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Psychology Project

Obsessive Compulsive Disorder

Roshni K T
620
VIII Semester




Contents
Introduction ............................................................................................................................... 2
Anxiety .................................................................................................................................... 2
Obsessions .............................................................................................................................. 2
Compulsions ........................................................................................................................... 3
History of OCD............................................................................................................................ 5
Causes ........................................................................................................................................ 6
Biology .................................................................................................................................... 6
Environment ........................................................................................................................... 6
Insufficient Serotonin ............................................................................................................. 7
Family History ......................................................................................................................... 7
Stressful Life Events................................................................................................................ 7
Comorbidity ............................................................................................................................ 7
Issues .......................................................................................................................................... 8
Treatment .................................................................................................................................. 9
Psychotherapy ........................................................................................................................ 9
Medications ............................................................................................................................ 9
Psychosurgery ...................................................................................................................... 10
Other ways of coping with OCD ........................................................................................... 10



Introduction:
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder in which one has
unreasonable, unwanted and repeated thoughts, feelings, sensations, ideas and fears
(obsessions) that lead you to engage in repetitive behaviours (compulsions). It can be defined
as recurring and persistent thoughts, impulses or images experienced at the same time during
the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only
provides temporary relief. Not performing the obsessive rituals can cause great anxiety. OCD
is categorized as an Anxiety Disorder, which affects almost 3% of the population. It is
considered to be the fourth most common mental disorder. It is believed to originate in
adolescence or early adulthood and most patients recognise that their obsessions are irrational
and their compulsions are excessive or unreasonable. First, let us examine what these terms
are:
Anxiety: Overwhelming sense of impending doom, feeling than an action has not been
completed. Eg: thinking the door is unlocked which could cause harm.
Obsessions: Obsessions are nothing but involuntary intrusive cognition. Repetitive and
constants thoughts, images, behaviour or impulses that cause anxiety or distress and are ego
dystonic, i.e., not produced voluntarily. Thoughts, images, or impulses which are a product of
ones head and not real-life problems. The person attempts to suppress or ignore such
thoughts, impulses, or images or to neutralize them with some other thought or action. The
person recognizes that the obsessional thoughts, impulses, or images are a product of his/her
own mind (not imposed from without, as in thought insertion)
Types: doubts (74%), thoughts (34%), Fears (26%), Impulses (17%), Images (7%), others
(2%). Eg: constant fear of germs, thinking that harm will come to a loved one, doubt whether
the door was locked, intense distress when objects are disordered or asymmetrical etc.
Obsessions often have common themes
Contamination, dirt, disease, illness (46%)
Violence and aggression (29%)
Moral and religious topics (11%)
Symmetry and sequence (27%)
Sex (10%)
Other (22%)
The themes often reflect contemporary concerns (the devil, germs, AIDS)
Compulsions: Repetitive behaviors or mental acts person does in reaction to obsessions.
Behaviours or mental acts are done to avoid or decrease distress. These behaviors or mental
acts are clearly excessive or not realistic. Compulsions go hand in hand with obsessive
thoughts. Cognitive compulsions consist of words, phrases, prayers or sequences of numbers.
Statistics for some Compulsions can be summed as Checking (63%), Washing (50%),
Counting (36%), Symmetry & precision (28%). Some common compulsions are: Hand
washing (so repetitive that they become raw), Counting (how many cards in a deck, over and
over again), Cleaning (spots on windows), Checking (the lights to make sure theyre off;
locked doors every few minutes, Request/demand assurances, Repeat actions & ordering.
OCD can be distinguished from general anxiety because it is an intrusion, and also from
phobias because they are focused on an external object. OCD has been connected to
psychosis because it can become an inner repeating voice with a personality in some people.
12% of OCD patients are schizophrenic and 40% had symptoms of OCD before going.
These recurring thoughts exaggerate anxiety or fears. Typical obsessions include worry about
being contaminated, behaving improperly, or acting violently. Some examples of OCD are
Obsessive washing hands, repeating phrases, checking doors countless times or other
repetitive motor behaviour. Statistics suggest that males have a high prevalence of checking
whereas women have a higher tendency of washing.
If one has obsessions and compulsions that are deviant, distressful, and dysfunctional (as in
interfering with regular living) then they most likely have OCD. OCD has a detrimental
impact on many factors of quality of life, including level of education, employment status,
and financial independence. No OCD medications have been shown to improve quality of
life. Specific criteria to be satisfied for a person to be clinically diagnosed:
Anxiety disorder with presence of obsessions or compulsions.
ego dystonic realize thoughts and actions are irrational or excessive.
Must take up more than 1 hour a day.
Must disrupt daily routine.
OCD is more common than schizophrenia, bipolar disorder, and panic disorders according to
the National Institute of Mental Health; but is still commonly overlooked by mental health
professionals and people who currently have obsessive compulsive disorder. Some famous
people with OCD are
Charles Darwin
Leonardo Dicaprio
Billy Bob Thornton
Jessica Alba
Donald Trump
David Beckham
Howard Stern
OCD cycle can be given as follows:

