Obsessive-Compulsive Disorder: Symptoms, Causes, and Treatments

A person who prefers a clean and tidy environment may be accused of being ‘OCD’ by their peers and families. We are also familiar with multiple characters, such as Monica from the TV series Friends, who are also labelled ‘OCD’. However, the disorder is more complex than the primitive and layman’s understanding of it as being a ‘clean freak’. Obsessive-compulsive disorder (OCD) is a long-lasting (often lifelong) disorder, which involves a person getting trapped in a vicious cycle of obsessions and compulsions.

Obsessions are uncontrollable, intrusive, and recurring thoughts, images, and urges, which can cause great anxiety and trigger distressing feelings. They are irrational and attempts to reason prove to be ineffective. To manage and get rid of such thoughts, people are driven to engage in repetitive behaviours, known as compulsions. These behaviours are rigid, and often coupled with a sense of extreme fear of dire consequences to oneself or loved ones in case the behaviour is not performed.

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These obsessions and compulsions can come in the way of everyday activities, and hinder a person’s routine functioning. Some people with OCD realise their obsessive thoughts are unreasonable, whereas others think they are realistic. Even those people who know their intrusive thoughts are irrational face great difficulty in disengaging from them.

It is a disorder that affects people of all ages and walks of life. Usually, the onset of OCD takes place in the teen or young adult years, but it can begin in childhood as well. Symptoms of OCD are known to worsen when a person experiences increased stress. The severity of the disorder, and the types of obsessions and compulsions one experiences, change over time.

Diagnosis

As previously mentioned, OCD is not merely about having habits such as picking at scabs or biting your nails. Most people have mild compulsive behaviours and obsessive thoughts, but that does not mean everybody has ‘some degree of OCD’. A diagnosis of OCD requires the following criteria to be fulfilled: the presence of extreme obsessional thoughts and/or compulsions that are time-consuming (more than one hour a day), are intensely distressing and beyond one’s control, and impair one’s work or social interactions and other activities they value. People may have a few symptoms of OCD but not meet the full criteria for the disorder.

Symptoms and Types

OCD usually includes both obsessions and compulsions, but it is also possible for a person to have only one set of symptoms.

Obsessions

Being ‘obsessed’ with something is a commonly used phrase in everyday language. You may be ‘obsessed’ with a new song or a celebrity’s newest outfit. However, these casual ‘obsessions’ do not mean the person is facing any problems in their day-to-day life. These obsessions may even be enjoyable. However, the content of OCD obsessions is a lot more severe and disabling. The thoughts are intrusive and unwanted which are extremely distressing. They interfere when the person is trying to perform other tasks. Some of the common obsessions are:

1. Contamination Obsessions: These involve a fear of coming into contact with substances that are perceived to be contaminated, such as:

• Bodily fluids and secretions (e.g. blood, urine, sweat)
• Germs, microbes, and diseases (e.g. herpes, COVID-19)
• Environmental contaminants (e.g. radiation, dust, lead)
• Dirt
• Household chemicals (e.g. cleaners, battery acid)

2. Violent Obsessions: These include fear of acting on aggressive thoughts and impulses towards oneself or others and persistent horrific images in one’s mind.
3. Responsibility Obsessions: These involve excessive fear of being responsible for terrible incidents such as car accidents, fires, and robberies, and fear of harming others due to irresponsible behaviour like accidentally bumping into people or causing them to trip and fall.
4. Perfectionism Obsessions:

• Extreme concern with evenness and exactness, and fixation with symmetry and order
• Fear of forgetting important information
• Excessive need to know and remember
• Fear of making mistakes
• Difficulty handling uncertainty

5. Sexual Obsessions: These are unwanted and intrusive thoughts and impulses relating to sexual acts, including:

• Fear of acting on sexual urges
• Fear of harming relatives or children sexually
• Thoughts of aggressive and disturbing sexual acts

6. Religious/Moral Obsessions: These include excessive concern with right and wrong, accidentally committing blasphemous acts, offending god, and constant doubts that others disagree with one’s personal beliefs.
7. Identity Obsessions: These involve being extremely concerned with oneself, such as one’s sexuality and gender identity.
8. Other Obsessions:

• Relationship-related concerns, suspicion that one’s partner is disloyal, doubting the truthfulness of friends and family.
• Preoccupation with thoughts about death and existence, fixation with philosophical themes such as the meaning of life.
• Extreme awareness of bodily sensations and processes such as blinking and breathing.

Compulsions

People with OCD attempt to ease the distress caused by obsessional thinking by suppressing or ignoring obsessive thoughts, however, it only increases the suffering even further. Thus, they are forced to engage in repetitive behaviours. Not all habits and repetitive patterns are compulsions. They are acts that bring no pleasure and are only meant to temporarily relieve anxiety related to obsessions or prevent bad things from happening.

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They may be excessive and sometimes unrelated to solving the problem they are intended to fix, however, despite people with OCD realising this, they are driven to perform them anyway because of the lack of a better way to cope. People would rather not have to do these time-consuming tasks, but they feel helpless in the face of anxiety and fear.

Common compulsions observed in those suffering from OCD are:

1. Washing and Cleaning: People may wash and clean their hands, bodies, or possessions frequently or in specific ways. They may perform routine hygiene tasks repeatedly such as showering, brushing, and grooming.
2. Repetition: People may repeat routine activities and movements such as getting up and down from chairs, or may develop motor tics such as tapping, shoulder shrugging, and blinking. Vocal tics like repetitive throat-clearing, sniffing, or grunting sounds are also observed. They may also perform activities in multiples, such as doing a task 4 times because 4 is a good or right number.
3. Checking: People with OCD may constantly review their everyday activities to make sure they did not commit any harmful acts or mistakes, such as checking if they turned off the gas stove or their hairdryer, or locked their doors before leaving.
4. Avoidance: People with OCD often go to extreme lengths to avoid people, places, and situations that trigger their obsessions.
5. Other compulsions: People may count while performing tasks to end on a good number. They may follow rigid rules of order, such as arranging their clothes by colour or alphabetizing their books. Disruption of their order can be very upsetting for those with OCD. They may also repeatedly ask for reassurance from others.

