Obsessive Compulsive Disorder (OCD)

Obsessive compulsive disorder, also known as OCD, is a mental health condition which causes the sufferer to experience overwhelming compulsions and obsessions. This can create a huge impact on the individual’s life, causing often debilitating feelings of anxiety and guilt, and can often take up hours of that person’s day.

Obsessions can be defined by: irrational thoughts and fears, with examples of these can including: unwanted thoughts about certain topics, for example dirt and cleanliness, disease, the possibility of terrible events occurring, sex, violence, religious themes, and fixations with symmetry and routine.

Compulsions can be defined as: repetitive behaviours and rituals carried out to reduce anxiety. Examples of compulsions can include: the overwhelming urge to do tasks such as cleaning, checking locks, compulsive handwashing and cleaning of the body, repetitive counting, hoarding, and praying.

Approximately 1 in every 100 Australians and New Zealanders will have OCD at some point in their lives. OCD can affect anyone at any age but it usually starts in childhood or adolescence with most people being diagnosed by their late teens. Without proper treatment this condition can worsen and become chronic, taking over an individual’s life.

People who suffer from this condition are often aware of the irrationality of their thoughts and compulsions but are unable to do anything about them. This can cause guilt and shame, and lead to people keeping their condition a secret.

Symptoms of this condition vary greatly causing there to be no “typical” OCD symptoms and behaviour. People who suffer from OCD are also more likely to be susceptible to other mental health conditions such as depression, bipolar disorder, schizophrenia, and borderline personality disorder. OCD can come and go, with some people even suffering from seasonal OCD, and the symptoms can often get better or worse over time.

 

SYMPTOMS:

·        Constant or frequent intrusive and unwanted thoughts or mental images

·        Frequent hand washing and cleaning of the body

·        Frequent cleaning of items such as clothes, work desk, belongings, or the house

·        Constantly ordering things a certain way and needing to keep them in that particular order

·        Counting, repeating words, or tapping frequently

·        Constantly checking things such as locks, doors, windows, appliances, taps

·        Hair pulling

·        Skin picking

·        Praying frequently and excessively

·        Obsessive phobias of things such as dirt, toxins, germs, and other substances, as well as illnesses, disease, and the fear of harm or injury to self or others

·        Intrusive violent or sexual thoughts

·        Preoccupation with having things in order, or with following certain patterns

·        Intense irrational phobia of everyday objects or situations

·        Physical tics which are characterized by sudden, brief actions or movements such as blinking, grimacing, throat clearing, or jerking of the body

·        Feeling like you have to do things over and over again just to “make sure”

·        Constantly asking for and seeking reassurance

·        Having routines and rituals that must strictly be followed every day or they cause feelings of great discomfort

·        A short-lived temporary feeling of relief after completing these tasks, rituals, or obsessions

·        Being aware of the irrational nature of these thoughts and compulsions but being unable to prevent them

 

CAUSES:

The cause of OCD is not clear but, like many mental health disorders, it is thought to develop due to a combination of genetic and environmental factors.

·        Genetic: It is possible that certain genes may give an individual a predisposition to OCD as studies have shown having a first degree relative with OCD increased a person’s chances of developing the condition, and identical twins are more often affected than non-identical twins.

·        Biological: Functional, structural, and chemical abnormalities in the brain are currently being researched as a possible cause/link to OCD. There are some studies which have found a link between irregular levels of serotonin in the brain and the development of this condition.

·        Environmental: Studies suggest that some OCD behaviours could be developed following a stressful or traumatic event. It is also suggested that OCD habits and rituals may be traits learned from others such as a parent or relative.

 

DIAGNOSIS:

There is no “single” test for OCD but a health care professional can make a diagnosis based on an assessment of the individual’s behaviours, feelings, and thoughts.

There is however, a test which rates the severity of the OCD symptoms. This is known as the Yale-Brown Obsessive-Compulsive Scale and is used extensively in research and clinical practice to both determine the severity of OCD, and to monitor improvement during the treatment. It is designed to measure obsessions separately from compulsions and specifically measure the severity of symptoms without being biased toward the type of obsessions or compulsions present.

Diagnostic criteria for obsessions include: intrusive, recurrent, persistent thoughts and ideas that cause anxiety, stress, or anguish, and thoughts that are excessive and unreasonable and are unable to be ignored.

