Introduction
Humanity has experienced numerous types of psychiatric disorders for a very long time now. In the United States, for instance, some of the infamous disorders include, but not limited to, depression, schizophrenia, panic, tic, and maniac disorders.
Efforts to raise people’s awareness about OCD have been on the rise since the late 1990s and the first decade of the 21st century. The International OCD Foundation in America has been on the forefront to publicize OCD awareness campaign. OCD is one of the commonest mental disorders especially in the United States.
This anxiety disorder is characterized by obsessions and compulsive or repetitive behaviors that are an exaggeration of what a normal person would do. The research paper will define OCD, and discuss some of the common types of OCD. It will then elaborate on the major causes of OCD especially the genetically predisposing factors.
The existing therapeutic treatment approaches for this disorder like the use of medication or the Cognitive Behavioral Therapy (CBT) will also be discussed. The paper will offer an epidemiological overview and then conclude that there is need for further research into the understanding of OCD in order to reduce its prevalence and possibly find the cure.
Definition
Attempts to offer a comprehensive definition for Obsessive Compulsive Disorder has helped in differentiating it from other related anxiety disorders. Researchers have framed a number of working definitions in their quest to understand the disorder but all have common basis.
According to American Psychiatric Association (2004), it is a chronic illness characterized by a waxing waning course which has the potential of interfering with the normal functioning of the victim. Pedrick and Hyman (2005) define OCD as a psychiatric disorder that manifests itself through obsessions and compulsions.
They define obsessions as the persistent impulses, thoughts, images, or ideas that strike an individual’s mind resulting in intensified anxiety and distress. The person acknowledges that the obsessive thoughts are not appropriate and are almost senseless, yet it is difficult to ignore them due to their persistence. Moreover, the individual knows that the thoughts are his or her mind’s creation and not imposed.
Compulsions, on the other hand, have been defined by the two authors as the repetitive behaviors or cognitive acts which are performed in an attempt to reduce the anxiety arising from the obsessive thoughts and ideas. Such repetitive mental acts include; praying, counting, word repetition and continuous review of past or anticipated events. Repetitive behaviors include; redoing actions, ordering, checking, cleaning, and hand washing to avoid germs.
National Institute of Mental Health defines OCD as a type of anxiety disorder which is characterized by repeated, annoying thoughts called obsessions resulting in repeated behaviors known as compulsions (2009).
We can therefore provide a general definition of OCD as a kind of mental disorder which is characterized by unprecedented thoughts that leads to a sufferer having anxious feelings, by repetitive mental actions aimed at minimizing anxiety, or even a combination of obsessions and compulsions. Usually, such actions can be distinguished from the normal acts by considering the amount time of spent. OCD can be so alienating since the person feels insecure as long as the obsessions are not dealt with or eradicated.
Types of OCD
Research findings reveal that virtually everyone naturally experiences anxious feelings, uncertainty, dread, or general worry (Dombeck, 2001). These have been regarded as normal emotional responses that can help persons in promoting their security and solve puzzles in life. Normally, the feelings do not last for a long period of time and are not experienced quite often. However, people with OCD have extremely high levels of these feelings that are otherwise regarded as being normal.
Obsessive Compulsive Disorder sufferers experience overwhelming anxious feelings that in most cases are considered difficult to overcome. They are bombarded with unregulated bad thoughts that stretch every feeling of worry beyond the limits. These obsessions and compulsions become part of life without which their daily life would be interfered. According to Pedrick and Hyman, obsessions and compulsions are closely related. OCD patients can either have both or compulsive thoughts may come to mind to counter the obsessions.
Therefore, compulsions are not necessarily outwardly manifested. Most psychiatric researchers have categorized obsessions and compulsions into six major types depending on the associated compulsions. According to research findings, 90% of OCD sufferers have both obsessions as well as compulsions (Mayo Clinic staff, 2008). It is important to note that a person may experience more than one type of OCD. The onset of most types of OCD occur at childhood or teenage.
Checkers
The first type of OCD is that of checkers. Researchers have described such people as having irrational worries of potential catastrophic events on them or others due to their actions or lack of doing something. Such people are compelled to repeatedly check on doors, padlocks, or household appliances in order to evade potential disasters if anything goes wrong.
