Comprehensive Notes on Obsessive-Compulsive Disorder

Introduction to Obsessive-Compulsive and Related Disorders

  • Obsessive-Compulsive and related disorders are characterized by:

    • Intrusive, unwanted thoughts/impulses (Obsessions).

    • Repetitive behaviors/mental acts (Compulsions).

  • Cause distress, impair functioning, and interfere with daily activities.

  • DSM-5 recognizes it as a distinct diagnostic category.

  • Includes:

    • Hoarding disorder.

    • Body dysmorphic disorder.

    • Trichotillomania.

    • Excoriation.

Body Dysmorphic Disorder

  • Preoccupation with perceived imperfections in appearance.

  • Obsessed with perceived flaws to the point that they believe they are ugly.

  • Entails repetitive activities or thinking.

Trichotillomania

  • Recurrent hair pulling.

  • Causes significant anguish and functioning issues.

Dermatillomania

  • Excessively frequent picking at one’s own skin that results in lesions.

  • The skin-picking activity is very disturbing.

Hoarding Disorder

  • Accumulate an excessive quantity of things and keep them in an unorganized way, which typically leads to uncontrollable clutter.

Obsessions

  • Recurrent and persistent thought, urge, or image that is experienced as intrusive and unwanted.

  • Individuals try to suppress or ignore the thought by engaging in other thoughts or images.

  • Obsessions frequently manifest as:

    • Wishes.

    • Urges.

    • Images.

    • Ideas that the person tries to eliminate or repress.

Types of Obsessions

  • Four major types of obsessions, each being associated with a pattern of compulsive behavior.

Symmetry Obsessions

  • Maintaining order and following certain procedures.

Prohibited Thoughts

  • Improper thoughts, such as violent intrusive thoughts or visions of themselves acting violently or abusively, it can make them feel dangerous.

Cleanliness or Contamination Anxieties

  • Center around cleanliness or contamination anxieties.

  • Individuals who have this discomfort frequently believe that there are germs nearby.

Hoarding

  • Intrusive thoughts regarding the acquisition of objects and a difficulty in getting rid of them.

Compulsions

  • Behavior or ideas used to control obsessions and bring comfort.

  • Produce distress or anxiety if not carried out “correctly”.

  • People feel compelled to participate in the compulsive behavior.

  • Only factor into a mental health diagnosis when they cause distress, get in the way of daily living, or put someone’s health in danger.

  • OCD is one of the most incapacitating mental illnesses due to the poorer quality of life and significant functional impairment it causes, Stein et al. (2009).

  • The individual must also understand that the fixation is a creation of their own minds rather than something that was forced upon them (as might occur in schizophrenia).

  • However, in OCD, the compulsive behaviour that goes along with the excessive, persistent, and distressing ideas disrupt daily activities.

  • The regularity, intensity, and degree to which obsessions and compulsions are resisted and are distressing vary between normal and abnormal obsessions and compulsive behaviour

In-text Questions

  • Majority of obsessive thoughts center around

  • (c) Cleanliness or contamination anxieties

  • is a behavior or ideas used to control obsessions and bring comfort.

  • Compulsions are behaviors or ideas used to control

  • (a) Obsessions

  • thoughts are intrusive or violent which can make OCD patients feel dangerous

  • (d) Prohibited thoughts

Prevalence, Age of Onset, Gender Differences, and Co-Morbidity with Other Disorders

  • Indian life time prevalence was 0.6%.

  • A review found a pooled prevalence of 1.6% with a range of 0.47% to 2.76% in various studies.

  • Males begin significantly sooner than females do.

  • OCD typically first manifests around the age of 20, but it can happen at any age, even as early as two years old in infants.

  • OCD frequently co-occurs with illnesses like Tourette’s syndrome, depression, and social phobia.

Psychosis and OCD

  • Obsessive doubts, washing, and checking compulsive behaviours were found to be the most prevalent OC symptoms in OCD with psychosis

  • First Rank symptoms of schizophrenia were present in about half of the cases.

Bipolar Disorder and OCD

  • Depression, social phobia, and generalized anxiety disorder were all linked to bipolar and OCD.

  • OCD was present in the majority of patients before they developed bipolar illness, and it got worse during depression and got better during mania.

Parkinson’s Disease and OCD

  • Regarding OC symptoms, clinical and subclinical OCD, and tics, there was no variation between the groups.

Schizophrenia and ADHD

  • Paranoid symptoms and first- rank symptoms of schizophrenia were more prevalent in schizo-obsessive individuals.

OCD and ADHD

  • Between 0 and 51% of OCD patients have ADHD

  • Differentiating between primary attentive symptoms and attentive symptoms secondary to anxiety disorders is crucial for prognosis and treatment because both of the two conditions may show symptoms of inattention.

Case Study of OCD

  • Sita, a 30-year-old, is married and mother of four and has had anxiety for a while.

  • She had been depressed for the previous three months, and her family doctor eventually recommended that she must get counseling.

  • Sita had been plagued by intrusive, repeated thoughts about the security of her kids for the past few months.

