What is Obsessive Compulsive Disorder (OCD)?

What is obsessive compulsive disorder?

Obsessive- compulsive disorder (OCD) , also known as an obsessive-compulsive disorder , is a mental health disorder that affects people of all ages and lifestyles and occurs when the person is caught in the obsession and compulsion cycle.

Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing emotions.

Compulsions are behaviors that an individual engages in to get rid of obsessions or relieve distress.

Most people have obsessive thoughts and compulsive behaviors at some point in their lives, but that doesn’t mean we all have “a little bit of OCD.” For a diagnosis of obsessive compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it often puts the person in a difficult situation and prevents important activities that need to be done.

What causes obsessive compulsive disorder?

For OCD to develop, several components usually need to come together, such as:

Genetic factors

Various research projects have found an increased incidence of OCD and anxiety disorders in relatives of those affected. Children are also at increased risk of developing it if one or both parents have OCD. However, since most people with obsessive compulsive disorder have healthy families, the genetic link is considered quite low. It is also unclear to what extent children inherit some thoughts and behaviors from their parents through model learning.

Neurobiological factors

In those affected, certain areas of the brain are hyperactive. These fields are special filter systems for information processing. Successful treatment of compulsions is related to the normalization of the hyperactivity of these brain regions. The compulsion to collect (hoarding essentially worthless objects) due to neurobiological factors also occurs more frequently and may exist independently of OCD.

Upbringing styles

Sensitive children can become insecure if high expectations are imposed on independence and responsibility at an early stage, if mistakes are too critically evaluated and successes are under-recognised. They then react more cautiously and fearfully in interpersonal contact and do so just to be safe. They try to be perfect and try to avoid mistakes and criticism, and in this way, obsessive compulsive disorder can develop. If parents repeatedly warn their children of dangers and are overprotective, this can trigger OCD later on. However, parenting styles are never solely responsible for the disease.

Formative events in the life story

If extraordinary stresses occur throughout life (for example, physical or sexual violence, emotional neglect, premature death of a parent), people who are already insecure can feel very overwhelmed. Obsessive-compulsive symptoms are used as a proxy to try to regain control of a situation that seems impossible to cope with.

Personality characteristics

People who absolutely want to avoid mistakes often cling to obsessive thoughts and compulsive actions. High levels of anxiety and low self-esteem also require more security and therefore can lead to compulsions. Marked shyness and poor assertiveness are also risk factors for obsessive compulsive disorder.

Triggers

There are emotionally stressful life events often associated with intense, negative emotions. This includes severe stress in private and family life, a transition to a new stage of life, or a state of persistent professional overload. These events do not have to be the cause of OCD. However, it is possible for susceptible people to be affected by this condition and develop OCD again.

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What are the symptoms of obsessive compulsive disorder?

In the case of obsessive-compulsive disorder, the person feels a strong internal urge to repeat or do things that they consider – at least at the onset of symptoms – to be pointless or exaggerated. Attempts to defend oneself against this urge often fail, and even this attempt to resist leads to an increase in thoughts and impulses. Stressful thoughts and feared disasters run into consciousness and create great restlessness, tension, or disgust.

Although the mind knows that the thoughts and fears are absurd or exaggerated, the sense of threat cannot be appeased. Obsessive thoughts and compulsive actions are tried to be eliminated with things that the person sees as a precaution and feels obliged to do. Insight into the absurdity of thoughts and actions is often a cause for shame for oneself. As a result, many patients try to hide their symptoms from friends and family.

Obsessions as a symptom

Obsessions (or obsessions) are thoughts, images, or impulses that occur over and over again and appear to be beyond the person’s control. Individuals with obsessive compulsive disorder do not want to have these thoughts and find them disturbing.

In many cases, people with OCD find that these thoughts don’t make any sense. Obsessions are typically accompanied by intense and disturbing emotions such as fear, disgust, doubt, or the feeling that things have to be done “right”.

In the context of OCD, obsessions are time-consuming and get in the way of important activities that the person values. It is extremely important to keep in mind that OCD prevents the person from doing the necessary activities and partially determines whether he or she has OCD as a psychological disorder rather than an obsessive personality trait.