For students with OCD, they constantly check their homework, or test questions just to ensure they are right and they may end up rubbing the correct answers or failing to complete assignments. Other people may repeatedly check on the well-being of others due to their exaggerated worries. There is an inexhaustible list of things that an OCD sufferer would want to check.
Washers and cleaners
This type is associated with the fear of contamination by germs or dirt in general. In order to wade off this obsession, the sufferer resorts to washing the hands, taking a bath, or constantly cleaning the surrounding and disinfecting it. The actions temporarily relieve the fear but in a short while the worries come back. This results to repeated behavior of washing and cleaning.
Orderers
The sufferers are characterized by the need for “perfection” through constantly trying to put everything in order. They may be compelled to produce neat handwriting or the strict ordering of things like books, papers and other belongings. This trend can also be to the ‘watchman-like’ habit where the sufferer keeps watch on the environment just to make sure they are in order unlike under normal situations where general arrangement is done.
Pure Obsessionals
This category of people is worried by unsolicited, intrusive, horrifying thoughts and visual images of harming other people. For instance, the sufferer experiences violent thoughts of hurting their loved ones, or being caught in immoral behavior like an embarrassing sexual action.
Since these are purely obsessive thoughts, the persons resort to repetitive compulsive thoughts like constantly praying, counting, or word repetition. Moreover, a compulsive mental reviewing of bad situations may be used to bring reassurance. The obsessions would not cease to come and soon the compulsive thoughts become the order of the day. This type is also called OCD without overt compulsions.
Hoarders
This category of people involves those who attach a lot of value on things that would normally be junk or trash. They fear that discarding some items would bring evil or bad lack and would thus be compelled to hoard them. The sufferers, however, are not able to explain why they actually feel the urge to collect and store the things.
People with Scrupulosity
The people suffering from such are usually worried about religious issues and have moral concerns. The obsessions trigger compulsive prayer or other religious or ritual services. They constantly seek reassurance about what they believe in as far as religion or moral beliefs are concerned.
Causes of OCD
For a long period of time now, OCD has proved to be a difficult puzzle to the researchers and they are constantly on the run to fully comprehend it. It has also been found that Obsessive Compulsive Disorder is not a contagious disease since it is a mental disorder and hence it is a state of mind.
One cannot catch OCD the same way as cold. Scientists are yet to identify the exact causes of OCD. However, research findings by psychiatric researchers have established some basis for understanding the causes of OCD (Fenske & Schwenk, 2008). Two major categories of the causes have been identified; psychological and biological.
Psychological
Ancient beliefs in Europe about obsessive disorders were mostly associated with the devil. This explained the trend where obsessed individuals or rather ‘possessed’ were treated through exorcism which was believed to drive out demons.
It was during the early years of the 20th century that Sigmund Freud associated obsessive compulsive disorders to conflicts taking place in the sufferer without his knowledge (Nestadt, 2008). Freud explained that obsessive thoughts can only be suppressed to the unconscious part of the mind, a case which serves to minimize compulsions. The tension created results in the development of the various signs and symptoms of OCD (Dombeck, 2001).
The psychological dimension uses the cognitive-behavioral model to explain how OCD develops through negative reinforcement of different forms of anxiety which end up forming a cycle (repetition). This perception, however, has since changed and current researchers are focusing on the biological causes as shall be discussed below.
Biological
Serotonin imbalance
Psychiatric experts believe that OCD has a direct relationship with the levels of a chemical normally found in the brain called serotonin which is a neurotransmitter. It is believed that it is either a cause or it could be the effect of OCD. The presence of this chemical in proper levels helps in the interpretation of information.
However, interfering with the flow of serotonin through blockage causes the brain’s “alarm system” to be overwhelmed and ends up misinterpreting information. As a result, according to research, the misinterpreted information causes the detection of false danger and thus “false alarms” are activated (Davidson & Whitefield, 2007). Subsequently the mind starts engaging these thoughts which turn out to be obsessions causing unrealistic fear.
