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Obsessive Compulsive Disorder and Obsessions


Obsessive Compulsive Disorders OCD is an anxiety disorder that is associated with obsessions and compulsions, each of which is defined below.

Obsessions : Obsessions are the mental component of OCD. They are thoughts, images, or impulses that repeatedly enter the mind, and feel out of the individual’s control. The person with OCD does not want to have these ideas, finds them intrusive, and usually at some point has recognized that they don't truly make sense. This is an important feature of obsessions, as it helps to distinguish them from other non-OCD symptoms such as worry or depressive preoccupations, and from other human experiences like fantasy. Obsessions are accompanied by troubling feelings that can take many forms, such as fear or apprehension, anxiety, disgust, tension, or a sensation that things are “not just right.”

Compulsions : The distressing feelings that arise from obsessions motivate people with OCD to engage in specific behaviors or rituals that may temporarily provide relief from their distress. These are compulsions, the main behavioural component of OCD. Compulsions are acts the person feels driven to perform over and over again, or sometimes according to specific personal "rules." OCD compulsions do not give the person pleasure; they are performed to obtain relief from discomfort caused by the obsessions. This is an important feature of compulsions because it helps to distinguish them from other non-OCD problems like gambling or Deaddictions, other impulsive behaviors (e.g., spending too much money, stealing), or normal behaviors such as avid hobbies or pastimes. Even though compulsions are usually recognized as excessive, embarrassing, or problematic, people with OCD feel powerless to resist them.

Obsessive-compulsive disorder (OCD) is a type of mental illness that causes repeated unwanted thoughts. To get rid of the thoughts, a person does the same tasks over and over. For example, you may fear that everything you touch has germs on it. So to ease that fear, you wash your hands over and over again.

OCD is a chronic, or long-term, illness that can take over your life, hurt your relationships, and limit your ability to work or go to school.

Causes of Obsessive Compulsive Disorders Biological Factors

•   Brain Activity – There is much current interest in identifying brain areas involved in OCD, using imaging techniques like positron emission tomography (PET) and magnetic resonance imagery (MRI). To date, research has identified a number of brain areas where people with OCD appear to have different amounts of activity compared to those without OCD. These include complex brain circuits involving the front part of the brain (the orbital cortex) and parts of deeper structures (the basal ganglia), which are thought to be involved in controlling feelings and actions. The precise nature of these differences is not completely understood, and studies often have inconsistent results.

•   Neurotransmitters – Neurotransmitters are chemical messengers that pass information from one nerve cell in the brain to the next. The neurotransmitter most clearly implicated in the development and maintenance of OCD is serotonin. The greatest evidence for this comes from the finding that medications that act to increase levels of serotonin at several sites in the brain – such as serotonin reuptake inhibitors – are effective in reducing obsessions and compulsions.

•   Genetics – Evidence is quite strong that OCD runs in families. No specific genes for OCD have yet been identified, so vulnerability to OCD cannot be determined via genetic testing. However, research suggests that genes can play a role in the development of the disorder. Recent research suggests that when a parent has OCD, the risk that a child will develop OCD is increased slightly, but this may only be true for some forms of OCD. For example, factors implicated in familial include age of onset (e.g., childhood-onset OCD tends to run in families) and family history of tic-related disorders, like Tourette’s disorder.

Psychological Factors

•   Beliefs about Obsessions – People’s interpretations of events are often a major cause of their emotional responses to them. In the case of OCD, misinterpretations often focus on the meaningfulness of obsessive thoughts. Research has shown that almost everyone has intrusive thoughts once in a while – almost like mental “hiccups” -- and also that the themes of these normal intrusive thoughts are identical to those found in obsessions (e.g., being responsible for something bad happening, doubts about whether a task was done properly). The difference may be that in OCD these thoughts are interpreted differently, giving them the power to cause much greater distress. Problematic beliefs about obsessions can take many forms. Examples include the belief that having a thought is the same as doing an action (e.g., if I think about pushing a loved one into traffic it is as bad as actually doing it) or the belief that having a thought means that I would be responsible for any harmful consequences if I did not take all possible actions against it.

•   Personality Traits – Research has shown that several general personality traits may be linked to some forms of OCD. One of these is trait anxiety, or the predisposition to be made anxious more easily, or more frequently, or by a greater number of experiences, than other people. Another is anxiety sensitivity, or the tendency to feel uncomfortable with, and have catastrophic thoughts about, one’s anxiety (e.g., a racing heart may prompt thoughts that one might lose control or go crazy). Another trait sometimes associated with OCD is perfectionism, particularly when it entails excessively high or rigid standards for oneself that rarely, if ever, feel satisfied.

•   Attention & Information Use – People with OCD tend to pay special attention to information that is in line with their concerns, and less attention to information that isn’t. For example, someone with contamination concerns related to contracting AIDS may focus in on a statement he once heard about the remote possibility that mosquitoes can transmit the disease. The anxiety prompted by this information has several problematic consequences: a) the desperate search to check this threatening fact with 100% certainty – rarely possible in the real world – results in other information that is neutral or contradictory being downplayed, and b) anxiety reducing compulsive behaviors like reassurance-seeking, prompted by this information, may be reinforced because they feel like rational information seeking.

