The 8 main comorbidities of Obsessive-Compulsive Disorder

These are the psychological disorders that sometimes overlap with Obsessive-Compulsive Disorder.

Obsessive-Compulsive Disorder (OCD) is a psychopathological condition that, due to its clinical expression, can condition life in a very important way. Since it is also a condition of chronic course, it is possible that at some point in its evolution it may concur with other disturbances of the psychic sphere that overshadow the prognosis.

In fact, most of the studies that deal with the issue underline that suffering from OCD is a risk factor for comorbidities of a very different nature. This circumstance becomes a therapeutic challenge of enormous magnitude for the psychology professional who deals with it, and an emotional challenge for the patient who faces it.

Comorbidity" is understood as the presence of two or more disorders in a single individual and moment, so that the result of their concomitance becomes much more than the simple sum of them. It is, therefore, a unique journey for each patient, since it also interacts with those personality traits that are specific to him/her.

This article will address some of the mental health mental health problems that may arise throughout the life of OCD sufferers (the comorbidities of OCD) although it is essential to emphasize that their occurrence is not mandatory. We will only speak of an increased risk, that is, of an additional element of vulnerability.

Obsessive compulsive disorder

The Obsessive-Compulsive Disorder (OCD) is a clinical picture characterized by. the presence of intrusive thoughts followed by ritual acts with a clear functional relationship, aimed at reducing the discomfort generated by the former.aimed at reducing the discomfort generated by the former. With the passage of time, the link between them tends to strengthen, so that thinking and acting enter a cycle from which it is not easy to escape.

Most often, the person is aware that his or her "problem" is irrational or disproportionate, but there are cases in which such a "problem" is irrational or disproportionate.However, there are cases in which such an assessment may not be present, especially in the case of children or adults with poor introspection.

There are effective treatments, both psychological (exposure to mental content, cognitive restructuring and so on) and pharmacological (especially with serotonin reuptake inhibitors and tricyclic antidepressants). If an adequate program is not articulated, the evolution is usually progressive and insidiously diminishes the quality of life of the sufferer. In addition, it is a mental health problem that very often occurs with other disorders, as will be seen below.

Comorbidities of OCD

As we saw earlier, OCD is a condition of enormous clinical relevance for the person who suffers from it, with a great capacity to condition the development of his or her daily life. In addition, the possibility has been documented that a series of secondary mental problems may also appear, a series of secondary mental problems that complicate its expression and treatment.. This phenomenon (known as comorbidity) involves interactions between the problems referred to, from which combinations loaded with a profound idiosyncrasy are derived. In this text we will deal with some of the most relevant ones.

1. Major depression

Mood disorders, and more specifically major depression, are perhaps one of the most frequent comorbidities in OCD. Both are associated with intrusive thoughts that generate intense discomfort, which is associated with altered activity of structures located in the prefrontal region of the brain.Both are associated with altered activity of structures located in the prefrontal region of the brain. When they occur together, they usually affect each other, thus accentuating the obsessive ideas and their general impact. In other words, both the OCD and the depression itself are aggravated.

Most commonly, sadness and loss of ability to experience pleasure arise as an affective response to limitations imposed by OCD on activities of daily living, since in severe cases it becomes an enormously invasive pathology. Also has also been suggested that both entities are linked to alterations in serotonin function.a neurotransmitter that contributes to mood maintenance and may explain its remarkable comorbidity. Up to two thirds, approximately 66% of subjects with OCD, will suffer from depression at some point in their lives.

It is known that the prevalence of depressive symptomatology in these patients has a direct impact on the presence of obsessive ideas, reduces therapeutic adherence and increases the risk that the intervention will not be effective. It is therefore important to be well aware of the synergistic effects of this dual pathology, to articulate a therapeutic program in which possible adverse contingencies are foreseen and to stimulate motivation throughout the process.

2. Anxiety disorders

Another of the usual comorbidities of OCD is anxiety problems; and especially with social phobia (18%), panic disorder (12%), specific phobias (22%) and generalized anxiety (30%).. The presence of these, as with depression, is of particular concern and requires the use of mixed therapeutic approaches, in which cognitive behavioral therapy must be present. In any case, the prevalence of these psychological problems is statistically higher in OCD patients than in the general population.

One of the main causes corresponds to the overlap between the expression of OCD and anxiety. So much so that, a few years ago, OCD itself was included in the category. Undoubtedly the most frequent is that it is "confused" with generalized anxiety, since in both cases there would be a preoccupation with negative thoughts. However, they can be differentiated by the fact that in the generalized anxiety the feared situations are more realistic (related to issues of ordinary life) and that rumination acquires here egosyntonic properties (it is understood as useful).

Panic disorder is also very common in people with OCD, which is associated with an autonomic hyperactivity (of the sympathetic nervous system) that is difficult to predict, and whose symptoms derail any attempt to develop life normally. Specific phobias, or irrational fears, are also common when exploring people with OCD. In this case they are usually related to very different pathogens (in the case of cleaning obsessions), and must be distinguished from hypochondriacal fears of suffering a serious illness.

Obsessive-compulsive personality disorder.

People with OCD are more likely to have an obsessive-compulsive personality profile, that is, based on a perfectionism of such magnitude that it restricts the normal development of everyday life. It can often be a pattern of thought and behavior that was present before the onset of OCD itself, as a kind of breeding ground for it. The synergy of the two would lead to the appearance of invasive mental contents that would aggravate the high self-demand, greatly accentuating the behavioral and cognitive rigidity.

