What exactly are obsessions and compulsions?

Obsessive-Compulsive Disorders Research Paper

Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress..Obsessive-Compulsive Disorders Research Paper

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Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of obsessive compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it consumes a lot of time and gets in the way of important activities that the person values.

What exactly are obsessions and compulsions?
Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don’t make any sense. Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values. This last part is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.

Unfortunately, “obsessing” or “being obsessed” are commonly used terms in every day language. These more casual uses of the word means that someone is preoccupied with a topic or an idea or even a person. “Obsessed” in this everyday sense doesn’t involve problems in day-to-day living and even has a pleasurable component to it. You can be “obsessed” with a new song you hear on the radio, but you can still meet your friend for dinner, get ready for bed in a timely way, get to work on time in the morning, etc., despite this obsession. In fact, individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms.

Even if the content of the “obsession” is more serious, for example, everyone might have had a thought from time to time about getting sick, or worrying about a loved one’s safety, or wondering if a mistake they made might be catastrophic in some way, that doesn’t mean these obsessions are necessarily symptoms of OCD. While these thoughts look the same as what you would see in OCD, someone without OCD may have these thoughts, be momentarily concerned, and then move on. In fact, research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning.

What is obsessive-compulsive disorder (OCD)?
It’s normal, on occasion, to go back and double-check that the iron is unplugged or your car is locked. But if you suffer from obsessive-compulsive disorder (OCD), obsessive thoughts and compulsive behaviors become so consuming they interfere with your daily life. OCD is an anxiety disorder characterized by uncontrollable, unwanted thoughts and ritualized, repetitive behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational—but even so, you feel unable to resist them and break free.

Like a needle getting stuck on an old record, OCD causes the brain to get stuck on a particular thought or urge. For example, you may check the stove 20 times to make sure it’s really turned off, or wash your hands until they’re scrubbed raw. While you don’t derive any sense of pleasure from performing these repetitive behaviors, they may offer some passing relief for the anxiety generated by the obsessive thoughts.

You may try to avoid situations that trigger or worsen your symptoms or self-medicate with alcohol or drugs. But while it can seem like there’s no escaping your obsessions and compulsions, there are plenty of things you can do to break free of unwanted thoughts and irrational urges and regain control of your thoughts and actions..Obsessive-Compulsive Disorders Research Paper

OCD obsessions and compulsions
Obsessions are involuntary thoughts, images, or impulses that occur over and over again in your mind. You don’t want to have these ideas, but you can’t stop them. Unfortunately, these obsessive thoughts are often disturbing and distracting.

Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, if you’re afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive rituals and behaviors often end up causing anxiety themselves as they become more demanding and time-consuming. This is the vicious cycle of OCD.

Most people with OCD fall into one of the following categories:
Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen, or they will be punished.
Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. They may also suffer from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.
OCD signs and symptoms
Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time (at least one hour per day), and interfere with your daily life and relationships.

Most people with obsessive-compulsive disorder have both obsessions and compulsions, but some people experience just one or the other.

Common obsessive thoughts in OCD include:

Fear of being contaminated by germs or dirt or contaminating others
Fear of losing control and harming yourself or others
Intrusive sexually explicit or violent thoughts and images
Excessive focus on religious or moral ideas
Fear of losing or not having things you might need
Order and symmetry: the idea that everything must line up “just right”.Obsessive-Compulsive Disorders Research Paper
Superstitions; excessive attention to something considered lucky or unlucky
Common compulsive behaviors in OCD include:

Excessive double-checking of things, such as locks, appliances, and switches
Repeatedly checking in on loved ones to make sure they’re safe
Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety
Spending a lot of time washing or cleaning
Ordering or arranging things “just so”
Praying excessively or engaging in rituals triggered by religious fear
Accumulating “junk” such as old newspapers or empty food containers
OCD symptoms in children
While the onset of obsessive-compulsive disorder usually occurs during adolescence or young adulthood, younger children sometimes have symptoms that look like OCD. However, the symptoms of other disorders, such as ADHD, autism, and Tourette’s syndrome, can also look like obsessive-compulsive disorder, so a thorough medical and psychological exam is essential before any diagnosis is made.