Some admissions of patients suffering from OCD are mentioned below,
Every morning I wake up and wash my hands. Before I eat I wash my hands. Before
I go anywhere I wash my hands. Its horrible. Although I know they are germ free,
Obsessions
Anxiety
Compulsion
Relief
my hands still feel dirty no matter how many times I clean and scrub and scrap. I try
so hard to wash them once and move on, but I just cant seem to overcome this
problem.
My room is spotless. I get upset when everything isnt orderly. I hate the feeling I get
when something is out of place or when a pile is off centered. It dictates my life. Im
constantly wishing that one day I will wake up and not care if my room is a mess. But
one can only wish..
I close each door before I go to bed. Then I tap each door a second time to insure that
they are truly closed. I plan to go to bed at 12 and I end up checking doors until 1 in
the morning. Im always exhausted and in fear of the door not being completely
closed. Having this ailment eats me inside out. It controls every aspect of my life.
I cant walk at a normal pace anymore. I check to see where each foot lands on the
pavement before I let it hit the ground. I avoid every crack that is visible. I cant even
walk beside my friends comfortably anymore. I hate not being able to get up from a
chair, and walk across the room comfortably.
History of OCD:
In the 14
th
& 15
th
century the common thought was that people were possessed by the devil
and OCD then was thought of as symptoms of religious melancholy and naughty thoughts
and were thus treated by exorcism. Around the 17
th
century it was believed that people were
cleansing their guilt. The 18
th
century, however, finally considered medical issue and by the
20
th
century people began treating patients with behavioral techniques. Pierre Janet and
Sigmund Freud isolated OCD from the disorders it was grouped with. Freuds Views, known
as the Psychodynamic theory, were that
A patient's mind responds maladaptively to conflicts between unacceptable,
unconscious sexual or aggressive id impulses and the demands of conscience and
reality
The ego defends against the id by isolation and reaction formation
The imperfect success of the ego gives rise to OCD symptoms
Recent research on mice points toward a genetic cause. A missing gene making a certain
protein caused the mice to scratch and groom themselves compulsively until an OCD drug
was introduced. However, continuing research is being done about the causes of OCD and
better treatments
Causes:
The cause of Obsessive Compulsive Disorder isnt fully understood but there are some main
theories yet, none have been confirmed. Several studies have shown that there are brain
abnormalities in patients with OCD, but more research is needed. Some of the prevalent
theories are:
1) Biology- some scientists believe that OCD may be a result of changes in ones bodys own
natural chemistry or brain functions. PET (Positron Emission Tomography) scans show
people with OCD have different brain activity from others, i.e., increased activity in the
frontal lobe and basal ganglia. This theory believes that OCD is a result of
miscommunication between the orbital frontal cortex, the caudate nucleus, and the thalamus.
Caudate nucleus doesnt function properly and causes thalamus to become hyperactive and
sends never-ending worry signals between OFC and thalamus OFC responds by
increasing anxiety. CT/MRI tests show a decrease in the size of the caudate nuclei of people
suffering from OCD.
2) Environment- Some scientist believe that OCD stems from ones behavior-related habits
that have been learned over time. Some environmental factors could be:
a. Infection: A streptococcal infection of the throat is known to occasionally result in
the body confusing healthy cells with the infection and causing cellular damage. If
this has happened with the brain, the bodys infection fighting system can attack the
outside of nerve cells in the Basal Ganglia part of the brain with the result that OCD
symptoms occur. Some research suggests that these symptoms dont seem to last very
long and the occurrence of this infection OCD seems to be very rare.
b. Depression: People with depression sometimes develop OCD symptoms, and those
with OCD very often develop depression. Dealing with both together is very difficult
without clinical intervention and it is notoriously difficult to undertake an exposure
programme while the depression is high.