Unfortunately, obsession is the term commonly used in everyday language. These more casual uses of the word mean that the person is intellectually preoccupied with a topic, an idea, or even a person. This “obsessive” in the everyday sense does not involve problems in everyday life and can even be useful at times.

You may be “obsessed” with a new song you hear on the radio, but despite this obsession, you can meet your friend for dinner, get ready for bed on time, and start work in the morning. In fact, individuals with OCD are obsessed with their OCD symptoms because it feels like they are reducing their struggle.

Everyone has a thought about getting sick from time to time, worrying about the safety of a loved one, or wondering if some mistake they’ve made could spell disaster. This does not mean that these obsessions are necessarily symptoms of obsessive compulsive disorder.

While these thoughts may look the same as you see in OCD, someone without OCD may also have these thoughts, worry for a moment and then go about their normal life.

In fact, research has shown that most people have unwanted obsessive thoughts from time to time. But in the context of OCD, these obsessive thoughts occur frequently and interfere with daily functioning, triggering extreme anxiety.

Common obsessions in OCD

Obsessions with fear of contracting certain diseases and infections:

  • Fear of contamination of bodily fluids such as feces and urine
  • Fear of contagion of germs and diseases
  • Fear of exposure to harmful things such as radiation
  • Fear of exposure to household chemicals
  • Fear of contamination

Obsessions related to fear of losing control:

  • Fear of controlling the urge to self-harm
  • Fear of controlling the urge to hurt others
  • Fear of violent or scary images in one’s mind
  • Fear of swearing or insulting, even if it’s thoughtful
  • fear of stealing something

Obsessions with fear of harm:

  • Fear of being responsible for something terrible to happen, like a fire or theft
  • Fear of harming others due to not being careful enough
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Obsessions with perfectionism:

  • Concern about neatness or precision
  • Anxiety needing to know or remember
  • Fear of losing or forgetting important information while throwing something away
  • Inability to decide to keep or throw things away
  • fear of losing something

Obsessions with unwanted sexual urges:

  • Forbidden or deviant sexual thoughts or images
  • Forbidden or deviant sexual urges about others
  • Obsessions about sexual orientation
  • Sexual obsessions involving children or incest
  • Obsessions with aggressive sexual behavior towards others

Obsessions with religious subjects:

  • Concern about offending God
  • Hypersensitivity to things like right/wrong

Other obsessions:

  • Worry about contracting a physical illness
  • Superstitions about lucky and unlucky numbers
  • Giving meaning to certain colors

Compulsions (repetitive behaviors) as a symptom

Compulsions are the second part of OCD. These are repetitive behaviors that a person uses to neutralize their obsessions, reduce anxiety, or eliminate their obsessions.

People affected by obsessive compulsive disorder realize that it is only a temporary solution, but they rely on compulsions as a temporary escape because they feel they have no other choice. Compulsions may also include avoiding situations that trigger obsessions. Repetitive behaviors can get in the way of important activities that the person values.

Similar to obsessions, not all repetitive behaviors or rituals are compulsions. Here, it is necessary to look at the function and context of the behavior. For example, bedtime routines, religious practices, and learning a new skill all involve repeating an activity over and over, but are often a positive and functional part of daily life.

Behaviors depend on context. If one works in a library, organizing eight hours a day is not a compulsion. Similarly, if you’re meticulous only for details or if you like everything neatly arranged, you may have “compulsive” behaviors that don’t fall under obsessive compulsive disorder. In this case, compulsive refers to a personality trait or something about yourself that you really prefer or like.

In most cases, individuals with OCD are tempted to engage in compulsive behavior and do so constantly because they feel compelled to do so. In OCD, compulsive behavior is done to try to escape or reduce the anxiety or the presence of obsessions.

