Obsessive-Compulsive Disorder is a very real and very disrupting anxiety disorder. This paper will discuss the symptoms of OCD as well as the criteria for diagnosis. Diagnosis is not always simple and certain criteria must be met to get a professional diagnosis. Treatment options will also be examined which include therapy and medications. The medical professional and/or mental health professional plays a vital role in this process.
Of all the anxiety disorders recognized by the DSM, Obsessive-Compulsive Disorder is perhaps one of the most diagnosed anxiety disorders. This article will discuss exactly what Obsessive-Compulsive Disorder is, the symptoms of the disorder, and the history of OCD. Treatment options will also be addressed.
What is Obsessive-Compulsive Disorder?
Obsessive-Compulsive Disorder is a type of anxiety disorder. Anxiety disorders are common types of mental health conditions and according to the National Institute of Mental Health, at least 18% of adults in America have some type of anxiety disorder. (NIMH, 2009). While obsessive thoughts are a large part of the disorder, this is not a thought disorder. The obsession is the thoughts that plaque the OCD suffer. The compulsive part is the need (compulsion) to perform a particular ritual(s) over and over again. “Obsessions take the form of either a perceived threat of physical harm to oneself or others or, in some cases, more of a metaphysical or spiritual threat to oneself, others, or perhaps a deity.”(Phillipson, Ph.D.) People who suffer from OCD are typically aware of their condition and
that how they behave is both irrational and unreasonable. Trying to convince someone who suffers from OCD that things will be ok has little effect as reassurance is not a good curer of these feelings. Though the rational part of the suffer knows that things will be okay, this give very little relief from the symptoms.
The Symptoms of Obsessive-Compulsive Disorder
Since this disorder deals with both obsessions and compulsions, there are many symptoms connected to OCD and they vary from person to person. Not all people with OCD have every one of the symptoms. While some people do have the majority of them, others may only have a few. “OCD obsessions are repeated, persistent and unwanted ideas, thoughts, images or impulses that you have involuntarily and that seem to make no sense. These obsessions typically intrude when you're trying to think of or do other things.”(Mayo Clinic, 2011). As far as the obsession part goes, most obsessions have a theme to them. Some of these themes are:
• Fear of germs or being contaminated
• The need to have items in a certain place or order
• Aggressive impulses
• Out of the ordinary sexual thoughts
Signs of obsessive symptoms may include the following:
• Fear of touching things that others have touched due to germ phobia
• Doubting whether you did a routine task such as locking the door or turning off a light
• Images of harming others such as your children
• Skin problems from picking at scabs or dead skin
The compulsion part of this disorder has its own set of symptoms that combine with the obsessive symptoms to make OCD. “OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors are meant to prevent or reduce anxiety related to your obsessions.”(Mayo Clinic, 2011). The compulsion symptoms also usually have themes:
• Counting things
• Repeatedly checking things
• Washing hands
• Needing constant reassurances
• Needing to be organized and orderly at all times
Signs of compulsive symptoms may be:
• Checking doors repeatedly to ensure they are locked
• Checking stove repeatedly to ensure it is turned off
• Leaving the house and turning around to make sure you did not forgot to unplug something
• Washing hands to the point of skin rawness
• Arranging various objects, such as food items or pictures frames to make sure that they all point the same way.
These are just a few of many symptoms of both obsessions and compulsions. After addressing this information, the next question is what causes Obsessive-Compulsive Disorder.
What Causes Obsessive-Compulsive Disorder
The causes of OCD are still largely unknown. However, there are three main theories that psychologist’s rely on to answer this question; biology, environment, insufficient serotonin. (Mayo, 2011).
The biological theory is based on the thinking that this disorder may be caused by changes in the bodies’ chemistry and or brain functions. “OCD also may have a genetic component, but specific genes have yet to be identified.” (Mayo Clinic,
2011).The environmental theory is based on the thinking that the person’s obsessions and compulsions are actually behavior that has been learned over a period of time. Under this assumption, the disorder starts slowly and gradually becomes worse. Last but not least is the insufficient serotonin theory. The thinking behind this is that “An insufficient level of serotonin, one of your brain's chemical messengers, may contribute to obsessive-compulsive disorder.” (Mayo Clinic, 2011). While this has not yet been proven to be a solid cause of OCD, research has shown that people with OCD that take medication containing serotonin experience improvement in their symptoms.
Research has identified some risk factors that put a person in danger of developing Obsessive-Compulsive Disorder; stressful events in life and family history. If a parent has OCD the chances of the child having it are more increased than if the parent did not have this disorder. Also, a person who has strong reactions to stressful situations is more prone to develop OCD. “If you tend to react strongly to stress, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of obsessive-compulsive disorder.” (Mayo, 2011).
Complications Caused by OCD
As with any mental health disorder, OCD can cause other life complications. The following are the most common complications of OCD:
• Thoughts of suicide
• Relationship troubles
• Eating disorders secondary to OCD
• Hard time going to public places such as work or school
• The contraction of dermatitis due to excessive hand washing
• An overall poor quality of life
All of these can further complicate the existing condition of obsessive-compulsive disorder. If these, in addition to the symptoms, impact life to the point that the OCD has taken over, it may be beneficial to seek medical attention for this disorder.
