OBSESSIVE-COMPULSIVE

DISORDER
(OCD)

Pop Ariana Narcisa

Class XI-B
Colegiul Tehnic Ana Aslan
Obsessive-compulsive
disorder

 Obsessive-compulsive disorder is
a mental and behavioral disorder in which an
individual has intrusive thoughts and/or feels the
need to perform certain routines repeatedly to the
extent where it induces distress or impairs general
function.
 As indicated by the disorder's name, the primary
symptoms of OCD are obsessions and compulsions.
Obsessions are persistent unwanted thoughts, mental
images, or urges that generate feelings
of anxiety, disgust, or discomfort.
 Common obsessions include fear of contamination, obsession
with symmetry, and intrusive thoughts about religion, sex,
and harm. Compulsions are repeated actions or routines that
occur in response to obsessions. Common compulsions
include excessive hand washing, cleaning, counting,
ordering, hoarding, neutralizing, seeking assurance, and
checking things. Washing is in response to the fear of
contamination. Ordering is the preference for tasks to be
completed a specific way (e.g., organizing clothes a specific
way). Hoarding is the collecting of unnecessary objects (e.g.,
collecting food wrappers).
 Neutralizing is the act of engaging in a ritual to make up for
supposedly "bad behavior". Checking is the compulsion to
check particular objects/places to ensure they are a certain
way (e.g., checking to ensure the water is turned off). People
with OCD tend to be overly cleanly, repeatedly count objects,
and seek reassurance to avoid making a mistake. Many adults
with OCD are aware that their compulsions do not make
sense, but they perform them anyway to relieve the distress
caused by obsessions. Compulsions occur so often, typically
taking up at least one hour per day, that they impair one's
quality of life.
  The cause of OCD is unknown. There appear to be
some genetic components, and it is more likely for
both identical twins to be affected than both fraternal twins.
Risk factors include a history of child abuse or other stress-
inducing events; some cases have occurred after streptococcal
infections. Diagnosis is based on presented symptoms and
requires ruling out other drug-related or medical causes; rating
scales such as the Yale–Brown Obsessive Compulsive Scale (Y-
BOCS) assess severity. Other disorders with similar symptoms
include generalized anxiety disorder, major depressive
disorder, eating disorders, tic disorders, and obsessive–
compulsive personality disorder. The condition is also
associated with a general increase in suicidality.
Treatment for OCD may involve psychotherapy such as cognitive
behavioral therapy (CBT), pharmacotherapy such
as antidepressants, or surgical procedures such as deep brain
stimulation. CBT increases exposure to obsessions and prevents
compulsions, while metacognitive therapy encourages ritual
behaviors to alter the relationship to one's thoughts about
them. Selective serotonin reuptake inhibitors (SSRIs) are a
common antidepressant used to treat OCD. SSRIs are more
effective when used in excess of the recommended depression
dosage; however, higher doses can increase side effect
intensity. Commonly used SSRIs
include sertraline, fluoxetine, fluvoxamine, paroxetine, citalopra
m, and escitalopram. Some patients fail to improve after taking
the maximum tolerated dose of multiple SSRIs for at least two
months; these cases qualify as treatment-resistant and require
second-line treatment such as clomipramine or atypical
antipsychotic augmentation. Surgery may be used as a final resort
in the most severe or treatment-resistant cases, though most
procedures are considered experimental due to the limited
literature on their side effects. Without treatment, OCD often lasts
decades.
 Obsessive–compulsive disorder affects about
2.3% of people at some point in their lives, while
rates during any given year are about 1.2%. It is
unusual for symptoms to begin after age 35, and
around 50% of patients experience detrimental
effects to daily life before age 20. Males and
females are affected equally, and OCD occurs
worldwide. The phrase obsessive–compulsive is
sometimes used in an informal manner unrelated
to OCD to describe someone as excessively
meticulous, perfectionistic, absorbed, or
otherwise fixated.
 Signs and symptoms