Common compulsions (repetitive behaviors) in OCD

Compulsions about cleaning:

  • Excessive or specific washing of hands
  • Excessive showering, bathing, brushing, grooming or toilet routines
  • Excessive cleaning of household items or other objects
  • Doing all sorts of things to prevent or remove contact with contaminants

Compulsions to check:

  • Constantly checking things out for fear of harming others or oneself
  • checking things for concern to make sure nothing terrible happens
  • Constantly checking yourself or someone else so that no mistakes are made
  • Checking his physical condition or parts of his body

Compulsions that are felt to be repeated:

  • Reading or writing the same thing over and over
  • Repetitive routine activities, such as going in or out, getting up from a chair
  • Repetitive body movements such as tapping and blinking
  • Repeating activities multiple times, such as doing a task three times

mental compulsions:

  • Mental examination of events to prevent harm
  • Praying to prevent possible dire consequences
  • Constantly reviewing spoken words for fear of being misunderstood

Other compulsions:

  • Constantly checking and arranging until you feel that things are done right
  • Asking the same thing over and over to trust

How is obsessive compulsive disorder diagnosed?

The doctor asks for exact symptoms and personal medical history in a detailed interview. A diagnosis of obsessive compulsive disorder is when the obsessive thoughts or repetitive movements are so prominent that they affect the lives of those affected. It is then recommended that the affected person meet with a psychiatrist and psychotherapist. After the doctor has reviewed all the indicators, he or she can distinguish whether it is indeed a case of OCD or an underlying disease.

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The following details are important for the diagnosis of OCD:

  • The obsessive thoughts or repetitive behaviors must have been present for at least two weeks.
  • Repetitive behaviors are meaningless and must originate from obsession.
  • Symptoms should affect daily life.
  • Repetitive actions must be the result of one’s own choice.
  • Resistance and consequent failure should lead to inner restlessness and fear.

Certain questionnaires are also used to ask about symptoms of obsessive thinking and compulsive behavior.

A thorough physical examination is also important. Because sometimes organic causes may be responsible for the observed symptoms. For example, compulsions occur more frequently in some neurological diseases. Sometimes an EEG examination or magnetic resonance imaging (MRI) of the skull is required to rule out other diseases .

How is obsessive compulsive disorder treated?

Since the problem of obsessive compulsive disorder has many different causes, treatment options are also multiple. OCD treatment is multifaceted and includes:

Behavioral therapy

A central component of behavioral therapy is practicing skills to cope with unpleasant emotional states triggered by obsessive-compulsive fears. Under the guidance of a trained therapist, after careful preparation, a person will become acquainted with situations that trigger compulsive fears.

If you don’t give in to the urge to act, you will learn that uncomfortable feelings can be dealt with even without compulsive actions. By repeating this exercise, the affected person will gain more and more confidence.

It is often necessary to repeat this method in daily life. the result will be less and less unpleasant thoughts and feelings. Although this procedure may seem stressful and even unimaginable at first, many people can benefit from it.

Coping group

In the group, it is aimed to understand how thoughts, feelings and impulsive actions, which are personal vicious circles, develop. Along with other affected people, the person will develop strategies for how to counteract it. The individual affected by obsessive compulsive disorder will learn to understand and cope with the restrictions initially experienced as meaningless. As part of an individual exposure plan, he will step by step approach situations that may be imperative and use new strategies. It will also be actively supported and encouraged by other group members.

Cognitive therapy

Cognitive strategies accompany exercise-focused therapies. While doing this, negative evaluations and thoughts are noticed, their sensitivities are checked and alternatives are developed if necessary. The goal is to perceive the thoughts experienced no longer as disturbing and threatening, but as part of the meaningless daily stream of thought.

For example, it is aimed to understand that the sudden thought “I may harm someone without realizing it” does not mean that the person is a dangerous or bad person. They realize that negative thoughts only become threatening when they give them meaning. The goal of obsessive compulsive disorder therapy is to help achieve more realistic expectations in the long term.

Medication

Drugs that work on the serotonin system are also effective in the treatment of obsessive compulsive disorder. However, in order to achieve an effect, serotonin reuptake inhibitors must be given in adequate doses and for a sufficiently long period of time. They work only when a certain concentration of active ingredient is present in the blood and various adaptation processes take place in the brain. This can take up to 12 weeks. When the drug is stopped again, obsessive thoughts and repetitive actions usually reappear. Therefore, behavior therapy, which is the treatment of forced exposure, should always be additionally carried out. In principle, drugs are the second option and should only be used when cognitive behavioral therapy is insufficient.

Remember, your doctor will decide which medicine to take and how.

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