Everybody fears and worries in certain situations, but for a few people the worrying and thinking is excessive and obsessive and they need to undertake a few compulsive rituals to get rid of their unwanted thoughts. A typical example would be the person that is obsessed with clean hands (obsessive) and thus washes them constantly for over 15 minutes (compulsively over and over and over.). The definition of an obsession is a disturbing preoccupation with an idea or feeling. These thoughts are often accompanied by urges or impulses to act in a certain way. Repeatedly checking if the doors are locked, washing hands, cleaning utensils over and over again and other repetitive tasks are common symptoms of an obsessive compulsive disorder.
People who suffer from obsessive compulsive disorder do not necessarily gain pleasure from their repeated acts but it provides them a temporary relief. Thus each ritual needs to be performed over and over again and never allows complete satisfaction.
Symptoms of Obsessive Compulsive Disorder:
- Endless cycles of repetitive thoughts (obsessions) and behaviors (compulsions)
- Most of the thoughts are distressing (because they are violent or obscene, or simply because they are senseless)
- Doubts about completion of task – Repeated checking,
- Fear of dirt and/or contamination,
- Repeated doubts about life or friends and family,
- Need to keep things in a specific order or symmetry,
- Fearing something bad will happen if an object/item is thrown away,
- Repeated thoughts/images of sexual fantasies ,
- Sudden impulses of aggression or horrific things.
- Fear of causing harm to yourself or others,
- Unreasonable interest in religious rituals,
- Repeatedly checking if loved one is safe.
- The patterns of behavior take up too much time and interfere with their daily lives.
- The sufferer often tries to resist the thoughts but often fails.
Case Story:
Carla is a 27 year old customer care executive. By nature she likes cleanliness and wants things to be perfect. Since the last three months she’s been increasingly worried about the cleanliness of her house. She fears that the utensils in the kitchen are dirty and contaminated.
She washes the utensils 5-6 times daily, but if she doesn’t do this, then she feels extremely anxious and worried and feels something bad may happen to her family. Irrational Rituals like these make her nervousness go away, but only for a short while.
While Carla knows the fears are irrational, she is unable to control her thoughts. She even repeatedly washes her hands just to make sure they are clean. Lately these habits are slipping out of Carla’s control and she feels more and more anxious.
Her husband Chris is concerned about her behavior and he believes these thoughts are ridiculous and they make no sense to him, but Carla can’t ignore her thoughts.
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What causes Obsessive Compulsive Disorder?
- An imbalance in the neurochemical serotonin is thought to be responsible for OCD. Serotonin acts as a “bridge” in sending nerve impulses from one nerve cell to the next, and helps in regulating repetitive behaviors, when there is an imbalance in Seretonin this mechanism is deranged and repetitive behaviors ensue.
- Patients usually have decreased serotonergic activity but increased dopaminergic activity. This explains why selective serotonin uptake inhibitors (SSRI antidepressants) and neuroleptics that work on dopaminergic system have some value in treating obsessive compulsive disorder.
- Research studies have also found Autoimmune factors in the body of the patients which act against brain peptides (basal ganglia) and cause OCD like symptoms.
- Other mental or psychological stress factors may also trigger OCD.
- Role of genetics is confirmed by studies showing that twins have a higher incidence of the illness. Family history may reveal depression/anxiety/mood disorders in relatives.
How common is Obsessive Compulsive Disorder?
- Occurs in 0.5 – 2% of general population
- OCD effects about 3.3 million adult Americans.
- It is just as prevalent in men as in women and it attacks people of all ages.
- OCD has an early onset , usually before the age of 25 years
- Most adults recognize symptoms beginning in childhood. In some cases symptoms get better with age, but not always.
- Sometimes symptoms increase or ease up depending on life events.
Treatment for Obsessive Compulsive Disorder:
A) Therapy:
Cognitive Behavior Therapy:
Individual Cognitive Behavior Therapy (CBT) is known to be effective for OCD.
Dr. Jeffrey Schwartz’ Four Steps method is known to be effective in the treatment of OCD:
The basic principle is that by understanding what these thoughts and urges really are, you can learn to manage the fear and anxiety that OCD causes. Managing your fear, in turn, will allow you to control your behavioral responses much more effectively. You will use biological knowledge and cognitive awareness to help you perform exposure and response prevention on your own. This strategy has four basic steps:
Step 1: Relabel :
Learn to recognize obsessive thoughts and compulsive urges. You should literally make mental notes, such as, ‘This thought is an obsession; this urge is a compulsive urge.”