OCD self-help tip 1: Learn how to resist OCD rituals
No matter how overwhelming your OCD symptoms seem, there are many ways you can help yourself. One of the most powerful strategies is to eliminate the compulsive behaviors and rituals that keep your obsessions going.

Don’t avoid your fears. It might seem smart to avoid the situations that trigger your obsessive thoughts, but the more you avoid them, the scarier they feel. Instead, expose yourself to your OCD triggers, then try to resist or delay the urge to complete your relief-seeking compulsive ritual. If resistance gets to be too hard, try to reduce the amount of time you spend on your ritual. Each time you expose yourself to your trigger, your anxiety should lessen and you’ll start to realize that you have more control (and less to fear) than you think.

Anticipate OCD urges. By anticipating your compulsive urges before they arise, you can help to ease them. For example, if your compulsive behavior involves checking that doors are locked, windows closed, or appliances turned off, try to lock the door or turn off the appliance with extra attention the first time.

Create a solid mental picture and then make a mental note. Tell yourself, “The window is now closed,” or “I can see that the oven is turned off.”
When the urge to check arises later, you will find it easier to re-label it as “just an obsessive thought.”
Refocus your attention. When you’re experiencing OCD thoughts and urges, try shifting your attention to something else. You could exercise, jog, walk, listen to music, read, surf the web, play a video game, make a phone call, or knit. The important thing is to do something you enjoy for at least 15 minutes, in order to delay your response to the obsessive thought or compulsion. At the end of the delaying period, reassess the urge. In many cases, the urge will no longer be quite as intense. Try delaying for a longer period. The longer you can delay the urge, the more it will likely change..Obsessive-Compulsive Disorders Research Paper

Tip 2: Challenge obsessive thoughts
Everyone has troubling thoughts or worries from time to time. But obsessive-compulsive disorder causes the brain to get stuck on a particular anxiety-provoking thought, causing it to play over and over in your head. The following strategies can help you get unstuck.

Write down your obsessive thoughts or worries. Keep a pad and pencil on you, or type on a laptop, smartphone, or tablet. When you begin to obsess, write down all your thoughts or compulsions.

Keep writing as the OCD urges continue, aiming to record exactly what you’re thinking, even if you’re repeating the same phrases or the same urges over and over.
Writing it all down will help you see just how repetitive your obsessions are.
Writing down the same phrase or urge hundreds of times will help it lose its power.
Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.
Create an OCD worry period. Rather than trying to suppress obsessions or compulsions, develop the habit of rescheduling them.

Choose one or two 10-minute “worry periods” each day, time you can devote to obsessing. Choose a set time and place (e.g. in the living room from 8:00 to 8:10 a.m. and 5:00 to 5:10 p.m.) that’s early enough it won’t make you anxious before bedtime.
During your worry period, focus only on negative thoughts or urges. Don’t try to correct them. At the end of the worry period, take a few calming breaths, let the obsessive thoughts or urges go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions and compulsions.
When thoughts or urges come into your head during the day, write them down and “postpone” them to your worry period. Save it for later and continue to go about your day.
Go over your “worry list” during the worry period. Reflect on the thoughts or urges you wrote down during the day. If the thoughts are still bothering you, allow yourself to obsess about them, but only for the amount of time you’ve allotted for your worry period.
Create a tape of your OCD obsessions. Focus on one specific worry or obsession and record it to a tape recorder, laptop, or smartphone.

