When we meet someone who is keen on keeping their things organized and clean, we jokingly say, “You’re OCD.” However, there is a huge difference between being a neat freak and having OCD. Obsessive Compulsive Disorder is defined as having obsessive thoughts and compulsive behavior. The person makes an attempt to neutralize the obsessions by engaging in compulsive behavior. Obsessions are recurrent and persistent thoughts, urges, images, or impulses that are experienced as disturbances, unwanted, or inappropriate. Compulsive behavior is the repetitive behavior of checking, counting, cleaning, repeating, ordering, and arranging to reduce distress or prevent any dreaded event or situation from occurring. The symptoms cause clinically significant impairment and distress in their social, occupational, and other areas of functioning.
The mild to extreme level of disturbances caused by OCD, for example, cleaning and washing rituals for 15–20 minutes to the extreme behavior of washing hands for more than an hour to a point where the hands start to bleed. Checking ritual: it is common for us to check things before we leave our house, from the mild behavior of checking everything three to four times to the extreme of going back to the house from a half-way journey just to check if the lights are off and the doors are locked.
OCD obsessions are:
- Fear of contamination
- Fear of harming oneself or others
- Religious obsessions
- Sexual obsessions
- Concerned with the need for particular symmetry
- Pathological doubt
- Aggression
Compulsive behaviours are:
- Checking
- Counting
- Cleaning
- Ordering & Arranging
- Repeating
- All the obsessions and compulsions are caused to reduce the anxiety and distress, to gain a sense of control, and to prevent dreadful events or situations from occurring.
Causes of OCD
Learned Behaviours
A two-process theory claims that OCD is caused by learned behavior. When a neutral stimulus is associated with fear or stress, it can lead to anxiety or stress. This is known as classical conditioning. For example, hand shaking is a neutral stimulus that is associated with the fear of contamination, which increases intrusive thoughts causing disturbances in the person. To reduce the distress, the person washes their hands for 10 to 15 minutes. The hand washing ritual definitely reduces the person’s fear and distress; on the other hand, it also reinforces obsessions and compulsions. In some cases, the avoidance behavior also causes reinforcement.
Cognitive factors
The thoughts and attempts to suppress obsessive thoughts can become a cause for an increase in OCD symptoms.
Inflated sense of responsibility: when it is associated with certain beliefs, people with OCD believe that if they keep thinking of harming someone, they might end up causing harm to someone. This becomes the motivating factor for them to engage in compulsive behavior.
Attention bias: in a situation, they are more inclined to notice the disturbing things and ruminate on them, which increase their symptoms.
Biological Causes
There are many scientific studies determining the genetic, brain abnormalities, and dysfunction of neurotransmitters like serotonin, GABA, and glutamate that have been determined to cause the symptoms of OCD. However, these factors and how they are fully related to the disorder are not fully understood.
Treatment
Behavioural and Cognitive Behavioural Treatments
Exposure and response prevention are effective treatments for treating clients with OCD. Initially, the client is exposed to the stimuli that provoke the obsessions. Response prevention is where the client refrains from engaging in any compulsive behavior. This entire process sounds distressing, but the psychologist breaks it down and takes the client through a step-by-step process. The outcome of the therapy is to decrease the reinforcement and give enough time to pass the anxiety or distress that creates the obsession. For example, a person who takes a bath 10 times a day will be asked to not bathe for a day. When they accomplish this, they are asked to take a bath for only 10 minutes a day. Homework is assigned by the therapist for the clients to do their work to get better. Many people refuse such treatment and drop out early, but people who stick with it show a 50 to 70 percent reduction in symptoms.
- CBT is also effective in addressing the distorted thinking pattern. In some treatments, exposure and response prevention are used along with CBT.
The results of therapies are seen to be more effective than medication if the client is regular for the treatment sessions and in doing their assignments.
Medication
Medication such as clomipramine and fluoxetine are used to reduce the intensity of OCD symptoms. Medication should only be prescribed by a psychiatrist. A major disadvantage of medication is that when it is discontinued, it can cause a relapse.
Neurosurgical techniques for the treatment of severe cases are also considered, as OCD is a crippling and disabling disorder. The surgical technique is not recommended for everyone who has OCD. The major aspects considered are that the person should have had severe OCD for at least 5 years and shouldn’t have responded to any treatment.
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