Learn to Relabel intrusive thoughts and urges in your own mind as obsessions and compulsions~and to do so assertively. Start calling them that; use the labels obsession and compulsion. For example, train yourself to say, “I don’t think or feel that my hands are dirty. I’m having an obsession that my hands are dirty.” Or, “I don’t feel that I have the need to wash my hands. I’m having a compulsive urge to perform the compulsion of washing my hands.”
These urges are caused by biological imbalances in the brain. By calling them what they really are–obsessions and compulsions–you begin to understand that they do not really mean what they say.
Step 2: Reattribute:
The goal is to learn to Reattribute the intensity of the thought or urge to its real cause, to recognize that the feeling and the discomfort are due to a biochemical imbalance in the brain. It is OCD–a medical condition.
Using the Reattribute step will also help you to avoid performing rituals in a vain attempt to “get the right feeling” (for example, a sense of “evenness” or a sense of completion). Knowing that the urge to get that “right feeling” is caused by a biochemical imbalance in the brain, you can learn to ignore the urge and move on. Remember, “It’s not me–it’s my OCD.”
Step 3: Refocus
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In Refocusing, the idea is to work around the OCD thoughts and urges by shifting attention to something else, if only for a few minutes. Any constructive, pleasant behavior will do. Hobbies are particularly good.
Step 4: Revalue:
After adequate training in the first three steps, you are able in time to place a much lower value on the OCD thoughts and urges that were previously causing much distress.
The goal is to perform these steps daily. (The first three steps are especially important at the beginning of treatment.)
When the thought comes, you first Relabel it as an obsessive thought or a compulsive urge and then Reattribute it to the fact that you have OCD–a medical problem. Then Refocus your attention to this other behavior that you have chosen.
For more reading on the Dr. Jeffrey Schwartz’ Four Steps , go to http://www.ocduk.org/2/foursteps.htm
Self-treatment is an essential part of this technique for learning to manage your responses to OCD on a day-to-day basis.
Exposure and Response Prevention (ERP):
Exposure and Response Prevention (ERP) has also proven effective in the treatment of OCD.
ERP is a method of treatment in which the patient is exposed repeatedly to the situation that causes them distress and anxiety (e.g. exposure to dirt) and the patient is prevented from performing repetitive actions that lessens that anxiety (e.g. washing their hands).
Prior to the start of the therapy the patient is counseled and the patient is fully aware of what to expect. After an initial increase in anxiety, the levels come down gradually. This is extremely therapeutic, as the patient feels that they have confronted their worse fears without anything terrible happening.
In many cases a combination of CBT and Exposure and Response Prevention has shown promising results.
Group CBT can also help in the treatment of OCD.
B) Medical treatment for OCD:
SSRIs(Selective Serotonin Re-uptake Inhibitors) are considered as first line treatment for OCD and are recommended.
Caution is advised in view of increased risk of suicidal thoughts and self-harm in people with depression.
Clomipramine, sertraline, paroxetine fluoxetine, citalopram, escitalopram and fluvoxamine are effective.
Recommended Dosages:
- Fluoxetine – 60-80 mg,
- Paroxetine 40-60 mg,
- Sertraline 200 mg
A trial of SSRI therapy should be continued for atleast 8 to 12 weeks, with at least 4-6 weeks at the maximal tolerable dosage.
SSRIs should be taken for at least 1-2 years before planning to discontinue. There is also Linden method of treatment for treating anxiety disorders.
How to Prevent recurrence of Obsessive Compulsive Disorder in future:
Once the symptoms of OCD have improved, a number of strategies can help maintain the gains you have made.
- Learn as much as you can about OCD and keep reading about it
- Train yourself to handle compulsive urges; learn and use healthy strategies for coping with stress and fears.
- If you are using medication, continue to take it until your doctor advises you to taper it down and stop it.
- Share facts that can help you with obsessive compulsive disorder and get your family and friends involved in your recovery.
- Create a healthy lifestyle with a balanced diet, exercise and good sleep habits.
- Try to develop a well-balanced life with enough time for work, family, friends and leisure activities.
- Plan your schedule for follow-up treatment.
- Set goals and plan your future.
- Be prepared to handle setbacks: Sometimes you may see a recurrence of symptoms, have a clear plan to identify and deal with the symptoms of they reappear.
- You also need to know the best non medical treatment techniques which will help you to cure obssessive compulsive disorder.
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