sun, B., Voon, V., & Wang, Z. (2021). Neuroanatomical Substrates and Predictors of Response to Capsulotomy in Intractable Obsessive-Compulsive Disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 6(1), 29–38. https://doi.org/10.1016/j.bpsc.2020.05.005

Team, S. (2022, February 16). OCD statistics 2022. The Checkup. Retrieved May 13, 2022, from https://www.singlecare.com/blog/news/ocd-statistics/#:%7E:text=About%202.3%25%20of%20the%20population,show%20that%20treatment%20is%20effective.

Toro-Martínez, E. (2014). DSM-5: OCD and related disorders. Vertex (Buenos Aires, Argentina), 25(113), 63-67.