Diagnostic criteria for compulsions include: rituals and patterns of behaviour that take up a considerable amount of time, and repetitive physical or mental acts or rituals which are performed excessively to reduce anxiety. In some cases, diagnosis can take some time due to the doctors’ requirement to distinguish between other similar mental health conditions such as depression, schizophrenia, and anxiety disorders.

 

TREATMENT:

OCD can be effectively treated with psychological treatments and medications.

The most common medication prescribed for this condition are typically selective-serotonin reuptake inhibitors (SSRI’s). An example of an SSRI prescribed for this condition is fluoxetine (also known as Prozac), and it works to reduce intrusive thoughts and compulsions, and any associated depression.

 

Exposure and response prevention therapy (ERP therapy): This is the most effective psychological treatment for OCD and occurs with a psychologist or psychiatrist there to support the patient. The first step of ERP is to make a list of things or activities which makes the patient anxious and order them on a scale from easiest to hardest. Starting at the easiest activity, they then go ahead and perform it with the help of a therapist. During the activity they will be encouraged to experience the anxiety and then refrain from performing the compulsion, while waiting for their anxiety levels to drop. The patient then repeats the activity until they become used to it and then progress onto the next situation.

 

Cognitive behaviour therapy (CBT): This therapy is a treatment based on the idea that how you think and act affects the way you feel. With this therapy, the patient works with a therapist to recognise the patterns of thinking and behaviours that are causing them problems and actively challenge them. The aim of this treatment is to assess the negative thought’s the individual is having, and to replace them with more positive and constructive thoughts and behaviours. A person undertaking CBT will learn coping skills and techniques both tailored to their OCD health issue, and more general ones which will help with everyday life.

 

Surgery may be used as a last resort in people who do not improve with other treatments. In this procedure, a surgical lesion is made in the area of the brain known as the cingulate cortex. Studies show that approximately 30% of participants benefitted from this procedure.

 

Electroconvulsive therapy, deep brain stimulation and Vagus nerve stimulation are other surgical options which do not include the destruction of brain tissue. Electroconvulsive therapy has been found to have some effect in severe and refractory cases of OCD. This treatment involves passing a carefully controlled electric current through the brain to induce a seizure, which acts to affect the brain’s activity. Doctors are not sure exactly how ECT works, but it is thought that the electric current stimulates the production of certain chemicals in the brain, such as serotonin and dopamine, which are generally lacking in people who suffer from mental disorders. It seems to actively increase the metabolism and effectiveness of these chemicals, while also improving blood flow through the brain and changing the metabolism of areas in the brain which may be affected by depression. Recent research also suggests that this therapy can help the growth of new cells and nerve pathways in certain areas of the brain.

 

Deep brain stimulation is a neurosurgical procedure which involves the implantation of a medical device called a neurostimulator into the desired area of the brain, which then sends electrical impulses to specific targets in the brain for the treatment of neuropsychic and movement-related disorders. It has been shown to beneficial in the treatment of otherwise treatment resistant disorders with the added benefit of being completely reversible, unlike the lesioning techniques mentioned above. DBS is not a treatment for OCD but can effectively treat the symptoms by disrupting the abnormal patterns of brain activity that become prominent in this condition. it does this by emitting constant pulses of electrical charge delivered at settings which are thought to restore normal brain rhythms. The implantation (electrodes) implanted in the brain are connected to a device known as a neurostimulator which is imbedded in the chest and connected via an insulated wire which is also implanted. It is similar to a pacemaker, and people who have this device are given an external remote control which allows them to turn it on and off whenever they wish, although in some cases the device stays on at all times.

 

Vagus nerve stimulation therapy is a medical treatment that involves delivering electrical pulses to the vagus nerve via a generator implanted under the clavicle and through a wire which travel up the neck and wrap around the left vagus nerve at the carotid sheath. It is used as an adjunctive treatment for certain types of intractable-epilepsy, and treatment-resistant depression and mental disorders including OCD. The vagus nerve sends information to brain regions essential in anxiety regulation (locus coeruleus, orbitofrontal cortex, insula, hippocampus, and amygdala), therefore this pathway may be involved in manifesting various cognitive symptoms that characterize anxiety disorders. More study is needed on the effectiveness of this method for the treatment of OCD.

 

Repetitive Transcranial Magnetic Stimulation is a non-invasive therapy which is administered via a helmet filled with magnetic coils. The coils carry electricity and produce a magnetic field similar in strength to an MRI scan. The flow of electricity which pulses through the device targets areas of the brain and causes the neurons in the brain in certain areas to become either more or less active. Specific area of the brain can be stimulated repeatedly to cause long-lasting changes in the activity of the neurons. The activity level of these neurons has been linked to symptoms of mental illnesses, including OCD.  During the treatment, the patients are awake and do not experience any pain. The system even has a cooling system installed so the wearer does not overheat.