In general, it is known that subjects with an obsessive-compulsive personality who suffer from OCD show symptoms of greater intensity and greater scope, since their perfectionism is projected towards much more intense efforts to control the degree of invasiveness of the obsessions, which paradoxically ends up making them worse.

4. Bipolar disorder

The literature has described people with OCD as having an exacerbated risk for bipolar disorder, although there are discrepancies on this point. While certain authors do not believe that the two disorders have anything in common, and attribute any possible similarities to particularities in the acute episodes of OCD (compulsive behaviors similar to those of mania), others stress that the risk of bipolarity for these patients is twice that of the general population..

It has been described that people with OCD who also suffer from bipolar disorder indicate a greater presence of obsessive ideas, and that their content is adapted to the acute episode being experienced at each moment (depressive or manic). There is also evidence that those with this comorbidity report more obsessive thoughts (sexual, aggressive, etc.) and a higher number of suicide attempts, when compared to patients with OCD without bipolarity.

5. Psychotic disorders

In recent years, on the basis of new empirical evidence, a label has been proposed to describe people with psychotic disorders. a label to describe people living with both OCD and schizophrenia: schizo-obsession..

These are subjects whose psychosis differs greatly from that seen in patients without obsessive-compulsive symptoms; both in terms of clinical expression and response to pharmacological treatment or cognitive impairment profile, indicating that it could be an additional modality within the broad spectrum of schizophrenias. In fact, it is estimated that 12% of patients with schizophrenia also meet diagnostic criteria for OCD.

In these cases, OCD symptoms are observed in the context of acute episodes of their psychosis, or also during their prodrome, and must be distinguished from each other. The fact is that they are disorders that share a common neurological basis, which increases the likelihood of OCD.This increases the likelihood that at some point both disorders coexist. The shared structures would be the basal ganglia, the thalamus, the anterior cingulate and the orbitofrontal/temporal cortex.

6. Eating disorders

Certain eating disorders, such as anorexia or bulimia, may share some features with OCD itself. The most important of these are perfectionism and the presence of ideas that repeatedly burst into the mind, triggering reassurance behaviors.

In the case of eating disorders These are thoughts associated with weight or shape, along with the constant verification that you have not changed size or that your body remains the same as the last time you looked at it. or that the body remains the same as the last time it was looked at. This is why the two should be carefully distinguished during the diagnostic phase, in case the criteria for one or the other are met.

Cases of OCD have been documented in which an obsession with food contamination (or that the food might be infested with a pathogen) has reached such a level that it has precipitated a restriction of food intake. It is in these cases that it is particularly important that a thorough differential diagnosis be carried out, as the treatment of these pathologies requires the articulation of very different procedures. In the event that they come to coexist at some point, it is very likely that purging or physical overexertion behaviors will increase..

7. Disorder by tics

Tic disorder is an invasive condition characterized by the unavoidable presence of simple/stereotyped motor behaviors, which arise in response to a perceived urge to move, which is only relieved at the instant it is "executed". It is therefore functionally very similar to what occurs in OCD, to the point that manuals such as the DSM have chosen to include a subtype reflecting such comorbidity. Thus, it is considered that approximately half of the pediatric patients with a diagnosis of OCD show this type of motor aberrations, especially among boys whose problem is not as severe as in OCD.This is especially true among males whose problem debuted at a very early age (early in life).

Traditionally it has been believed that the children with OCD who in addition referred one or more tics were of difficult approach, but the certain thing is that the literature on the matter does not show conclusive data. While in some cases it is pointed out that in children with OCD and tics the presence of recurrent thoughts with aggressive contents is greater, or that they are patients with a poor response to pharmacological and psychological treatment, in others no differential nuances that merit greater seriousness are appreciated. Nevertheless, yes that there is evidence that the OCD with tics shows a more notorious pattern of familiar historyso that its genetic load could be greater.

8. Attention Deficit Hyperactivity Disorder (ADHD)

The studies that have been carried out on the comorbidity of these disorders show that 21% of the children with adhd have a family history of ADHD. 21% of children with OCD meet the diagnostic criteria for ADHDa percentage that drops to 8.5% in adults with OCD. This is curious, since they are conditions that affect the same brain region (the prefrontal cortex), but with very different activation patterns: in one case by increase (OCD) and in the other by deficit (ADHD).

To explain this paradox, it has been proposed that the excessive cognitive fluency (mental intrusion) of OCD would generate a saturation of cognitive resources, which would result in a saturation of cognitive resources.This would result in an impairment of the executive functions mediated by this area of the nervous system, and therefore with an attentional difficulty comparable to that of ADHD.

On the other hand, it is estimated that the reduction in prevalence between childhood and adulthood could be due to the fact that from the age of 25 years onwards the prefrontal cortex matures completely (as it is the last area of the brain to do so), and also to the fact that ADHD tends to "soften" as time goes by.

Bibliographic references:

• Lochner, C., Fineberg N., Zohar, J., Van Ameringen, M., Juven-Wetzler, A., Altamura, A., Cuzen, N., Hollander, E. ...Stein, D.. (2014). Comorbidity in obsessive-compulsive disorder (OCD): A report from the International College of Obsessive-Compulsive Spectrum Disorders. Comprehensive psychiatry, 55(7), 47-62.
• Pallanti, S., Grassi, G., Sarrecchia, E., Cantisani, A. y Pellegrini, M. (2011). Obsessive–Compulsive Disorder Comorbidity: Clinical Assessment and Therapeutic Implications. Frontiers in psychiatry / Frontiers Research Foundation, 2 (70), 70.