3) Insufficient Serotonin- Some scientists believe that an insufficient level of serotonin,
the chemical messenger, may contribute to the development of OCD. Serotonin is a chemical
called a neurotransmitter that allows nerve cells to communicate with each other by working
in the space between nerve cells, called the synaptic cleft. According to research, Serotonin is
involved with biological processes such as mood, aggression, sleep, appetite and pain. It also
seems that Serotonin is capable of connecting to nerve cells in the brain in many different
ways and so can cause many different responses. In order to send chemical messages
serotonin must bind to the receptor sites located on the neighbouring nerve cells. OCD suffers
may have blocked or damaged receptor sites preventing serotonin from functioning to full
potential. However, it is not even fully established if it is all or part of the Serotonin chemical
or another chemical entirely acting on it; or a malfunction in one or more of the receptors in
the brain that Serotonin attaches to that causes the OCD problems
Other factors that may increase the risk of developing or triggering obsessive compulsive
disorder include:
Family History- having parents or other family members with the disorder may increase
ones chance (upto 35% in first degree relation) of developing Obsessive Compulsive
Disorder. Research points to the likelihood that OCD sufferers will have a family member
with the problem or with one of the other OCD Spectrum of disorders. An American
study suggested that up to 30% of teenagers with OCD had a member of the immediate
family with the problem or with obsessive symptoms. Other studies tend to suggest that if a
sufferers OCD began in adulthood there is less chance of this persons offspring contracting
it than if the problem was contracted in childhood, specifically if the latter is the type of OCD
that tends to start in childhood (if there are different types).
Stressful Life Events- if one tends to get stressed easily, the risk of developing OCD
increases. Some examples of the same may include Cognitive appraisal of intrusive thoughts,
Overestimation of danger, Inflated personal responsibility, Thought-action fusion, Thought-
suppression, Cognitive deficits in selective attention, Deficits in inhibiting irrelevant stimuli
(particularly internal ones such as intrusive thoughts).
Comorbidity: The patient has excessive comorbidity with other diseases. Common
diseases: Depression, Schizophrenia, Tourette Syndrome. Depression is the most common
comorbid condition with OCD
Many people with OCD suffered from depression first
2/3 of OCD patients develop depression which makes OCD symptoms worse and
more difficult to treat
People with OCD common diagnosed as Schizophrenic, thus, hard to separate obsessions
from delusions
Issues:
Some complications that obsessive compulsive disorder may cause or be associated with
include:
Suicidal thoughts and behavior
Alcohol or substance abuse
Other anxiety disorders
Depression
Eating disorder
Inability to attend work or school
Troubled relationships
Overall poor quality of life
Other Illness close to OCD include:
Obsessive compulsive personality disorder
Generalized Anxiety disorder
Anorexia and Bulimia Nervosa
Hypochondriasis
Pathologic skin picking
Trichotillomania
Tourette syndrome
Treatment:
OCD is a long-term (chronic) illness with periods of severe symptoms followed by times of
improvement. However, a completely symptom-free period is unusual. Most people improve
with treatment. Symptoms cant result from effects of other medical conditions or substances.
Although difficult to treat, OCD treatment may help one bring symptoms under control. The
main treatments include:
Psychotherapy- a type of therapy called cognitive behavioral therapy has been
shown to be the most effective form of therapy for people with OCD. Cognitive
therapy changes the way they think to deal with their fears and behavioral therapy
changes the way they react to anxiety-provoking situations. Cognitive behavioral
therapy involves retraining ones thought patterns and routines so that compulsive