OCD can present with a wide variety of symptoms. Certain groups of symptoms usually occur together; these groups
are sometimes viewed as dimensions, or clusters, which may reflect an underlying process. The standard assessment
tool for OCD, the Yale–Brown Obsessive Compulsive Scale (Y-BOCS), has 13 predefined categories of symptoms.
These symptoms fit into three to five groupings. A meta-analytic review of symptom structures found a four-factor
grouping structure to be most reliable: a symmetry factor, a forbidden thoughts factor, a cleaning factor, and a hoarding
factor. The symmetry factor correlates highly with obsessions related to ordering, counting, and symmetry, as well as
repeating compulsions. The forbidden thoughts factor correlates highly with intrusive and distressing thoughts of a
violent, religious, or sexual nature. The cleaning factor correlates highly with obsessions about contamination and
compulsions related to cleaning. The hoarding factor only involves hoarding-related obsessions and compulsions, and
was identified as being distinct from other symptom groupings.
Some OCD subtypes have been associated with improvement in performance on certain tasks, such as pattern
recognition (washing subtype) and spatial working memory (obsessive thought subtype). Subgroups have also been
distinguished by neuroimaging findings and treatment response, though neuroimaging studies have not been
comprehensive enough to draw conclusions. Subtype-dependent treatment response has been studied, and the hoarding
subtype has consistently been least responsive to treatment.
While OCD is considered a homogeneous disorder from a neuropsychological perspective, many of the symptoms may
be the result of comorbid disorders. For example, adults with OCD have exhibited more symptoms of attention–
deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) than adults without OCD.
 Causes

The cause of OCD is unknown. Both environmental and genetic

factors are believed to play a role. Risk factors include a history
of Adverse Childhood Experiences or other stress-inducing
events.
Drug-induced OCD
Some medications and other drugs, such
as methamphetamine or cocaine, can induce obsessive-compulsive
disorder (OCD) in people without previous symptoms.
Some atypical antipsychotics (second-generation antipsychotics)
such as olanzapine (Zyprexa) and clozapine (Clozaril) can induce
OCD in people, particularly individuals with schizophrenia.
 Causes
Genetics
There appear to be some genetic components of OCD causation, with identical twins more often
affected than fraternal twins. Furthermore, individuals with OCD are more likely to have first-
degree family members exhibiting the same disorders than matched controls. In cases in which
OCD develops during childhood, there is a much stronger familial link in the disorder than with
cases in which OCD develops later in adulthood. In general, genetic factors account for 45–65% of
the variability in OCD symptoms in children diagnosed with the disorder. A 2007 study found
evidence supporting the possibility of a heritable risk for OCD.
Research has found there to be a genetic correlation between anorexia nervosa and OCD,
suggesting a strong etiology. First and second hand relatives of probands with OCD have a greater
risk of developing anorexia nervosa as genetic relatedness increases.
A mutation has been found in the human serotonin transporter gene hSERT in unrelated families
with OCD.
Diagnosis

Formal diagnosis may be performed by a psychologist, psychiatrist,

clinical social worker, or other licensed mental health professional.
OCD, like other mental and behavioral health disorders, cannot be
diagnosed by a medical exam. Nor are there any medical exams that
can predict if one will fall victim to such illnesses.To be diagnosed
with OCD, a person must have obsessions, compulsions, or both,
according to the Diagnostic and Statistical Manual of Mental
Disorders (DSM). The DSM notes that there are multiple
characteristics that can turn obsessions and compulsions from
normalized behavior to "clinically significant". There has to be
recurring and strong thoughts or impulsive that intrude on the day to
day lives of the patients and cause noticeable levels of anxiousness.
These thoughts, impulses, or images are of a degree or type that lies
outside the normal range of worries about conventional problems. A
person may attempt to ignore or suppress such obsessions, or to
neutralize them with some other thought or action, and will tend to
recognize the obsessions as idiosyncratic or irrational.
 Prognosis

Quality of life is reduced across all

domains in OCD. While psychological or
pharmacological treatment can lead to a
reduction of OCD symptoms and an
increase in reported quality of life,
symptoms may persist at moderate levels
even following adequate treatment courses,
and completely symptom-free periods are
uncommon. In pediatric OCD, around 40%
still have the disorder in adulthood, and
around 40% qualify for remission.
 History

Plutarch, an ancient Greek philosopher and historian, describes an ancient Roman man who possibly had scrupulosity, which could be a
symptom of OCD or OCPD. This man is described as "turning pale under his crown of flowers," praying with a "faltering voice," and
scattering "incense with trembling hands."
In the 7th century AD, John Climacus records an instance of a young monk plagued by constant and overwhelming "temptations
to blasphemy" consulting an older monk, who told him: "My son, I take upon myself all the sins which these temptations have led you, or may
lead you, to commit. All I require of you is that for the future you pay no attention to them whatsoever." The Cloud of Unknowing,
a Christian mystical text from the late 14th century, recommends dealing with recurring obsessions by attempting to ignore them, and, if that
fails, to "cower under them like a poor wretch and a coward overcome in battle, and reckon it to be a waste of your time for you to strive any
longer against them", a technique now known as emotional flooding.