 

Community support can be a helpful asset to those suffering from OCD as it can be an extremely isolating condition. Studies show that people with OCD and their families can benefit greatly from support groups, especially those which include sharing coping strategies and actively develop support networks.

 

OCD in children:

Obsessive compulsive disorder is one of the most common psychiatric conditions affecting children and adolescents. OCD commonly has peaks of onset at two different life phases: pre-adolescence, and early adulthood. The first peak of OCD usually occurs around the age of 10 – 12 years and directly corresponds to the increased load in school, increased performance pressures, and the biologic changes of the brain and body due to puberty. The second peak usually occurs in early adulthood, which is generally also a time of stress and developmental transition and when educational and occupational stresses tend to be high. Children and adolescents have similar OCD symptoms as those of adults with the symptoms distinguishable from other healthy childhood development stages by the definition of “symptoms which impair function and distract the child from learning and developmental tasks”.

A way that childhood and adolescent OCD differs from adult OCD is that the affected individual may not notice or realize that their obsessive thoughts and compulsions are not normal or obsessive, as opposed to adults.

Religious and somatic symptoms appear to be more prevalent in children versus adolescent and adult OCD, and hoarding symptoms appear to be more common in both children and adolescents opposed to adult OCD. Another distinction between childhood OCD and OCD in adults is that their symptoms often include ‘just right’ obsessions, compulsions involving other family members such as parents or siblings, superstitious rituals, and an intense fear or avoidance of an ill or ‘contaminated’ sibling. Biological triggers in children may include an immune response to illnesses such as strep throat. Genetic causes are thought to attribute to 45 – 65% increased risk of a child developing OCD, although studies suggest that a child may have differing OCD symptoms to their parents, which also opposes the belief that OCD runs in the family due to learned traits and the child imitating the parent’s actions.

 

Diagnosis in children:

Diagnosing OCD in children is much the same as diagnosing the condition in adults. A psychologist, paediatrician, or child psychiatrist will make the diagnosis based on the child’s symptoms, and discussions with the parents, affected child, and sometimes school teachers as well.

 

Treatment in children:

Therapeutic treatment can be effective in reducing the compulsive ritual behaviours caused by OCD in children and adolescents. Cognitive Behavioural Therapy and Exposure and Response Prevention therapy are considered the best form of treatment for children, with family involvement proving to be highly beneficial. Parental interventions can also provide positive reinforcements when the child shows appropriate behaviours as an alternative to compulsive responses.

 

Helping someone with OCD:

You can help a friend or a loved one through dealing with this condition by:

·        Learning as much as you can about OCD

·        Encouraging them to face situations which make them feel anxious when appropriate

·        Encouraging them to get help if needed

·        Encouraging discussion about OCD as a common and treatable anxiety condition and which is not embarrassing and nothing to be ashamed of

·        Acknowledging any and all improvements, however small

·        Assuming a patient and non-judgemental attitude

·        Accompanying them to appointments

·        Gently refusing to perform their compulsions for them or aiding them in that aspect

·        Gently refusing to respond to requests for reassurance

·        Reaching out for help for yourself if you are caring for someone with this condition. This can be done by attending OCD carers education and skills groups, support groups, contacting a telephone hotline, attending workshops on stress management, relaxation, mindfulness, and healthy living, and even getting professional help such as counselling for yourself if needed.

 

Natural alternative treatments of OCD:

·        St John’s Wort: Studies show that antidepressant medications such as paroxetine and clomipramine target the serotonin system, making them effective in treating OCD. St John’s Wort also has similar effects on the serotonin system, making it an alternative natural treatment for reducing OCD symptoms. This herbal supplement can have many drug interactions so always consult with a doctor before taking any form of supplement.

·        Milk Thistle: This herb contains silymarin which is a flavonoid complex that has been shown to increase levels of the mood boosting chemical serotonin. Studies have shown that milk thistle may be just as effective as fluoxetine in treating OCD symptoms.

·        Borage oil: Borage is a plant whose flower and oil are both used for the treatment of OCD and has anti-anxiety effects similar to that of benzodiazepines such as Valium. This plant can cause mild to severe side effects and is not safe for pregnant or breastfeeding women, or people with liver damage.