Recount the obsessive phrase, sentence, or story exactly as it comes into your mind.
Play the tape back to yourself, over and over for a 45-minute period each day, until listening to the obsession no longer causes you to feel highly distressed.
By continuously confronting your worry or obsession you will gradually become less anxious. You can then repeat the exercise for a different obsession.
You’ve probably heard people jokingly proclaim themselves “OCD” as they straighten an askew picture on the wall or wipe their shopping cart handle down with antibacterial wipes, but are they just perfectionists or do they really have OCD? How common is obsessive-compulsive disorder (OCD)? What factors lead to a diagnosis?

What Is Obsessive Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by two core symptoms–obsessions and compulsions.

Obsessions are thoughts, images, or ideas that won’t go away, are unwanted, and cause extreme distress. For example, you might worry constantly about becoming contaminated with a deadly disease; that you will do something terrible, like scream out an obscenity at a funeral; or that something horrible will happen to a loved one.

Other common obsessions include repeated doubts, such as believing you may hit someone with your car; a need for order; aggressive or disturbing ideas such as thoughts of murdering your partner or child; and disturbing sexual and religious imagery.

Compulsions are behaviors that you feel you must carry out over and over. For instance, if you’re obsessed with contamination, you might wash your hands over and over again. Other common compulsions include cleaning, counting, checking, requesting or demanding reassurance, and ensuring order and symmetry..Obsessive-Compulsive Disorders Research Paper

Diagnosis of OCD
OCD cannot be diagnosed using a blood test, though a blood test may be used to rule out physical problems that could be causing symptoms.OCD is ultimately diagnosed based on the frequency, severity, and nature of symptoms using the clinical judgment of qualified mental health professionals.Obsessions and compulsions are usually continual and long-lasting and may negatively affect relationships, work, school, and other areas of life.

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People with OCD may spend an hour or more a day either thinking about their obsession or engaging in behaviors that temporarily relieve the anxiety caused by their obsession, (i.e., scrubbing their hands until they’re raw because they feel dirty). However, it is possible to have only the obsessions or only the compulsions and still be diagnosed with OCD. The key component of a diagnosis is that the OCD is interfering with your quality of life.

Causes of OCD
OCD affects about 1.2% of adults and is sometimes diagnosed in childhood. There is no difference in the rate of OCD among men and women. People of all cultures and ethnicity are affected.

No one knows exactly what causes obsessive-compulsive disorder, though there is evidence of a genetic component. If a parent, sibling, or child is diagnosed with OCD, there is a higher risk of developing the disorder, especially if the relative was diagnosed as a child or teenager.

There is also evidence that certain parts of the brain simply do not function correctly. Research on genetics and brain abnormalities is ongoing.

Treatment of OCD
OCD is not curable, but it responds to treatment with medication, particularly a class of antidepressants known as selective serotonin re uptake inhibitors (SSRI), as well as psychotherapy.

Exposure therapy may be particularly helpful to people whose OCD significantly impacts their quality of life.

Many people with OCD find that they get the best result by combining medical and psychological treatment.

I have been actively involved in the treatment of OCD since 1982 and have treated over 850 cases of the disorder. During that time, I have come to many valuable understandings that I believe are important tools for anyone planning to take on this disorder. Putting together this type of list always seems arbitrary in terms of what to include, but suffice it to say, however, it is presented, there is a certain body of information that can make anyone’s attempts at recovery more effective.

Some of these points may seem obvious, but it has always struck me as remarkable how little of this information my new patients, who are otherwise intelligent and informed people, are seen to possess coming into therapy.

You may not like some of the things on this list, as they may not be what you wish to hear. You don’t have to like them. However, if you wish to change, you will need to accept them. The concepts of change and acceptance go hand-in-hand and define each other. There are some things you will be able to change, and some you will have to accept. It is important to discriminate between the two, so as to not end up misdirecting your efforts..Obsessive-Compulsive Disorders Research Paper

My list is as follows:

1. OCD is chronic

This means it is like having asthma or diabetes. You can get it under control and become recovered but, at the present time, there is no cure. It is a potential that will always be there in the background, even if it is no longer affecting your life. The current thinking is that it is probably genetic in origin, and not within our current reach to treat at that level. The things you will have to do to treat it really control, and if you don’t learn to effectively make use of them throughout your life, you will run the risk of relapse. This means that if you don’t use the tools provided in cognitive/behavioral therapy or if you stop taking your medication (in most cases) you will soon find yourself hemmed in by symptoms once again.