Diagnosing and Treating OCD
How does one know when it is time to see a professional about their Obsessive-Compulsive Disorder? “Obsessive-compulsive disorder can be so severe and time-consuming that it literally
becomes disabling. You may be able to do little else but spend time on your obsessions and compulsions — washing your hands for hours each day, for instance.” (Mayo Clinic, 2011). Some people may think that because they are a bit obsessed with having a clean house or wash their hands a bit too much that they have OCD. This is not always the case and this is why diagnosis is so important. Most likely, the first scenario (severe and time consuming behavior) is a true case of OCD. “If your obsessions and compulsions are affecting your life, see your doctor or mental health provider. People with OCD may be ashamed and embarrassed about the condition. But even if your rituals are deeply ingrained, treatment can help.” (Mayo Clinic, 2011).
A professional can diagnosis your OCD in numerous ways. Before the appointment, the doctor may ask for the patient to keep a journal and write down whenever they have obsessive or compulsive feelings and what they do when these feelings come. The doctor may also want the patient to list any current or recent life changes or sources of stress. After examining this information, if the doctor feels that the possibility of OCD exists they will run a battery of tests, both medical and psychological. These test typically fall under three categories:
• Physical examination
• Lab testing
• Psychological evaluation testing
The physical examination includes regular tests that are done at a typical checkup, such as height and weight, and blood pressure and temperature. The lab testing may include drawing blood to get counts and check for drug and/or alcohol use. The psychological evaluation is much more in-depth and is perhaps the most telling of the three types of testing. The doctor will want to discuss your thoughts and feelings about your behaviors. “He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past.” (Mayo Clinic, 2011). If more information is required, the doctor may ask to speak to friends and family in order to get a fuller and more complete picture of the patient and their condition.
What are the Diagnostic Criteria?
Before a diagnosis for OCD can be made, the patient must fit a certain mold. The general criteria include having obsessions and compulsions (one or both) and the patient must be able to admit to the fact that their behaviors is irrational and
unusual. Finally, the obsessions/compulsions must have significant effect upon the patient’s daily life. For obsessions, the following must be met; thoughts that are both persistent and reoccurring, thoughts that the patient attempts to repress, and the understanding that the thoughts are the product of the patients own mind. For compulsions, the following must be met; behaviors that are repetitive in nature, behaviors that the patient feels that they are driven to perform, and the behaviors/rituals that are preformed result in settling the patients symptoms for at least a little while. Even with this criteria, it can be difficult to diagnosis. The symptoms of GAD (generalized anxiety disorder) are quite similar to those of OCD. Other illnesses that are similar in nature are depression, schizophrenia, and a plethora of other mental illnesses/disorders. (Mayo Clinic, 2011). This is why going to a professional is so important. The person suffering from these symptoms may not have OCD and be keeping themselves from getting the treatment they need for the real illness that they have.
Treatment For OCD
“Obsessive-compulsive disorder treatment can be difficult, and treatment may not result in a cure. You may need treatment for the rest of your life. However, OCD treatment can help you bring symptoms under control so that they don't rule your daily life.” (Mayo Clinic, 2011). The two most used treatments are medications and counseling/psychotherapy. The doctor will decide which treatment is best and often both medication and therapy are used together in order to get the optimal benefit.
One type of therapy that is widely used for Obsessive-compulsive disorder is CBT (Cognitive Behavioral Therapy).This type of therapy focuses on changing thought patterns in order to retrain your thinking. “One CBT approach in particular is called exposure and response prevention. This therapy involves gradually exposing you to a feared object or obsession, such as dirt, and teaching you healthy ways to cope with your anxiety.” (Mayo Clinic, 2011). If this can help manage thoughts and compulsions, then an improvement in overall quality of life can be obtained.
There are many medications available for treatment of OCD. The medication that is typically tried first is an antidepressant. Antidepressants cause serotonin levels to rise and as discussed above, serotonin levels may be a factor in the development of OCD. The following are approved by the FDA for the use of OCD treatment:
Sometimes a variety of drugs must be tried in order to find the right one that works for the patient. Whatever the medication, it must be given a chance to work. It should not be stopped as most of these medications have to be tapered off and not just quit cold turkey. If it appears that a medication is not working then the doctor may not take the patient off right away. The dosage may just need to be adjusted for the medication to work properly.
Sometimes the patient with OCD has such a severe case that stronger measures must be taken for treatment. The patient may benefit more from inpatient treatment at a Psychiatric hospital or a residential treatment center. Deep brain stimulation may also be a viable option for some patients with OCD. “Because these treatments haven't been thoroughly tested for use in obsessive-compulsive disorder, make sure you understand all the pros and cons and possible health risks.” (Mayo Clinic, 2011).
Obsessive-Compulsive Disorder is a complex and sometimes frightening anxiety disorder. The symptoms can vary widely with some people having just a few symptoms and others having all the symptoms. The causes can vary as well and even then medical professionals cannot say with certainty what causes a person to suffer from OCD. It is important for people who think they may suffer from OCD to see a medical professional in order to get a correct diagnosis. This is not disorder one has to deal with on their own; there are treatment options available. Talking to a doctor is the first step in taking back the OCD sufferers life.
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