behaviors are no longer necessary. The patient is exposed many times to a situation
that triggers the obsessive thoughts, and learns gradually to tolerate the anxiety and
resist the urge to perform the compulsion. Medication and CBT together are
considered to be better than either treatment alone at reducing symptoms.
Psychotherapy can also be used to: Provide effective ways of reducing stress, Reduce
anxiety, Resolve inner conflicts. This treatment should be done when people are ready
for. Must be customized for each persons specific form of OCD and their needs. No
side effects except increased anxiety with exposure to fear. Often lasts about 12
weeks. Positive effects off CBT last longer than those of medication. If OCD returns
can successfully treat again with same therapy. The best treatment approach for most
is CBT combined with medication
Medications- Anxiolytic benzodiazepine such as chloradiazepoxide or diazepam
give temporary relief from anxiety but not really effective on obsessions and
compulsions. Certain psychiatric medications are thought to help people with OCD.
The first medication usually considered is a type of antidepressant called a selective
serotonin reuptake inhibitor (SSRI). These drugs prevent excess serotonin from being
pumped back into original neuron that released it. It can then bind to receptor sites of
nearby neurons and send chemical message that can help regulate anxiety and
obsessive compulsive thoughts. They are the most effective drug treatment helping
about 60% of patients. These drugs include: Citalopram (Celexa), Fluoxetine
(Prozac), Fluvoxamine (Luvox), Paroxetine (Paxil), Sertraline (Zoloft), Anafranil etc.
The disadvantage is once medication is stopped, the symptoms usually reoccur so the
person needs to be put on medication indefinitely.
A physical exam can rule out physical causes, and a psychiatric evaluation can rule
out other mental disorders. Questionnaires, such as the Yale-Brown Obsessive
Compulsive Scale (YBOCS), can help diagnose OCD and track the progress of
treatment
Psychosurgery: This is considered to be the last resort when medicines and therapy
fail. It is a much debated procedure as it destroys brain cells. Types:
Radio Frequency Waves (most common in the U.S.): Destroys small amount
of brain tissue. Disrupts circuit in brain associated with OCD. 25-70%
effective
Other ways of coping with OCD
Join a support group- talking to other people who suffer from OCD can help you feel
like your not alone. It can also help you reach out to others facing similar challenges.
Stay focused on your goals- staying motivated on specific goals can help you manage
your illness by controlling the obsessions and compulsions as well.
Find healthy outlets- find ways to channel your energy into recreational activities or
hobbies
Stress management: One of the biggest triggers of OCD is stress. The following
should be practiced to manage the stress
Proper sleep
Social support
Stick with treatments (medication, therapy, etc)
Psychiatrist Jeffrey Schwartz, author of Brain Lock: Free Yourself from Obsessive-
Compulsive Behavior, offers the following four steps for dealing with OCD
1
:

1
Source: Westwood Institute for Anxiety Disorders
http://helpguide.org/mental/obsessive_compulsive_disorder_ocd.htm

RELABEL Recognize that the intrusive obsessive thoughts and urges are
the result of OCD.
REATTRIBUTE Realize that the intensity and intrusiveness of the thought
or urge is caused by OCD; it is probably related to a biochemical imbalance in
the brain.
REFOCUS Work around the OCD thoughts by focusing your attention on
something else, at least for a few minutes: do another behavior.
REVALUE Do not take the OCD thought at face value. It is not significant
in itself.


Bibliography
Books:
Kaplan and Saddocks, Synopsis of Psychiatry, Wolters Kluwers, Lippincott Williams
& Wilkins, 10
th
ed (2007)

Online Sources:
International OCD Foundation, http://www.ocfoundation.org/whatisocd.aspx
Help guide,
http://www.helpguide.org/mental/obsessive_compulsive_disorder_ocd.htm
National Institute of Mental Health, http://www.nimh.nih.gov/health/topics/obsessive-
compulsive-disorder-ocd/index.shtml