OBSESSIVE-COMPULSIVE DISORDER.

Obsessive-Compulsive Disorder (OCD) is a chronic and debilitating mental

health condition characterized by intrusive, distressing thoughts (obsessions)
and repetitive behaviours or mental acts (compulsions). Understanding OCD
involves delving into its epidemiology, etiology, clinical manifestations,
diagnostic criteria, treatment approaches, and the impact it has on individuals'
lives.

Obsessive-compulsive disorder (OCD) has two main parts:

Obsessions and compulsions:

• Obsessions are unwelcome thoughts, images, urges, worries or doubts that
some people describe it as mental discomfort rather than anxiety).

• Compulsions are repetitive activities that you do to reduce the anxiety caused
by the obsession. It could be something like repeatedly checking a door is
locked, repeating a specific phrase in your head or checking how your body
feels.

“It's not about being tidy, it's about having no control over your negative
thoughts. It's about being afraid not doing things a certain way will cause
harm.”

You might find that sometimes your obsessions and compulsions are
manageable, and other times they may make your day-to-day life really
difficult. They may be more severe when you are stressed about other things,
like life changes, health, money, work or relationships.
Related disorders There are some other mental health problems that are similar
to OCD because they involve repetitive thoughts, behaviours or urges.

• Perinatal OCD is when you experience OCD during pregnancy or after birth.

• Body dysmorphic disorder (BDD) involves obsessive worrying about one or

more perceived flaws in your physical appearance and developing compulsive
routines to deal with worries about the way you look.

• Compulsive skin picking (CSP) is the repetitive picking at your skin to relieve
anxiety or urges. It can be experienced as part of body dysmorphic disorder
(BDD).

• Trichotillomania is a compulsive urge to pull out your hair.

• Hoarding is when you collect, keep and find it hard to get rid of things, to the
point where it affects your day-to-day life.

• Obsessive compulsive personality disorder (OCPD) is a type of personality

disorder. It has some related traits to OCD, but is a different and separate
condition.

Epidemiology: OCD affects individuals of all ages, races, and socioeconomic

backgrounds, with estimates suggesting a lifetime prevalence of approximately
2-3% worldwide. The disorder often manifests during childhood, adolescence,
or early adulthood, although onset can occur at any age. OCD tends to follow a
chronic course, with symptoms waxing and waning over time. It is frequently
comorbid with other psychiatric disorders, including anxiety disorders,
depression, and tic disorders, further complicating its clinical presentation and
management.
Etiology:
The origins of OCD are complex, involving a combination of genetic,
neurobiological, and environmental factors. Studies on families and twins have
revealed a hereditary aspect to OCD, with close relatives of those affected
having a higher likelihood of developing the disorder. Neuroimaging research
has identified abnormalities in brain circuits, particularly those involving the
orbitofrontal cortex, anterior cingulate cortex, and basal ganglia, as key factors
in the development of OCD. Imbalances in neurotransmitters like serotonin,
dopamine, and glutamate are believed to play a role in the onset and persistence
of OCD symptoms.

Clinical Manifestations:
The defining characteristics of OCD encompass obsessions and compulsions.
Obsessions manifest as intrusive and distressing thoughts, images, or urges
perceived as unwanted. Typical obsessions revolve around themes like
contamination, harm, symmetry, and taboo subjects. Compulsions, on the other
hand, are repetitive actions or mental processes undertaken to relieve distress or
avert feared consequences prompted by obsessions. Common compulsions
involve rituals like washing, checking, counting, and mental activities such as
praying or silently repeating words.
 TYPES OF OBSESSIONS (Examples included).

1-*worrying you've already harmed someone by not

being careful enough. e.g. that you have knocked
somone over in your car.
worrying you're going to harm somone because you
will lose control. e.g.. that you will push somone in
front of the tain or stab them.
2-*voilent intrusive thoughts or image of yourself
1-Fear of causing or failing to prevent harm
doing somethingviolent or abusive. these thoughts
2- Intrusive thoughts, images and impulses. might make you worry that you are a dangerous
person.
*religious or blasphemous thoughts that are against
your religious beliefs.
*relationship intrusive thoughts oftet appear as
doubts about whether a relationship is right.

Fear of contamination: • Contamination (for example by dirt, germs or faeces).

You might worry that you have been contaminated and that you – or other
people – are spreading the contamination. You might worry that you have or
might get a disease.

• Mental contamination. You might experience feelings of dirtiness that are

triggered by a person who has harmed you in some way. These feelings may
also be triggered by your own thoughts, images or memories.

Fears and worries related to order or symmetry: • You might have a fear that
something bad will happen if everything isn't 'right' – for example if things are
not clean, in order or symmetrical.

Type of compulsion Examples include

Rituals: washing your hands, body or things around you a lot
• touching things in a particular order or at a certain time
• arranging objects in a particular way
Checking: • checking doors and windows to make sure they are locked
• checking your body or clothes for contamination
• checking your body to see how it responds to intrusive thoughts
• checking your memory to make sure an intrusive thought didn't actually
happen
• checking your route to work to make sure you didn't cause an accident.
Correcting thoughts: repeating a word, name or phrase in your head, or out loud
• counting to a certain number
• replacing an intrusive thought with a different image

Diagnostic Criteria: The Diagnostic and Statistical Manual of Mental Disorders,

Fifth Edition (DSM-5) outlines specific criteria for the diagnosis of OCD. To
meet diagnostic criteria, individuals must experience either obsessions,
compulsions, or both, which are time-consuming (taking more than one hour
per day) or cause significant distress or impairment in social, occupational, or
other important areas of functioning. Additionally, the obsessions and
compulsions must not be attributable to the physiological effects of a substance
or another medical condition.

Treatment approaches:
The management of OCD typically employs a comprehensive approach
integrating pharmacotherapy, cognitive-behavioural therapy (CBT), and
sometimes neuromodulation methods. First-line pharmacological treatment for
OCD involves selective serotonin reuptake inhibitors (SSRIs), like fluoxetine,
fluvoxamine, and sertraline, which elevate serotonin levels in the brain,
effectively mitigating symptoms for many patients. If SSRIs fail to produce the
desired response, augmentation strategies with antipsychotic medications such
as risperidone or aripiprazole may be explored.
Cognitive-behavioral therapy (CBT), particularly exposure and response
prevention (ERP), stands as the most extensively researched psychotherapy
method for OCD. ERP entails a methodical and gradual confrontation with
feared triggers or scenarios (exposure), coupled with abstaining from engaging
in compulsive actions (response prevention). This process fosters habituation
and diminishes anxiety as individuals discover that their feared consequences do
not occur through repeated exposure. Additionally, CBT for OCD may integrate
cognitive restructuring methods aimed at challenging and modifying
maladaptive beliefs and cognitive distortions linked to obsessions.

For severe and resistant cases of OCD, neuromodulation methods like deep
brain stimulation (DBS) or repetitive transcranial magnetic stimulation (rTMS)
could be options. DBS entails electrode implantation in OCD-related brain
areas, administering electrical impulses to regulate neural activity. rTMS applies
magnetic pulses to specific brain regions linked to OCD symptoms, aiming for
therapeutic effects.