2. Two of the main features of OCD are doubt and guilt

While it is not understood why this is so, these are considered hallmarks of the disorder. Unless you understand these, you cannot understand OCD. In the 19th century, OCD was known as the “doubting disease.” OCD can make a sufferer doubt even the most basic things about themselves, others, or the world they live in. I have seen patients doubt their sexuality, their sanity, their perceptions, whether or not they are responsible for the safety of total strangers, the likelihood that they will become murderers, etc. I have even seen patients have doubts about whether they were actually alive or not. Doubt is one of the more maddening qualities of OCD. It can override even the keenest intelligence. It is a doubt that cannot be quenched. It is doubt raised to the highest power. It is what causes sufferers to check things hundreds of times, or to ask endless questions of themselves or others. Even when an answer is found, it may only stick for several minutes, only to slip away as if it was never there. Only when sufferers recognize the futility of trying to resolve this doubt, can they begin to make progress.

The guilt is another excruciating part of the disorder. It is rather easy to make people with OCD feel guilty about most anything, as many of them already have a surplus of it. They often feel responsible for things that no one would ever take upon themselves

3. Although you can resist performing a compulsion, you cannot refuse to think an obsessive thought

Obsessions are biochemically generated mental events that seem to resemble one’s own real thoughts, but aren’t. One of my patients used to refer to them as “My synthetic thoughts.” They are as counterfeit bills are to real ones, or as wax fruit is to real fruit. As biochemical events, they cannot simply be shut off at will. Studies in thought suppression have shown that the more you try to not think about something, the more you will end up thinking about it paradoxically. The real trick to dealing with obsessions I like to tell my patients is, “If you want to think about it less, think about it more.” Neither can you run from or avoid the fears resulting from your obsessions. Fear, too, originates in the mind, and in order to recover, it is important to accept that there is no escape. Fears must be confronted. People with OCD do not stay with the things they fear long enough to learn the truth–that is, that their fears are unjustified and that the anxiety would have gone away anyway on its own, without a compulsion or neutralizing activity.

4. Cognitive/Behavioral Therapy is the best form of treatment for OCD

Cognitive/Behavioral Therapy (CBT) is considered to be the best form of treatment for OCD. OCD is believed to be a genetically-based problem with behavioral components, and not psychological in origin. Ordinary talk therapy will, therefore, not be of much help. Reviewing past events in your life, or trying to figure out where your parents went wrong in raising you have never been shown to relieve the symptoms of OCD. Other forms of behavioral treatment, such as relaxation training or thought-stopping (snapping a rubber band against your wrist and saying the word “Stop” to yourself when you get an obsessive thought) are likewise unhelpful. The type of behavioral therapy shown to be most effective for OCD is known as Exposure and Response Prevention (E&RP).

E&RP consists of gradually confronting your fearful thoughts and situations while resisting the performing of compulsions. The goal is to stay with whatever makes you anxious so that you will develop a tolerance for the thought or the situation, and learn that, if you take no protective measures, nothing at all will happen. People with OCD do not stay long enough in feared situations to learn the truth. I try to get my patients to stay with fearful things to the point where a kind of fatigue with the subject sets in. Our goal is to wear the thought out. I tell them, “You cant be bored and scared at the same time.” Compulsions, too, are part of the system and must be eliminated for the recovery process to occur. There are two things that tend to sustain compulsions. One is that by doing them, the sufferer is only further convinced of the reality of their obsessions, and is then driven to do more compulsions. The other is that habit also keeps some people doing compulsions, sometimes long after the point of doing them is forgotten. The cognitive component of CBT teaches you to question the probability of your fears actually coming true (always very low or practically nil), and to challenge their underlying logic (always irrational and sometimes even bizarre)..Obsessive-Compulsive Disorders Research Paper

