OBSESSIVE-COMPULSIVE DISORDER (OCD)
Obsessive-compulsive disorder (OCD) is a mental health disorder that causes recurring and intrusive impulses or thoughts that cause distress. These impulses are often accompanied by strict routines, repetitive behaviors, or mental acts that must be performed as part of the obsessive ritual.
The “obsessive” part of OCD refers to intrusive thoughts. These intrusive thoughts are often preoccupied with avoiding or mitigating personal harm or harm to a loved one. Common obsessions include fear of germs and contamination, a particular need for symmetry and order, disturbing thoughts, or a persistent fear of harm or danger.
The “compulsive” part of OCD refers to compulsive behaviors performed to mitigate the obsessions. An obsession with personal security, for example, can manifest as a compulsive behavior to check and recheck locks multiple times prior to leaving the house or going to bed for the night. Common compulsions include excessive handwashing or cleaning of living spaces, repetitive checking behavior (repeatedly checking door locks or household appliances, such as the stove), counting specific items (streetlamps, for example), touching objects, or arranging objects in a specific way.
What Causes OCD?
Research has still not determined exactly what causes OCD. There are a number of likely theories for potential causes of OCD, which include genetic factors, environmental factors, learned behavior or biological factors.
Biological Factors for OCD
Brain imaging studies have demonstrated different blood flow patterns in the brain in people with OCD compared to non-OCD sufferers. The basal ganglia region of the brain is one area that has shown differences in people with OCD and may account for obsessive-compulsive behavior. This area of the brain is primarily responsible for motor control but also plays an important role in other activities such as reward and reinforcement, addictive behaviors, emotional behaviors, and habit formation.
In a study involving children with OCD who demonstrated differences in the basal ganglia, the differences in the basal ganglia were linked to a streptococcal infection. The body’s immune response to infections creates antibodies that can cross-react with the basal ganglia, leading to a manifestation of OCD.
This theory does not fully explain occurrences of OCD, however, and it is likely that if the immune response is a factor, it requires another element, such as a genetic predisposition for OCD in order to activate.
Genetic Factors that Contribute to OCD
Research points to a genetic predisposition that could partially account for occurrence of OCD. In a meta-analysis review, it was determined that a person with OCD is four times more likely to have another family member who has OCD than someone who does not have the disorder, indicating that OCD may travel in families. A genetic predisposition toward OCD cannot fully account for OCD occurrence, however, as many people with OCD do not have any other family members diagnosed with OCD. While genetics may play a contributing role in OCD, a genetic predisposition is not the only contributing factor.
Psychological Factors that Contribute to OCD
Various psychological factors have been theorized to contribute to OCD, with research suggesting that OCD stems from learned avoidance behavior. The link between the obsession (thoughts) and the compulsion (the avoidance behavior) is thought to cause a continued perpetuation of the anxiety that feeds the obsession. As the person’s anxiety increases, the compulsive behavior increases as well. The compulsive behavior may alleviate the anxiety for a short period of time but does not eliminate it entirely, thus ensuring a constant and persistent state of heightened anxiety.
While each proposed theory has some scientific backing to suggest a possible cause for OCD, it is most likely that a combination of factors is responsible for causing OCD.
What are the Symptoms of PTSD?
OCD is characterized by a persistent state of worry and anxiety. The intrusive thoughts produce a fixation on a particular aspect (cleanliness, personal safety, neatness and order), which causes a constant state of anxiety about the aspect. The compulsive behavior associated with the aspect is an attempt to keep the aspect in acceptable order.
Common OCD Obsessions
- Needing things in a particular order
- Needing objects to be symmetrical
- Fear of dirt, germs, or contamination
- Unwanted thoughts, including aggression, sexual fixation or religious subjects
- Fear of being contaminated by touching objects others have touched or by shaking hands
- Recurring doubts that you have turned off the stove or locked the door
- Feeling intense stress if objects aren’t orderly or facing a certain way
- Thoughts about shouting obscenities or acting inappropriately in public
- Unpleasant sexual images
Common OCD Compulsions
- Making up rules or rituals to perform
- Highly ritualistic washing and cleaning
- Repetitive checking behavior (time, locks, appliances)
- Repetitive counting (streetlamps, taxis, sidewalk cracks)
- Touching objects in a particular way
- Silently repeating a prayer, word, or phrase
- Arranging items (such as in the pantry) to face the same way
Without treatment, OCD can become a prison that entraps people in a world consumed by intrusive thoughts and behaviors. Those living with OCD often describe it as a constant mental burden of thought, worry, and compulsive behavior that robs them of their free will. The mental energy required to deal with the obsessive thoughts and compulsive behaviors becomes exhausting, leaving them constantly drained.
OCD can cause self-isolation, where it becomes easier to stay at home rather than subject themselves to engaging with people or situations that may trigger compulsive behavior.
What Treatments Work for OCD?
While there is not currently a cure for OCD, there are several treatments which are effective at alleviating symptoms and making OCD more manageable. With treatment, those suffering from OCD can reduce or eliminate the intrusive thoughts and compulsive behaviors, allowing them to live a normal life.
Common Treatments for OCD
Therapy is often the first treatment recommended for OCD. Exposure and Response Prevention (ERP) therapy and Cognitive Behavioral Therapy (CBT) are two types of therapy that help patients with OCD. ERP therapy focuses on eliminating the compulsive behavior associated with the obsessive thoughts, while CBT focuses on understanding root causes and identifying appropriate thought patterns and coping strategies.
Antidepressants are also used to treat OCD. Several different types of antidepressants are FDA-approved for treating OCD. To find the medication that is right for you, visit a psychiatrist or psychiatric mental health nurse practitioner (PMHNP). In Utah, patients can visit Ampelis Health to see a psychiatrist or PMHNP to treat their OCD.
Transcranial Magnetic Stimulation (TMS)
TMS is an excellent, non-medication treatment for OCD. TMS is an FDA-approved treatment for OCD that directly targets brain function in order to overcome OCD thinking and behavior. TMS produces a stimulus/response effect in the brain, prompting the brain to develop new, healthy pathways that produce healthy brain function once again.
TMS therapy is delivered in a psychiatrist’s office and is safe and effective, with no systemic side effects. TMS has proven particularly effective in patients who did not achieve satisfactory relief from OCD through medication. In one study, two-thirds of medication-resistant OCD patients achieved a meaningful reduction in OCD symptoms after only four weeks. Source
For many patients suffering from OCD, TMS treatment has been a life-changing treatment that allowed them to finally reclaim their lives from OCD. Even when other treatments had failed, patients saw significant relief and remission from OCD symptoms after TMS treatment.
To be evaluated for TMS treatment for OCD, schedule an appointment with an Ampelis Health psychiatrist or PMHNP.
Which treatment is best for OCD?
All treatment options discussed above have a satisfactory track record of helping patients overcome OCD. Each patient’s circumstances are unique, and treatment outcomes will vary based on these individual circumstances. To determine which OCD treatment option is best for you, consult with a qualified mental health professional, such as an Ampelis Health Utah-based psychiatrist or PMHNP.