Causes

The exact causes of Obsessive Compulsive Disorder have been elusive to experts. However, certain risk factors which increase the chance of developing the disorder have been identified.

• Genetic Factors: Studies have shown that Those who have a parent or sibling with OCD have an increased chance of developing the disorder.
• Biology: Brain imaging studies indicate that there are differences in the frontal cortex and subcortical structures (areas of the brain that impact behaviour and emotional responses) of people with OCD.
• Temperament: Researchers have also found that people who experience negative emotions, exhibit behaviour that is reserved, and show symptoms of anxiety and depression as children are more prone to developing OCD.
• Childhood trauma: Some studies have shown a correlation between childhood trauma and OCD.

Treatments

Although Obsessive-Compulsive Disorder is lifelong and there are no remedies that can get rid of it completely, there are numerous treatment options that are greatly helpful in managing symptoms and leading anxiety-free lives, even for those with severe forms of the condition. A mental health professional can help guide a person with OCD in determining which combination of treatment options will be the most suitable taking into account the specificities of their condition. Following are some of the treatments available for those suffering from OCD:

1. Psychotherapy:

Psychotherapy is an effective treatment for both adults and children diagnosed with OCD. Several kinds of therapies may relieve the symptoms, independently or when combined with medication can be an effective treatment for adults and children with OCD. The most widely used is Cognitive behavioural therapy (CBT). It is a type of talk therapy that helps people identify their harmful or irrational patterns of thinking. During CBT, people learn to question their negative thoughts and determine the changes they can make in their feelings and actions, eventually transforming their behaviour.

A specific type of CBT, especially effective for OCD, is ‘Exposure and Response Prevention Therapy’ (ERP). In ERP, people with OCD, in a safe environment, are exposed to situations that trigger their obsessions (such as touching dirty objects) and instructed to avoid engaging in their usual compulsive behaviour (such as excessive hand washing). By staying in a feared situation without any terrible consequences, patients learn that their anxiety is unreasonable. People gradually learn to cope with their thoughts without relying on compulsions. This method may initially cause anxiety, which creates a risk of the patient abandoning the treatment prematurely. But with continual treatment, compulsions decrease for most people.

2. Medication:

Mental health professionals may prescribe medication for OCD. Antidepressants, known as SSRIs (selective serotonin reuptake inhibitors), typically used to treat many anxiety-related disorders, are effective for OCD as well. However, the SSRI is often higher for OCD than depression. It might take up to 2 to 4 months for them to start working.

3. Neuromodulation:

In rare cases, when neither therapy nor medication are helpful, doctors might consider neuromodulation treatments for OCD, which involve devices that alter the electrical activity in certain areas of the brain. One such treatment is repetitive ‘Transcranial Magnetic Stimulation’ (TMS). TMS is an FDA-approved, non-invasive therapy that uses magnetic fields to deliver low-intensity pulses which stimulate nerve cells. A more complicated, surgical procedure is ‘Deep Brain Stimulation’ (DBS). It uses electrodes that are implanted in your head to directly stimulate particular sites in the brain. However, because it is still highly invasive and complex, it is reserved only for very severe cases of OCD, when all other treatments have failed.

4. Relaxation:

Sometimes, simple activities such as meditation, yoga, and massages can also help alleviate OCD symptoms, especially when they have been aggravated because of stress.

Frequently Asked Questions

1. How do I know if I have OCD?

OCD is characterized by obsessions and compulsions that cause immense distress to an individual. Obsessions are unwanted, uncontrollable, and impulsive thoughts, urges or images that plague a person and cause them anxiety as a result of which they engage in compulsions. Compulsions are repetitive acts or behaviours that a person maladaptively engages in to alleviate their anxiety. These take up a lot of the individual’s time daily. 

2. Can OCD go away?

OCD cannot just go away. There is unfortunately no cure for this disorder but several treatments exist that can help patients to manage their symptoms and live a productive life. 

3. At what age does OCD start?

OCD can occur anytime between childhood and adulthood. There are two specific age ranges when it is diagnosed most commonly- between 10 to 12 years of age and between late teens to early adulthood. 

4. Does OCD affect memory?

Theoretically, OCD is expected to be linked to memory deficits but experimental evidence for the same has yielded mixed results. Many studies suggest that people with OCD have low confidence in their memories. 

5. Can I beat OCD on my own?

OCD is a debilitating mental health condition that requires professional attention. While it may be possible for some people to combat OCD on their own, a majority of people receive psychotherapy and medications for it. 

Conclusion

This article has explored OCD, including its definition, symptoms, risk factors associated with it, and treatment options. OCD goes far beyond the reductionist stereotypes of excessive cleanliness and organisation and can manifest in several ways. However appropriate and adequate treatments administered by mental healthcare professionals are significantly helpful for people suffering from OCD. But, the stigma around the disorder and the shame experienced by people with OCD can make it extremely difficult for them to seek professional help.

It is essential to understand OCD, for both those who are affected by it and society as a whole. By increasing awareness and eliminating misconceptions and myths around the disorder, we can reduce stigma and ensure that people with OCD receive the support they require. While further research continues to develop a better understanding of the underlying causes and possible treatments, we must remember that individuals with OCD are more than their condition, and treat them with empathy and compassion.