Dr. Zahid QutabDr. Zahid QutabDr. Zahid Qutab
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Lahore & Gujranwala
Dr. Zahid QutabDr. Zahid QutabDr. Zahid Qutab

Obsessive Compulsive Disorder آبسیسو کمپلسو ڈس آرڈر

Depression

ocd

This information is for those who want to know about OCD , and we hope it’s going to  be helpful for family or  friends .

People do have distressing thoughts that would come into their minds again and again, or  urges to do or repeat the same thing over and over again. Eventually that would start to dominate your life and hinder you from enjoying your life and even could completely  stop you from normal routine.

You may;

  • Get distressing thoughts all day long which keep on repeating in your  mind, even though you want or struggle to keep them out.

or

  • Have to count things, or repeat the same action like washing hands over and over again.

Then,  you could have obsessive-compulsive disorder (OCD).

The Basic Components of OCD

OCD has three main components;
Obsessions – the repeating thoughts that make you extremely anxious
Emotions – the anxiety you feel trying to resist thoughts
Compulsions – the things you may do to reduce your anxiety

Obsessions – the Repeating and Unwanted thoughts that make you anxious

Thoughts that are distressing, unpleasant, sexual or blasphemous. You try hard not to think about them, but they would not go away no matter what.
You may worry that you may get contaminated (by germs, dirt or disease).
Images in your mind – you see dead family members or see yourself doing actions that are violent like stabbing, shooting or cheating your partner.
Such thoughts can be very dangerous for the patient or their family members or co-workers.
Mostly, people with obsessions would not act on such thoughts even though they would fear doing them.
If you do have such thoughts, it is best to consult a mental health professional.
Ruminations – you may endlessly argue for hours with yourself whether you should do one thing or another .In simple words, you can’t make the simplest decision of daily life.
Doubts – you think that you might have caused an accident or have left doors and windows of a house or car unlocked.
Perfectionism – you feel bothered that other people are not perfect in their actions, if things are not in the exactly order you wanted . For example, if books are not lined up precisely the way you wanted on a bookshelf.

Emotions – the anxiety you feel

You may feel one of these emotions being tense, anxious, guilty ,disgusted or even depressed.
You may feel better if you carry out your compulsive ritual or act but later on would get depressed or anxious again.

Compulsions – the actions you do to reduce your anxiety

Altering obsessional thoughts – you think of other ‘ ‘ neutralizing’ thoughts like praying, counting or saying a special word over and over again. It feels it would prevent bad things from happening. E.g; In case of Blasphemous thoughts , you may start praying specific prayers to avoid guilt of being sinful.
Rituals – you start washing your hands frequently in fear of being contaminated , watching pornography due to sexual thoughts of imagery,
do things really slowly (Obsessional slowness)and precisely arrange objects. This can take up so much time that you yourself get tired from it.
Checking – your body for fear of contamination, checking if doors of house or car are locked or home appliances have been switched off or not.
Avoidance – of anything that triggers obsessional thoughts. You avoid touching specific objects e.g; if you have thoughts of killing someone with a knife, you might stop picking up a knife for even daily kitchen chores.
Hoarding – of useless possessions. You just can’t throw old or worn out or even dirty things away.
Reassurance – you repeatedly ask or seek help from others to tell you that everything is okay.

PREVALENCE;
1 in 50 people suffer from OCD at some part of their lives. Both men and women equally suffer from this disorder. It can start in childhood or adulthood.

What causes OCD?

Personality
If you are very clean ,meticulous with high standards you may have more chances to develop OCD. These qualities are actually  helpful, but can slip into OCD if they become too rigid and  extreme.
Ways of thinking
Nearly everyone has distressing thoughts or pictures in our minds at times – I might have hit that person while driving or did I lock the front door?
Most of us quickly dismiss these ideas and carry on with our lives. But if they start persisting or you keep repeating that incidents in your head.
Genes
OCD
is a  significantly complex disorder. Studies have shown that there is role of different genetic factors.

People who have a first degree relative with OCD are more likely to develop OCD .

Stress
Stressful life events and poor stress coping mechanisms
Life changes
Times where someone suddenly or abruptly has to take on more responsibility – for example, Sexual Abuse, at puberty or the birth of a child.
Brain changes
Researchers have found out that there changes in how chemical called serotonin  works in the brain and structural changes in frontal cortex.
Diagnosis

Diagnosis of OCD requires the presence of either obsessions or

compulsions or both. Also, the obsessions or compulsions are very  time-consuming (e.g. taking  more than 1 hour daily) and causes significant distress or decline  in personal , social or occupational function.
Obsessions or compulsions  are not attributable to the effects of a substance use or any other Condition (brain tumor in frontal areas leading to personality changes  )or any other mental disorder ( In GAD where Anxiety is always at its peak or Schizophrenia where OCD comes secondary to delusional thoughts).

That’s why, only a professional mental health worker can diagnosis you with OCD.

What causes OCD?

Tricyclic Antidepressant;
Clomipramine has been used as first line of drug for OCD but not now, because of its intolerance due to cardiac effects.

Selective serotonin uptake inhibitors.

SSRIs are very effective in reducing obsessional symptoms in a high dose. It inhibits the reuptake of serotonin. Correcting the impaired serotonin pathway in the brain. Addition of an antipsychotic agent usually at a low dose has quite beneficial effects.

Psychotherapy

Half of treatment of OCD is done with psychotherapy.
combined with medications, it does wonder for the patient.
1. Exposure and response prevention.
Obsessional rituals intensity decreases with a combination of exposure to a triggering stimulus ( for example, exposure to dirt in a person having fear of contamination), and response prevention which includes managing anxiety symptom s related to it by relaxation techniques such as deep breathing etc.
The main aim is to decrease the duration of compulsion.

2. The technique of thought-stopping is being used for many years .Specially in patients with just obsessional thoughts or ruminations .
3. Thoughts Recording
It is to record the frequency of obsessional thoughts to compare effects of suppression and distraction. It helps to see things retrospectively.
4. Neurosurgery and deep brain stimulation
The result of neurosurgery for severe OCD is so striking resulting in immediate reduction of symptoms but in long term are uncertain.
5. Electroconvulsive Therapy (ECT)
It is indicated in sever resistant cases of OCD or life threatening situations like shouting blasphemous content in public risking patients life.

PRECAUTIONS;

1. OCD can pose a life threatening situations for example, if someone having blasphemous regarding religion, he can become suicidal because of gulit/sin or others might also harm him physically or emotionally. Confidentiality is very important. This must never be shared with friends or even family members.

2. Comorbid drug use to alleviate anxiety symptoms; it will initially help but it would get things worse as it leads to addiction and dependence on drugs.

FAQ’S

Yes to some extent ,personality plays a role in patients who get OCD but not in all patients. It can even start in teenage when personality has not been developed fully.
You cannot label yourself or others. It has to fit in criteria to be evaluated by a mental health professional. you might have others symptoms of OCD as mentioned in the introduction. Even, if you don’t wash your hands repeatedly.
No, it’s not a permanent illness , patients go back to living healthy life if they adhere to proper treatment of both medications and psychotherapy. Alone psychotherapy or medication won’t help in longer run and chances of relapse would increase.