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Obsessive-compulsive disorder (OCD) is characterized by the presence of intrusive obsessions and distressing compulsions. OCD causes considerable distress and often disrupts normal work and occupational functioning. It was once believed that OCD was a rare disorder, but its prevalence has been on the rise.
Obsessions are repetitive thoughts, ideas, images or impulses that return to one’s mind in a stereotyped manner which are often identified as distressing and senseless. These thoughts are usually resisted, but unsuccessfully.
A need to keep things in a certain order, a need to pray in a certain way, an obsessive need for symmetry or a need to keep checking the stove knob despite knowing it is closed, a feeling of being dirty or requiring to wash stuff over and over again or an UN-understandable urge to step on peoples feet !
Compulsions are actions, like checking and washing which may or may not result from obsessions. Compulsions often help people get temporary relief from obsessions.
Raghav has repetitive thoughts that he hadn’t locked the door. Despite knowing he has indeed locked the door, these thoughts do not stop and cause intense distress and restlessness (Obsession), until he goes and checks if the door is indeed locked (Compulsion).
Another one, Raghav had to skip every alternate stair, if he did not something bad would happen.
Sandhya feels her hands are dirty and carry germs every time she touches anything. These thoughts distract her from the work at hand and cause immense pain and suffering (Obsession), these thoughts temporarily stop when she washes her hand 7 times (Compulsions).Examples of obsessions and compulsions
What are the symptoms ?
Common obsessive thoughts include:
- Fears – Intrusive fears of being contaminated by germs or dirt or other particles, a fear of losing control and harming yourself or those around you.
- Doubts – In regard to locks, stoves, safes and more recently logins.
- Images -Intrusive sexually explicit or violent images, images of religious blasphemy.
- Impulses – Touching objects, making gestures etc.
- A need for order and symmetry.
- Magical thinking and superstitions.
Common compulsive behaviors in OCD include:
- Repetitive washing.
- Repetitive checking.
- Repetitive counting.
- Repetitive ordering.
- Repetitive asking or confessing.
What are the numbers ?
An estimated 2-3 per cent of the population are said to suffer from obsessive-compulsive disorder, however people with OCD form up-to 10% of the clients who visit a psychiatrist. The disorder can occur in adolescence or childhood and sometimes as early as 2 years of age. The most common age of onset is less than 25 years of age. Higher prevalence is also seen among those who are single.
What causes OCD ?
Abnormal functions of brain regions such as the basal ganglia and the frontal lobe have been implicated in a number of imaging studies. Abnormalities in serotonin neurotransmission have also been found to play a major role. OCD is also associated with immune mechanisms (especially in relation to streptococcal infections). Compulsions also develop via conditioning, wherein neutral objects gain anxious significance and meaningless behaviour that reduces this anxiety can become compulsions. Ineffective, overcontrolling parenting is also known to cause OCD.
How is OCD treated ?
A number of treatment options are available for the effective management of OCD. Mild to moderately ill persons may not require any medication, whereas a few patients will require treatment with antidepressants.
The medications correct the neurotransmitter imbalances and can make a difference relatively quickly. Behavioural therapy (wherein dysfunctional behaviors are un-learnt) is the non pharmacological treatment of choice, and inherently requires more effort that taking pills. A combination of medication and therapy is ideal. Resistant cases may require antipsychotics and rarely, psychosurgery.
Will I get better ?
Up to 80% of those suffering from OCD will improve. A small subset of patients may remain the same or may become worse. Poor insight, the presence of yielding compulsions, delay in treatment and treatment non-compliance predict a poor prognosis.
Obsessive-compulsive disorder is a mental disorder that requires treatment. People with OCD often live with their symptoms for a long period of time before they try to seek help. This delay in seeking treatment can make treatment difficult.
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