OBSESSIVE COMPULSIVE DISORDERS

Obsessive compulsive disorders have two main components:

  • Obsessions are recurrent and intrusive thought/image or an urge that provoke anxiety and are time consuming. They are mental events, which are recognized as irrational and are ego dystonic.
  • Compulsions are mainly behavioural events like counting, checking or washing which are consciously and recurrently done to reduce the anxiety associated with obsessive ideas.

Epidemiology

OCD has a life time prevalence of 2 to 3%, present equally among both men and women, mean age of onset of symptoms is 20 years. In India, studies show that OCD is mostly observed among single persons compared to married couples.

Causes of OCD

As in all psychiatric disorders, OCD also has a bio-psycho-social model of action:

  • Biological factors

    Neurotransmitters:

    • Dysregulaion of serotonin and noradrenaline systems are most common causes. Some researchers also claim that dopamine and GABA deficits are also seen.
    • Some researchers also claim that in children some bacteria which cause sore throat like Beta hemolytic Streptococcal infections are also responsible for OCD.
    • OCD is seen more in persons having a family history of OCD. Its onset is usually associated with stress of any nature.

  • Psychosocial factors

    • Personality traits like perfectionism, excessive preoccupations to details may predispose individuals to OCD.
    • Psychodynamic theories give a lot of strength to early life trauma, strict parenting with OCD.

  • Clinical features

    Symptoms of an individual can overlap and change with time but broad category has four main features:

    • Contamination - The most common pattern is an obsession of contamination followed by washing or accompanied by compulsive avoidance of the presumably contaminated objects. The object is usually very hard to avoid (feces, urine, dust and germs). Patients rub their hands till skin peels secondary fungal infections are also seen. Patients believe that contamination spreads from object to object or person to person.
    • Pathological doubt - The second most common pattern is an obsession of doubt and a compulsion of checking. The obsession is usually to avoid some imagined danger like not locking the door or forgets to turn off the stove. These persons have a deep rooted self-doubt and always feel guilty about forgetting or committing something.
    • Intrusive thoughts - Third most pattern, only thoughts with mental and not motor compulsions. It usually involves repetitious thoughts of a sexual or repetitive act that is very distressing to the patient.
    • Symmetry - Fourth most common pattern is the need for symmetry or precision which can lead to a compulsion of slowness. Patients can take hours to eat a meal or shave their faces.

Management

Problems are first assessed by a mental health professional and later on depending upon the severity he may be given Psychotherapy, some medicines or both.