Hereditary
Research findings point to the possibility of OCD being inherited along family lines. Investigators have established that people with OCD were found to have one or more relatives with the same disorder or other related anxiety disorders which are associated with serotonin fluctuation in the brain (Nestadt, 2008). A study investigating identical twins has contributed towards the conviction that there exists a heritable factor in OCD, a neurotic anxiety (Davidson & Whitefield, 2007).
Furthermore, investigators have found that there is greater likelihood for closely related members of the family to exhibit similar disorders compared to control cases. As a result, scientists have concluded that there is greater tendency to inherit OCD through serotonin imbalance depending on the person’s genetic orientation. According to statistics from various studies of children with the disorder, 45-65% of OCD signs and symptoms are linked to genetic factors (Nestadt, 2008).
However, this tendency does not imply that the person will out rightly develop OCD. Serotonin imbalance is known to cause other types of anxiety disorders and depression which are closely associated with OCD. It is imperative to note that research is still under way to fully establish the genes responsible for the transmission of OCD in families.
Strep infection
Investigators are working to identify the relationship that is believed to exist between OCD and strep infection. This is mainly on how the body’s immune system responds to strep infection. The line of thought on this subject is the role that strep infection plays in the onset of OCD. After someone is infected with strep and OCD starts, it has been noted that the appearance of symptoms is so sudden. Getting strep infections, according to research, does not imply that one would get OCD (Coschug-Toates, & Toates, 2003).
Diagnosis
OCD, just like any other illness needs to be diagnosed in order for any treatment plan to be initiated. However, OCD is unique from other illness in that it has no laboratory test. This implies that other reliable approaches need to be employed in order to provide a basis for the treatment of OCD. In most cases, it takes the intervention of psychologists or psychiatrists to investigate instances of obsessions and compulsions by individuals (Coschug-Toates, & Toates, 2003). This will involve direct questioning and other professional tactics.
Psychiatric researchers have identified some common questions that can be used in diagnosing OCD. They include such questions as:
- Do you usually have fears, worries, thoughts, ideas, images, or feelings that keep bothering you or scare you?
- Do you usually feel a push to keep checking, repeating, asking, or do the same things over and over again?
- Do you usually feel that you have to do things in a regular pattern or a certain number of times, although it bothers you?
Such guiding questions have been found to work magic as far as formal OCD diagnosis is concerned. For the psychiatrist to conclude that one has OCD, the person must exhibit abnormal thoughts and feelings (obsessions), abnormal repetitive actions or thoughts (compulsions), or a combination of both which are intrusive in nature (American Psychiatric Association, 2004).
Basically, the person under investigation must exhibit one or more of the types of OCD characteristics described earlier for any clinically significant OCD treatment to be made. Furthermore, the psychologist or the psychiatrist must know how to quantify the severity of the manifestations of OCD both before and in the course of treatment (Coschug-Toates, & Toates, 2003). This will help in monitoring the patient’s response to medication and therapy.
Further research on effective ways of diagnosing OCD has recommended the use of differential diagnosis. There are a number of disorders that can be confused with OCD. Gambling addiction, eating disorder and Obsessive Compulsive Personality Disorder (OCPD) are the commonly confused.
A clear difference between OCD and OCPD is their impact on self-image. OCPD is compatible with how one looks at himself while OCD is completely incompatible with the concept that one has about himself (Pedric & Hyman, 2005). Finding out by questioning whether one derives pleasure from the obsessions would play a great role in diagnosing a person with OCD. Once the expert has diagnosed an individual with OCD, the treatment plan can then be rolled out.
Treatment
A number of treatment approaches for managing OCD have been proposed by psychologists and psychiatrists. It is important to set the record straight here that the cure for OCD is yet to be found. According to the National Institute of Mental Health psychiatrists, the use of behavioral therapy (BT), cognitive therapy (CT), as well as the use of medications should be prioritized when it comes to the treatment of OCD (2009).
Behavioral therapy & Cognitive therapy
These treatment approaches, according to research, share the same technique (NIMH, 2009). The technique is referred to as exposure and ritual prevention, abbreviated ERP. Sometimes ERP is used to mean exposure and response prevention. It is a psychotherapeutic method for treating people diagnosed with OCD (Fisher & Wells, 2005).
Having discussed the compulsions associated with OCD, this technique seeks to train the sufferer to withstand the anxiety that is usually associated with not heeding some compulsive behaviors. It involves systematic withdrawal from rituals to getting used to what was initially the source of obsessions (Comer, 2009). Investigators have identified ERP as the most effective method for treating OCD (NIHM, 2009).
It is also important to note that psychotherapy can take place in collective groups (OCD sufferers), family members, or in individual sessions depending on the patient’s preference.
Medication
The second method available for treating OCD is the use of clinically recommended medications. The most widely used is the selective serotonin reuptake inhibitors (SSRIs) which serve to regulate the excessive flow of serotonin into the initially producing neuron (NIHM, 2009).
Proper flow of serotonin checks the levels of anxiety in an individual in order to avoid unnecessary worries or obsessions (Comer, 2009). Some cases, however, have shown resistance to SSRI but the introduction of clomipramine has helped solve the problem since they combine very well with the SSRI drug. Clomipramine is a type of antidepressant which has been used for over two decades now (Coschug-Toates, & Toates, 2003). Recently, neuro-imaging investigations have established the pathophysiology surrounding OCD.
The sole objective of using medications to treat OCD is to effectively try to minimize the signs and symptoms of OCD albeit with the lowest drug dosage (Fenske & Schwenk, 2008). Response to medication depends on the person’s situation and the consistency with which the medication is taken.
Some OCD drugs are so strong that even as one feels better, the medication should be stopped systematically rather than abruptly if one is to avoid the associated side-effects (Kordon, Broocks, & Hohagen, 2005). In fact, all psychiatric medications are known to have serious side-effects as well as health risks. This implies that OCD medication should be checked to ensure that they do not clash with the medications due to other co-occurring disorders or illnesses (NHIM, 2009).
Sometimes these treatment approaches may not work effectively and hence the need for other alternative methods.
Psychosurgery
This is one of treatment option that may be used if the rest fail. It involves the surgical operation in a part of the brain. However, in the United States, this OCD treatment method should be the last option and can only be performed if the rest have proved unworthy. The requirement also specifies that it should be done in hospitals with recognized specialists (American Psychiatric Association, 2004).
Epidemiology
According to research findings by the National Institute of Mental Health (2009), about 25% of American population has been found to suffer from diagnosable mental disorders like depression, schizophrenia, and OCD.
OCD alone affects about 2.2 million adults in America, which represents 2% of the total population, and this problem is normally accompanied by eating problems, anxiety, or depressive disorders (NIMH, 2009). The rate at which it strikes men and women is almost equal. The onset is normally during childhood, adolescence, or early adulthood.
Of the total number of male suffering from OCD, it is estimated that 37% end up suffering from erectile dysfunction while more than half of them experience obsessions with sexual side-effects (Nurnberg, Hensley, Gelenberg, Fava, & Lauriello, 2003). A recent comparative research reveals that the trends of OCD symptoms in Japanese patients are not different from those diagnosed in America. This implies that OCD goes beyond cultural and geographical boundaries (American Psychiatric Association, 2004).
According to the same findings, researchers have universally hypothesized that most if not all sufferers are people of above average level of intelligence since the nature of OCD demands a presumably complicated pattern of thinking. Furthermore, it is estimated that OCD affects between 1-3% of the global population, hence making it most common compared to schizophrenia or even panic disorder (American Psychiatric Association, 2004).
Conclusion
The research has provided a detailed coverage of Obsessive Compulsive Disorder (OCD) which, according to researchers is a psychiatric disorder which is characterized by obsessions and compulsive behavior either overt or cognitive. It has offered a broad definition of OCD and their major types. The paper has also discussed the two major causes and the diagnosis criteria for the disorder.
Three of the available treatment methods for OCD including the epidemiological status of the disorder have been clearly highlighted in the paper. Having analyzed the disorder that is OCD and identified the difficulties associated with the disorder, we can conclude that a lot of deep research needs to be conducted by the scientists, especially the relationship between genetics and OCD. The concerted efforts may lead to a break through in finding the cure for this really distressing disorder.
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