·        Zinc: This element is essential in modulating the brain and body’s response to stress. It can actively inhibit excitatory neurotransmissions and activates multiple brain receptors, including GABA (gamma amino-butyric acid). Deficiency in this substance can lead to depression and anxiety disorders. Studies show that patients suffering from OCD had lower levels of Zinc in their body and were showing signs of deficiency.

·        Iron: Iron supplementation may be beneficial for OCD patients as studies have found that the majority of OCD sufferers iron levels were between 41 – 44% lower than those of non-OCD patients.

·        Probiotics: The probiotic strain Bifidobacterium Longum in particular has been found to be beneficial in treating OCD symptoms. Changes in gut bacteria have been linked to anxiety disorders, OCD in particular. It is thought that good gut bacteria can actively reduce the levels of the stress hormone cortisol in the body.

·        Carnocine: This is an anti-aging supplement which helps with the chelating (bonding to and removal) of extra minerals. Studies have shown that OCD patients had a 62% higher blood manganese concentration and a 12% higher blood calcium concentration than non-OCD patients. Carnocine is also shown to have powerful antioxidant effects on the brain, as well as having a modulatory effect on the excitatory neurotransmitter, glutamate. Glutamate is essential for wakefulness and alertness, but in excess, can become an excitotoxin, wreaking havoc on the nervous system. In people with major depression, there is often associated shortening of telomere length and elevated cortisol levels. Carnocine is known to protect and maintain telomere length and improve stress-induced cortisol change.

·        5-HTTP: This substance efficiently acts as a SSRI (Selective Serotonin Reuptake Inhibitor), and effectively stimulates the production of serotonin and prevents the reabsorption of it in the brain.

·        Inositol: Studies suggest that this supplement may have a beneficial effect on symptoms of anxiety, depression, OCD, and panic disorder. It is thought that inositol acts to regulate processes which involve transmissions in the brain and acts in a similar way to an SSRI drug. More research is needed on this topic.

·        Caffeine: Studies suggest that caffeine may be effective in treating the symptoms of OCD. There have been some mixed results however, and more research is needed on this topic.

·        Music therapy: Studies suggest that this type of therapy may be beneficial for people suffering from depression or anxiety disorders such as OCD because the music may help them to focus on something besides their obsessive thoughts or even redirect these thoughts entirely.

·        Meditation: Reports show that people who suffer from OCD find that mindfulness and meditation helped them avoid or control their triggers and symptoms.

·    Acupuncture: This treatment alleviates OCD symptoms by increasing serotonin transmission. It involves putting needles in certain points in the body to release energy blockages, reduce anxiety, and calm the mind.

·        Exercise: Studies show that exercise is extremely beneficial in improving health and aiding with conditions ranging from heart disease to mental illness. There is now significant evidence that aerobic exercise may help to reduce symptoms of mental illnesses as well as greatly reducing stress and anxiety levels.

·        Getting sufficient sleep: Studies show that sleep deprivation increases ‘anticipatory anxiety’ and is linked to an increased chance of anxiety disorders. Lack of sleep increases the production of stress hormones such as cortisol and adrenaline which can negatively effect mood and brain chemistry and stimulates the regions in the brain that contribute to excessive worrying.

 

REFERENCES:

https://www.yourhealthinmind.org/mental-illnesses-disorders/ocd

https://www.healthdirect.gov.au/obsessive-compulsive-disorder-ocd

https://www.healthdirect.gov.au/symptoms-of-ocd

https://www.healthdirect.gov.au/diagnosis-of-ocd

https://www.healthdirect.gov.au/causes-of-ocd

https://www.healthdirect.gov.au/treatments-for-ocd

https://thiswayup.org.au/how-we-can-help/cognitive-behavioural-therapy/

https://www.healthdirect.gov.au/cognitive-behaviour-therapy-cbt

https://www.rcpsych.ac.uk/mentalhealthinformation/therapies/electroconvulsivetherapy,ect.aspx

https://en.wikipedia.org/wiki/Deep_brain_stimulation

https://en.wikipedia.org/wiki/Electroconvulsive_therapy

http://www.neurosurgery.pitt.edu/centers-excellence/epilepsy-and-movement-disorders-program/deep-brain-stimulation-obsessive-compulsi

https://www.ncbi.nlm.nih.gov/pubmed/20633378

https://www.ocduk.org/vagus-nerve-stimulation

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https://en.wikipedia.org/wiki/Yale%E2%80%93Brown_Obsessive_Compulsive_Scale

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