  • Sita added that the extensive number of counting rituals she engaged in throughout each day severely interfered with her ability to go about her daily business.

  • Sita discovered that certain numerals had come to hold a special significance for her and that her fixation on them was preventing her from carrying out daily tasks.

  • Sita acknowledged the irrationality of these rituals but, nevertheless, maintained that she felt much more comfortable when she observed them conscientiously.

  • Along with her compulsive behaviour and obsessive thoughts, Sita also noted issues with her marriage and parenting.

  • Prior to her initial visit to the mental health facility, her spouse had been placed on complete physical disability for 11 months.

Symptoms Covered in the Case Study (in accordance with DSM-5)

  • Sita’s need to count things, which she feels compelled to do as a result of her fascination with numbers.

  • Sita had been plagued by intrusive, repeated concerns about the security of her kids.

  • Sita’s obsession with numbers and other behaviours, such as smoking cigarettes (Substance abuse).

  • Sita acknowledged the absurd of the routines, but she insisted that she felt much more at ease when she diligently followed them.

  • Sita’s inability to manage her children was making her increasingly upset, and she was receiving little to no assistance from her husband.

  • Unwarranted anxiety.

DSM-5 Criteria for Obsessive-Compulsive Disorder

  • Figure 4.4: DSM-5 Criteria of Obsessive-Compulsive Disorder (Source: https://www.google.com/url?sa=i&url=https%3A%2F%2Fneupsykey.com%-2Fobsessive-compulsive-and-related-disorders%2F&psig=AOvVaw25QopEtaooiBWol-6jlHOCo&ust=1678533220474000&source=images&cd=vfe&ved=0CBAQjRxqFwoTC-JiTq9id0f0CFQAAAAAdAAAAABA)

Dynamics of Obsessive Compulsive Disorder

  • There is not a single factor which contributes to OCD. But there are biological, psychological and social factors that are implicated in Obsessive-Compulsive Disorder.

Psychological Causal Factors

  • According to some psychologists, Obsessive-Compulsive behavior arises because it helps people feel less anxious.

  • Cognitive elements that contribute to the intense doubts associated with OCD have been explored by psychologists.

Figure 4.5: Flawed thinking areas

  • Individuals with OCD show Thought Confusion in which the stressful thought about an action, event, object, combine with the event.

OCD as Learned Behavior

  • The two-process hypothesis of avoidance learning developed by Mowrer is the basis for the prevalent behavioural or learning perspective on obsessive-compulsive disorder (1947).

  • Once they’ve established the connection, they might find that washing their hands can help them feel less anxious when they shake their hands or touch a doorknob.

OCD and Preparedness

  • By considering obsessive-compulsive disorder in the context of evolution, we have also improved our knowledge of the condition e.g., De Silva, Rachman, & Seligman, (1977); Rappoport, (1989).

Cognitive Causal Factors

  • Normal people may experience a paradoxical rise in undesired thoughts after trying to suppress them

Appraisals of Responsibility for Intrusive Thoughts

  • Cognitive theorists have made a distinction between intrusive or compulsive thoughts as such and the catastrophic assessments that people have about having such ideas.

  • The term “thought-action fusion” describes this.

Cognitive Biases and Distortions

  • Obsessive-compulsive disorder has also been linked to cognitive issues.

Biological Causal Factors

  • Genetic Factors

  • Most family studies have reported 3 to 12 times higher rates of OCD in first-degree relatives of OCD clients than would be anticipated from current estimates of the incidence of OCD, which is consistent with twin studies

  • Last but not least, research demonstrates that early-onset OCD has a higher genetic loading than later-onset OCD

OCD and the Brain

  • In the past 30 years, as brain-imaging tools have advanced, there has been a significant increase in the hunt for OCD-related abnormalities in the brain.

  • According to research, anomalies mostly affect the basal ganglia, a group of subcortical systems, as well as some specific cortical regions.

  • The orbital frontal cortex and the cingulate cortex/gyrus, which are both connected to the limbic region, have unusually high levels of activity in OCD sufferers, according to the results of numerous research employing PET scans.

Neurotransmitter Abnormalities

  • According to recent research, OCD symptoms may be caused by increased serotonin activity and enhanced sensitivity of particular brain regions to serotonin.

Social and Sociocultural Dimensions

  • Family factors like a controlling, overly critical parenting style, little parental affection, and a disapproval of autonomy are linked to the emergence of OCD symptoms (Challacombe & Salkovskis, 2009).

  • Those with OCD tend to experience more severe symptoms when they believe their relatives are critical or unfriendly (Van Noppen & Steketee, 2009).

In-text Questions

  • The obsessions and compulsions are

  • (a) Time consuming

  • According to Researchers individual with OCD show

  • (c) Thought confusion

Summary

  • The DSM-5 now recognizes them as a distinct diagnostic category, which includes OCD as well as hoarding disorder, body dysmorphic disorder (previously grouped with somatoform disorders), trichotillomania—compulsive hair pulling—previously grouped with impulse control disorders and excoriation—skin-picking