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What is Obsessive-Compulsive Disorder?
When unwanted thoughts persist despite deliberate efforts to forget or ignore them and these thoughts compel a person to perform repetitive “rituals” to alleviate anxiety from having these thoughts, that person may have obsessive-compulsive disorder.
Commonly abbreviated as OCD, this is a serious psychological disorder that is difficult to treat and often prevents affected individuals from leading normal, productive lives. For example, people who develop an abnormal fear of germs or dirt may be obsessed with thoughts of dying from disease if they don’t wash their hands every five minutes. Alternately, someone with OCD may think that something terrible will happen if they don’t count their steps when entering or leaving a room. Another may spend several hours getting ready for work because they cannot get the cap on the toothbrush tube just right.
Excessive hair plucking (trichotillomania), skin picking (dermatillomania) and hoarding are also included on the OCD spectrum. People with these obsessions and compulsions suffer from extreme levels of anxiety and dread that frequently develop into an even more debilitating co-morbid panic disorder. Relief is only obtained when they are allowed to complete a ritual that diminishes the anxiety associated with the obsessive thought.
People with obsessive-compulsive disorder know what they are doing is not normal but inevitably attempt to rationalize their compulsions when confronted with their behaviors. For example, someone who spends 30 minutes checking and rechecking a door to make sure it is locked will say that taking extra time to ensure the front door is locked is better than risk getting robbed or assaulted. Those who hoard items discarded by others will justify their behavior by saying things like “I might need that one day” or “I plan on fixing that chair and using it”.
Causes of OCD
Why people develop OCD is not clear but neuroscientists think it may have a genetic component coupled by dysregulation of neurotransmitters in the brain. Traumatic personal experiences may also contribute to OCD, such as someone who nearly dies from a serious bacterial or viral disease and develops a morbid fear of germs. They may become obsessed with the possibility they could contract the illness again if they don’t wash their hands 20 times a day and sanitize every object they touch. Unfortunately, the resulting obsession with cleanliness and compulsion to spend most of the day cleaning everything around them prevents many OCD sufferers from earning a living, enjoying relationships with others and appreciating the quality of live available to them.
Treating Obsessive-Compulsive Disorder
People with OCD need to take antidepressants (selective serotonin reuptake inhibitors) and typically need psychotherapy for the remainder of their lives. When SSRIs do not help an OCD sufferer control obsessive thoughts and compulsions, a psychiatrist may prescribe an atypical antipsychotic medication frequently given to people with bipolar disorder, an autism spectrum disorder or dementia. Stronger than antidepressants, atypical antipsychotics exert a more tranquilizing effect on the central nervous system to relieve extreme anxiety and agitation.
Behavioral (Exposure) Therapy
Also called “exposure and ritual prevention”, ET involves a therapist and an OCD patient exploring the meaning behind their obsessive-compulsive behavior and eventually realizing that nothing bad will happen if rituals are not completed. Considered a highly effective treatment for eliminating most OCD behaviors, exposure therapy requires the full cooperation of the patient in order to be successful. Consequently, some people with OCD (especially hoarders) find the experience too terrifying to continue and either remain on medication or simply stop therapy altogether.
Exposure therapy may begin with a psychologist allowing a patient to check the door lock only
twice before leaving their home. When someone with OCD (who is used to spending an hour rechecking a door to make sure it is locked) is not allowed to complete this ritual, their level of anxiety often elevates to a full-blown panic attack. It is the job of the psychologist to help the patient cope with this paralyzing anxiety by providing support, teaching them breathing and imagery relaxation techniques and proving that nothing catastrophic is going to happen if they do not follow through with their ritualistic behaviors.
Cognitive Behavioral Therapy
Intensive (daily) CBT is considered a frontline treatment for obsessive-compulsive disorder that can produce a significant improvement ( as high as 80 percent) in four to five weeks. In addition to helping patients recognize and restructure abnormal thought patterns, CBT has also been shown to change brain chemistry by normalizing blood flow and cerebral glucose metabolism in the frontal cortex, thalamus and other relevant areas of the brain.
Functional imaging research with OCD patients have repeatedly revealed abnormalities with blood flow and brain glucose in these regions. Research investigating the impact of CBT on the brain’s chemical processes discovered that PET scans of patients who underwent three months of CBT experienced normalization of glucose metabolism and reductions in blood flow to the thalamus and left frontal cortex.
Electroconvulsive Therapy
Severe cases of OCD that do not respond to medications, exposure therapy or CBT may respond to ECT, or electroconvulsive therapy, a type of brain stimulation therapy that is also used to mitigate chronic cases of profound clinical depression. Although physicians are not sure how ECT works to relieve symptoms of OCD and depression, it has proved to be a safe and effective procedure to use on patients who have exhausted all other options.
Psychosurgery
Psychosurgery to diminish OCD symptoms is another “last resort” treatment program that involves a neurosurgeon making a small lesion in the cingulate cortex and disabling gray matter areas with an electrode. According to several studies, nearly 40 percent of patients who have had psychosurgery for their OCD benefited from this operation and experienced significant relief from obsessive thoughts, compulsions and overwhelming anxiety.
Obsessive-Compulsive Programs Can Help
To find a mental health facility that offers obsessive-compulsive programs in your area, take advantage of our comprehensive directories that provide listings of hundreds of agencies specializing in treating OCD. Insurance may also help cover the cost of treatment. Find out more about insurance assistance by visiting https://rehabreviews.com/benefits-check.
[Source: Nature.com, NIH, NIH]