What Is Obsessive Compulsive Disorder (OCD)? What Causes Obsessive Compulsive Behavior?

Editor's Choice
Main Category: Psychology / Psychiatry
Also Included In: Anxiety / Stress;  Mental Health
Article Date: 08 Feb 2010 - 0:00 PDT

email to a friend   printer friendly   opinions  

A person with Obsessive-compulsive disorder, also known as OCD has an anxiety disorder. OCD is a chronic (long-term) mental health condition, a psychiatric disorder in which the patient has obsessive thoughts as well as compulsive behavior.

Obsession - an unwanted idea, thought or impulse that keeps returning into the person's mind, like a boomerang. The thought or idea is unwelcome, uncontrollable and persistent. The individual cannot help thinking about it, even though it creates anxiety and distress.

Compulsions - repetitive, excessive and meaningless mental exercises or activities which the individual performs in an attempt to relieve anxiety (avoid distress and worry). Compulsions are not done for pleasure; they are not voluntary activities. An example is arranging and rearranging items in a set order, or going through a long ritual of checking that all the doors are locked.

An individual with OCD may be preoccupied with regular and ritual handwashing, hoarding items, there may be sexual or aggressive impulses, some may have specific religious beliefs, fear of certain dates and particular numbers. There may be rituals which others find bizarre, such as swishing the curtains backwards-and-forwards a number of times before either leaving them opened or closed.

In severe cases, these repetitive behaviors can leave the person isolated and physically and emotionally drained. The OCD may be so consuming that the patient is unable to manage economically. To others, the person with OCD may appear delusional or psychotic. However, an OCD sufferer is aware of his/her actions, thoughts and behaviors - they know their behaviors are irrational; this fact distresses them even more. The patient is in a vicious circle of rituals, repetitive behaviors, anxiety, obsessive thoughts - and worrying about it all exacerbates all the symptoms.

According to the American Psychiatric Association, approximately 2% of adult Americans have OCD. The National Health Service (NHS), UK estimates that between 1% and 3% of UK adults and 2% of children and teenagers have OCD.

According to Medilexicon's medical dictionary, obsessive-compulsive disorder (OCD) is:

a type of anxiety disorder the essential features of which include recurrent obsessions, persistent intrusive ideas, thoughts, impulses or images, or compulsions (repetitive, purposeful, and intentional behaviors performed to decrease anxiety in response to an obsession) sufficiently severe to cause marked distress, be time-consuming, or significantly interfere with the person's normal routine, occupational functioning, or usual social activities or relationships with others.

What are the signs and symptoms of obsessive-compulsive disorder?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Signs and symptoms of OCD include:

• Obsessions - thoughts become so prominent that other thoughts take a back seat; the patient is dominated by specific thoughts and ideas. Examples may be fear of dying or being harmed, fear of harming other people, an aversion of anything that may be dirty and cause infection, fear of doing something dangerous, etc.
• Anxiety
• Compulsion - often the compulsion is related to the obsession. If the patient has an obsessive fear of dirt and infection, then ritual and repetitive handwashing may be the compulsion. On the other hand, though, the compulsion may not be linked to anything logical and seems to have a life of its own. Examples of compulsion include repeating words or phrases, counting, checking door locks and gas taps, doing things in a certain sequence, etc.
• Temporary relief - compulsive behaviors bring some relief. But anxiety soon returns when the obsessions kick in again.

Many who suffer from OCD also suffer from panic attacks.

In severe cases the thoughts and behaviors become extremely time-consuming and disabling, and the patient has very little time and energy to do anything else.

What are the causes of obsessive-compulsive disorder?

Nobody is really sure what causes OCD. Most agree it is most likely a combination of biological, psychological, genetic and possibly circumstantial factors.

• Genetics - people whose parent or sibling has/had OCD have a significantly higher risk of developing it themselves. However, no gene has been identified as being linked to OCD.
• Brain chemistry - experts suggest that some changes in the balance of some neurotransmitters, such as serotonin may play a role. Neurotransmitters are chemicals the brain uses to pass data from one (brain) cell to another.
• Brain characteristics - some studies, using imaging scans of the brain have shown that a significant number of people with OCD have abnormalities in the basal ganglia (a group of nerves in the brain).
• Emotional upheaval - some experts believe an emotional upheaval, such as bereavement may be contributory factor in OCD.

How is obsessive compulsive disorder diagnosed?

A formal diagnosis is made by a psychiatrist or psychologist. The patient must have obsessions, compulsions or both, according to the DSM (Diagnostic and Statistical Manual of Mental Disorders), created by the American Psychiatric Association.

Diagnostic Criteria (DSM-IV 300.3 OCD)

A. The Person Exhibits Either Obsessions or Compulsions
Obsessions are indicated by the following:

• The person has recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
• The thoughts, impulses, or images are not simply excessive worries about real-life problems
• The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action
• The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

Compulsions are indicated by the following:

• The person has repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
• The behaviors or mental acts are aimed at preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (Note: this does not apply to children.)

C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities or relationships.

D. If another axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with drugs in the presence of a substance abuse disorder).

E. The disturbance is not due to the direct physiologic effects of a substance (e.g., drug abuse, a medication) or a general medical condition.

Diagnostic challenges

ICD is sometimes confused with OCPD (obsessive-compulsive personality disorder). People with OCD are usually aware that their behavior is not rational; their obsessions distress them, but nevertheless they feel compelled by them.

People with OCPD are not aware that there is anything abnormal about themselves - they think their behavior and thoughts are rational.

OCD is ego dystonic (in conflict with the person's self image) while OCPD is ego syntonic (not in conflict with the person's self image).

A person with OCPD gets pleasure with his/her obsessions or compulsions while a person with OCD is distressed and anxious about it. An OCD person does not actively want to perform his/her compulsive task and does not enjoy it.

What is the treatment for Obsessive-compulsive disorder?

Treatment for obsessive-compulsive disorder usually includes CBT (cognitive behavior therapy), an SSRI antidepressant medication, or a combination of CBT and medication.

If symptoms are mild the patient may only need a few sessions of CBT.

If symptoms are moderate there may be more CBT sessions as well as SSRI antidepressant medication.

Those with severe symptoms will require intensive and long-term CBT, as well as SSRI medication.

What is cognitive behavioral therapy (CBT)? The focus is on current thinking, behavior and communication, instead of past experiences. CBT is oriented towards problem solving. It is based on the idea that the way we think about things affects how we feel. CBT aims to help people in the way they think (cognitive) and the way they act (behavior).

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations