Definition
The severe psychological disorder known as obsessive-compulsive disorder (OCD) is characterized by a pattern of intrusive thoughts (obsessions) and repetitive actions or mental acts (compulsions). The existence of upsetting and unreasonable obsessions and accompanying compulsions characterizes OCD. Former diagnostic manuals included OCD under the general heading of anxiety disorders, but it now has its own chapter in the DSM-5 devoted to obsessive-compulsive and related disorders (Oltmanns & Emery, 2019). The presence of unwanted, intrusive thoughts and the habitual behaviors that follow are the defining characteristics of these disorders.
Symptoms
Compulsions and obsessions are the two main symptom categories of OCD. Obsessions are defined as persistent, bothersome cognitive events that can manifest as urges, images, or thoughts (Oltmanns & Emery, 2019). These obsessions suddenly enter the patient’s awareness, causing a spike in their level of subjective anxiety. What distinguishes obsessive thinking from ordinary concerns is content: generally, it refers to thoughts that are nonsensical and socially unacceptable, with common topics being violence, sex, or contamination (Oltmanns & Emery, 2019).
Compulsions are recurring actions or thoughts a person engages in to reduce the anxiety caused by obsessions (Oltmanns & Emery, 2019). Compulsions that involve actions like silently repeating a prayer or verifying that a door is locked can be viewed as unreasonable by the person who engages in them. Patients try to resist their illogical compulsions, but find it difficult.
Diagnosis
The existence of obsessions or compulsions is the basis for diagnosing OCD: most OCD sufferers display both of these symptoms. These obsessions or compulsions have to be time-consuming—taking up more than an hour each day—or they have to be impairing social functioning or causing subjective distress in order to be eligible for the diagnosis (Oltmanns & Emery, 2019). The diagnosis must consider that these thoughts cannot be merely excessive anxieties about reasonable issues like unpaid bills.
The degree of understanding of the beliefs linked to OCD symptoms is also considered. There are three types of insight:
- absent insight/delusional beliefs (convinced that the OCD beliefs are valid);
- poor insight (thinking that the OCD beliefs are probably true);
- good or fair insight (acknowledging that these beliefs are unlikely) (Oltmanns & Emery, 2019).
OCD can be differentiated from other disorders like skin-picking and hair-pulling disorders. When someone has OCD, intrusive thoughts cause anxiety to soar sharply, which is reduced by compulsive behaviors. On the other hand, people who suffer from other disorders may report feeling as though they are in a trance-like state when they perform their behaviors (Oltmanns & Emery, 2019). Generally, their actions are not brought on by bothersome, unwanted thoughts or urges.
Course, Outcome, and Frequency
The progression and results of OCD can differ, and although OCD is frequently regarded as a chronic illness, its severity can change. With treatment, some people might see a decrease in their symptoms, while others might have long-term impairments (Oltmanns & Emery, 2019). The disorder usually manifests in childhood or adolescence; stressful times may worsen symptoms (Oltmanns & Emery, 2019). OCD can cause severe distress and interfere with daily activities, such as employment and social interactions.
Remarkably, OCD is less common than major depression and most anxiety disorders. With a 12-month prevalence rate of 1.2 percent, OCD affects about 2 percent of the American population at some point in their lives (Oltmanns & Emery, 2019, p.168). Comparable prevalence rates have been documented in other nations, suggesting that OCD is comparatively universal.
Causes and Gender Differences
Among many different factors that can lead to OCD, biological and cognitive factors are the most important. The cognitive model of OCD states that excessive attention to one’s assessment, adverse emotional reactions, difficulty focusing on the outside of problems, and active coping strategies are the hallmarks of worry and anxious apprehension (Oltmanns & Emery, 2019). Thought suppression, the deliberate attempt to stop thinking about upsetting thoughts, has the paradoxical potential to make these unwanted thoughts and the feelings accompanying them more intense.
Maladaptive attempts to suppress unwanted or threatening thoughts deemed dangerous or forbidden may contribute to OCD. When people resist or repress the emotions associated with these thoughts, it can have a rebound effect and result in the development of obsessive thoughts. OCD may be more common in those highly sensitive to emotions because they struggle to regulate overly dramatic reactions.
Neurological and biological factors also influence OCD. According to research, specific brain areas, such as the basal ganglia, orbital prefrontal cortex, and anterior cingulate cortex, are involved in the neurological underpinnings of OCD (Oltmanns & Emery, 2019). When OCD patients are exposed to stimuli that set off their obsessions, these regions become overactive (Oltmanns & Emery, 2019). OCD is distinct from other anxiety disorders due to its particular pattern of brain activity. OCD does not show a discernible gender difference, unlike many other mental disorders. The disorder is equally likely to affect men and women.
Treatment
There are several psychological and biological ways to treat OCD, but exposure and response prevention is the most successful psychological strategy. This therapy aims to prevent the usual compulsive responses by prolonged exposure to anxiety-inducing situations (Oltmanns & Emery, 2019). Given that OCD patients rely on their obsessive rituals to ease the anxiety their obsessions cause, combining exposure and response prevention is imperative. Most OCD patients benefit from this approach, according to controlled outcome studies, and clinical improvements are usually seen within a few weeks of treatment.
Another effective treatment for OCD is medication, with SSRIs being prescribed the most frequently. When treating OCD, SSRIs like sertraline, fluvoxamine, and fluoxetine work well and are recommended over other drugs because they have comparatively fewer side effects (Oltmanns & Emery, 2019). Another drug widely used to treat OCD is the tricyclic antidepressant clomipramine, which has proven effective in numerous controlled studies (Oltmanns & Emery, 2019). Even though relapse is common if medication is stopped, patients who continue taking these medications can maintain improvements.
Reference
Oltmanns, T. F. & Emery, R. E. (2019). Abnormal psychology (9th ed.). Pearson.