What is obsessive compulsive disorder (OCD) and how is it treated?

Obsessive-compulsive disorder (OCD) is a pronounced neurotic pathology characterized by the appearance of anxiety and various obsessive thoughts that provoke the performance of certain ritual-like actions. After performing the desired action, there is a decrease in the level of anxiety.

According to the classification of mental illness, obsessive-compulsive disorder is an anxiety disorder. In a mild form, the disease is present in 30% of adults and 15% of children. Less than 1% of people have persistent, clinically proven OCD. OCD sufferers make up 1% of all patients receiving treatment in psychiatric institutions. It is believed that men and women are affected approximately equally.

Short information about obsessive compulsive disorder

10 basic signs of compulsive-obsessive disorders

Obsessive-compulsive disorder can have many different signs and manifestation, but we have outlined 10 main ones in which you can suspect the disorder presence:

- The need for regular counting - accompanied by an urgent need to verify the correctness of the action several times in a row. Money, packaging, own steps, etc. are constantly recalculated. This condition arises as a result of a deep sense of irresponsibility or as a result of fear for own safety;
- Very frequent hand washing is the most common symptom. A person can wash their hands after every action, such as after grabbing a door handle or kitchen countertop. The reason for this behavior is the fear of bacteria. People try to protect themselves from the surrounding "impurity";
- Incorrect analysis of relationships. The OCD sufferer constantly analyzes the words and phrases of others. They try to find some hidden meaning even in innocent jokes. The analysis of the relationship is accompanied by intense emotion;

- Need for constant cleaning. It appears as an addition to frequent hand washing. A person is overcome by a constant sense of uncleanness in the house. It can appear almost immediately after cleaning. The cause of this condition is germophobia, i.e. fear of germs;
- Excessive organization. People with OCD try to bring self-organization to perfection. Even 1-5 seconds can play a significant role in completing a specific task. All things and objects must have their place. Sometimes this behavior can be confused with perfectionism;
- Obsessive rechecking of own actions. A person can check several times whether they turned off the kettle, closed the front door, etc. They often have the feeling that they forgot something in the house and can come back several times for rechecking. The state arises as a result of excessive concern for their safety;
- Fear of getting into trouble. A person can have an extreme fear of being beaten on the street or fired at work, even for no real reason. The person may be afraid to leave the house or communicate with the boss. OCD sufferers often avoid dating due to panic fear of meeting new people and may question their own orientation;
- Constant search for support. OCD sufferers try to find support from loved ones. They are very afraid to appear funny or incompetent in front of strangers. However, getting this support can make the problem worse;
- Dissatisfaction with their own appearance. A person can be convinced of the presence of a certain aesthetic flaw even in its absence. Such beliefs often lead to rash actions, such as plastic surgery. A person can be concerned about losing weight even if they have a slender figure;
- Obsessive sexual thoughts. The person may be thinking about taboo desires or obscene behavior. There may be doubts about their own sexual orientation. Constant sexual fantasies may arise for passers-by or colleagues.

OCD causes

Today, doctors do not know the exact reasons for the development of obsessive-compulsive disorders. But there are several key factors that can cause pathology:

- Biological factors;
- Genetic factors;
- Psychological theories, including exogenous-psychotraumatic factors associated with the person's environment: family, relatives, colleagues, friends, etc .;
- Sociological theories.

Just 15 years ago, OCD was considered a rare condition with unclear etiology (cause). The multiple studies have helped better understand the mechanism of the disease and find the optimal treatment solutions. For instance, only recently it had been discovered that at the basis of OCD lie neurotransmitter disorders. The use of this knowledge has allowed the development of pharmacological treatment aimed specifically at serotonergic neurotransmission. This revolutionized the recovery prospects of millions of OCD sufferers around the world.

The discovery that intense serotonin reuptake inhibition (SSRI) is the key to effectively treating OCD was the first phase of a revolution and stimulated clinical trials that showed the effectiveness of such selective inhibitors.

OCD therapy

Despite the fact that OCD is a complex group of symptom complexes, the principles of treatment for them are the same. The most reliable and effective method of treating OCD is drug therapy, during which a strictly individual approach to each patient should be manifested, taking into account the characteristics of the manifestation of OCD, age, gender, and the presence of a history of other diseases. When any disorders similar to mental ones appear, it is necessary, first of all, to contact specialist, psychotherapists or psychiatrists, to establish the correct diagnosis and to get prescribed competent adequate treatment.

When treating, it should be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods of remission (improvement in the condition). The apparent suffering of the patient often seems to require vigorous, effective treatment, but the natural course of this condition should be kept in mind to avoid the typical mistake of overly intensive therapy. It is also important to consider that depression is often associated with OCD, and that depression is often associated with improvement of obsessive symptoms.

Treatment of OCD begins by educating the patient about the symptoms and, if necessary, reassuring them that they are not the initial manifestation of insanity (a common concern for obsessive-compulsive patients). Sufferers of these or those obsessions often involve other family members in their rituals, so relatives need to treat the patient firmly but sympathetically, mitigating the symptoms if possible, and not aggravating it by the excessive indulgence of the sick fantasies.

In the treatment of compulsive-obsessive disorders, two main methods are used: medication and psychotherapy. In most cases, a combined method of treatment is used, involving the implementation of psychotherapeutic measures, taking into account the drug effect on the body.

Classical psychotherapy involves three key techniques: cognitive-behavioral correction, the 4-step technique, and exposure and prevention.

The choice of the optimal method of treatment is determined only by the doctor, taking into account the data of the initial examination, the individual characteristics of the organism, based on the test results.

Drug therapy

The following therapeutic approaches exist for the currently identified types of OCD:

- The most commonly used pharmacological agents for OCD are serotonergic antidepressants, anxiolytics (mainly of the benzodiazepine series), beta-blockers (to control vegetative manifestations), MAO inhibitors (reversible), and triazole benzodiazepines (alprazolam). Anxiolytic drugs provide some short-term relief of symptoms, but they should not be prescribed for more than a few weeks at a time. If treatment with anxiolytics is required for more than one to two months, small doses of tricyclic antidepressants or minor antipsychotics sometimes help.

- The drugs for OCD treatment with negative symptoms or severe ritualized obsessions, is atypical antipsychotics - risperidone, olanzapine, quetiapine, in combination with either SSRI antidepressants (Paroxetine), or other antidepressants, or with moclobemidine. Potentially can be used benzodiazepine derivatives (alprazolam, clonazepam, bromazepam).
- Any comorbid depressive disorder is treated with an adequate dose of antidepressant medication. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessive symptoms.
In cases where obsessive-phobic symptoms are observed in schizophrenia, intensive drug therapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram) has the greatest effect. In some cases, it is advisable to use traditional antipsychotics (low doses of haloperidol, trifluoperazine) and parenteral administration of benzodiazepine derivatives.

OCD treatment forecast

About two-thirds of people with OCD improve within a year, more often by the end of that period. If the disease lasts more than a year, fluctuations are observed during its course - periods of exacerbations are interspersed with periods of improvement in health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic personality with severe symptoms of the disease, or if there are continuous stressful events in the patient's life. Severe cases can be extremely persistent; for example, a study of hospitalized patients with OCD found that three-quarters of them remained symptomatic after 13–20 years.

Post by: Elizabeth Agrer, clinical pshychiatrist, Copenhagen, Denmark