•   Life Experiences – Life stress puts people with OCD at risk for worsening of their symptoms. During stressful periods (e.g., a new baby, work stress, marital problems, exams at school), people with OCD often report increased obsessions and greater difficulty resisting compulsions. Other emotional problems, such as depression, may also interact with OCD vulnerability to worsen its symptoms.

Symptoms of Obsessive Compulsive Disorders Obsessions can take a countless number of forms. Common examples include the following:

•   Contamination (e.g., fears of germs, dirtiness, chemicals, AIDS, cancer)

•   Symmetry or exactness (e.g., of belongings, spoken or written words, the way one moves or completes actions)

•   Doubting (e.g., whether appliances are turned off, doors are locked, written work is accurate, etc.)

•   Aggressive Impulses (e.g., thoughts of stabbing one’s children, pushing loved ones into traffic, etc.)

•   Accidental Harm to Others (e.g., fears of contaminating or poisoning a loved one, or of being responsible for a break in or a fire)

•   Religion (e.g., sexual thoughts about a holy person, satanic thoughts, distressing thoughts regarding morality)

•   Sexual (e.g., thoughts about personally upsetting sexual acts)

•   Other miscellaneous obsessions having to do with themes such as lucky or unlucky colors or numbers, or with the need to know “trivial” details (e.g., house numbers, license plates) Like obsessions, compulsions can take many forms, which can include the following:

•   Washing and Cleaning (e.g., excessive showering, hand washing, house cleaning)

•   Checking (e.g., locks, appliances, paperwork, driving routes)

•   Counting (e.g., preferences for even or odd numbers, tabulating figures)

•   Repeating Actions or Thoughts (e.g., turning lights on and off, getting up and down in chairs, re-reading, re-writing)

•   Need to Ask or Confess (e.g., asking for reassurance)

•   Hoarding (e.g., magazines, flyers, clothing, information)

•   Ordering and Arranging (e.g., need for things to be straight, sequenced, or in a certain order)

•   Repeating Words, Phrases, or Prayers to Oneself (e.g., repeating "safe" words or prayers)

Other Behavioural Features of Obsessive-Compulsive Disorder

Although obsessions and compulsions are the key symptoms of OCD, other common features include the following:

•   Avoidance – Compulsions are performed in the attempt to reduce negative emotions, such as anxiety, that arise from obsessions. Another behavior that can also perform this function is avoidance. People with OCD often find that they avoid situations that provoke obsessions. Avoidance can take many forms – some of them quite subtle – and can have a profound impact on the individual’s day-to-day life. For example, a person with intrusive thoughts about harming his child may feel a need to avoid being alone with the child, bathing or dressing the child, or even looking at pictures of the child, all because these situations have the power to evoke distressing obsessions.

•   Thought Suppression – Some obsessions, particularly those that are personally offensive or frightening, can prompt the person to spend a lot of energy deliberately trying to force obsessive thoughts out of awareness, or to suppress them. Although thought suppression is an understandable strategy, research has shown it to be problematic in OCD in several ways: a) deliberately trying not to think of a specific thing usually has the contrary effect of making the thought more likely to return, and b) unintentionally, it reinforces the notion that the obsession is a valid belief or fear, when in fact it is not; this can serve to strength the distress power of the obsession. Either way, the effect of thought suppression may be to increase obsessions.

Diagnosis of Obsessive Compulsive Disorders A recognition (at least some of the time) that the obsessions or compulsions are excessive or unreasonable (this criterion does not apply to children). The individual’s obsessions or compulsions cause significant distress (i.e., it bothers the person that he or she has the problems) or significant interference in the person’s day-to-day life. For example, the obsessions or compulsions may make it difficult for the person to perform important tasks at work, interfere with relationships, or get in the way of other day-to-day tasks. If another psychological problem is present, the obsessions and compulsions are not restricted to it. For example, people with bulimia often ruminate about food and engage in repetitive behaviors, such as binge eating and purging. This would not be considered OCD. The obsessions and compulsions are not simply due to a substance or medical condition.

The phobic situation(s) is avoided or else is endured with intense anxiety or distress.

The avoidance, anxious anticipation or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

In individuals under the age of 18, the duration is at least 6 months.

The anxiety, panic attack, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder.

Treatment of Obsessive Compulsive Disorders The most effective treatment by far for OCD is cognitive behaviour therapy (CBT), and this should always be the first line treatment, as there is much evidence to support its use. Many people are offered other psychological treatments but, other than behaviour therapy and cognitive behaviour therapy, there is no evidence that such treatments are effective so we do not offer them in the clinic. CBT is a short term, structured, problem focussed and goal directed form of therapy. It helps the person get a full understanding of how the problem works, introduces new ways of looking at it, and teaches the person the necessary skills to understand and overcome their problem. It aims to enable the person to become their own therapist when therapy ends. In randomised control trials 75% of service users with OCD are significantly helped by this therapy. CBT is not known to have any risks associated with it.