5. While medication is a help, it is not a complete treatment in itself

It is human nature to always want quick, easy, and simple solutions to life’s problems. While everyone with OCD would like there to be a magical medicinal bullet to take away their symptoms, there really is no such thing at this time. Meds are not the “perfect” treatment; however, they are a “pretty good” treatment. Generally speaking, if you can get a reduction in your symptoms of from 60 to 70 percent, it is considered a good result. Of course, there are always those few who can say that their symptoms were completely relieved by a particular drug. They are the exception rather than the rule. People are always asking me, “What is the best drug for OCD?” My answer is, “The one that works best for you.” I have a saying about meds: “Everything works for somebody, but nothing works for everybody.” Just because a particular drug worked for someone you know, does not mean that it will work for you.

Relying solely on meds most likely means that all your symptoms will not be relieved and that you will always be vulnerable to a substantial relapse if you discontinue them. Discontinuation studies (where those who have only had meds agreed to give them up) have demonstrated extremely high rates of relapse. This is because drugs are not a cure, but are rather a control. Even where they are working well, when you stop taking them, your chemistry will soon revert (usually within a few weeks) to its former unhealthy state. Meds are extremely useful as part of a comprehensive treatment together with CBT. They should, in fact, be regarded as a tool to help you to do therapy. They give you an edge by reducing levels of obsession and anxiety. While those with mild OCD can frequently recover without the use of meds, the majority of sufferers will need them in order to be successful. One unfortunate problem with meds is the stigma attached to them. Having to use them does not mean that you are weaker than others, only that this is what your particular chemistry requires for you to be successful. You cant always fight your own brain chemistry unaided. Using psychiatric drugs also does not mean that you are “crazy.” People with OCD are not crazy, delusional, or disoriented. When relieved of their symptoms, they are just as functional as anyone.

6. You cannot and should not depend upon the help of others to manage your anxiety or to get well

To begin with, and most obviously, you are always with you. If you come to depend upon others to manage your anxiety by reassuring you, answering your questions, touching things for you, or taking part in your rituals, what will you do when they are not around? My guess is that you will likely be immobilized and helpless. The same is true if you only work on your therapy homework when others are nagging or reminding you. No one can want you to recover more than you do. If your motivation is so poor that you cannot get going on your own (assuming that you are not also suffering from an untreated case of depression), then you will have learned nothing about what it takes to recover from OCD. As mentioned at the beginning, since OCD is chronic, you will have to learn to manage it throughout your life. Since you can find yourself on your own at any point, unpredictably, you will always need to be fully independent in managing it.

7. The goal of any good treatment is to teach you to become your own therapist

In line with the last point, good Cognitive/Behavioral treatment should aim to give you the tools necessary to manage your symptoms effectively. As therapy progresses, the responsibility for directing your treatment should gradually shift from your therapist to you. Whereas the therapist may start out by giving you assignments designed to help you face and overcome your fears, you should eventually learn to spot difficult situations on your own and give yourself challenging homework to do. This will then be a model for how you will need to handle things throughout your life.

8. You cannot rely upon your own intuition in deciding how to deal with OCD

In using your intuition to deal with what obsessions may be telling you, there is one thing you can always count on: it will always lead you in the wrong direction. It is only natural to want to escape or avoid that which makes you fearful. It’s instinctive. It really amazes me how common this is. This may be fine when faced by a vicious dog or an angry mugger but, since the fear in OCD results from recurring thoughts inside your head, it cannot be escaped from. The momentary escape from fear that compulsions give fools people into relying upon them. While compulsions start out as a solution, they soon become the main problem itself as they begin taking over your life. People with OCD never stay with what they fear long enough to find out that what they fear isn’t true. Only by doing the opposite of what instinct tells you will you be able to find this out..Obsessive-Compulsive Disorders Research Paper

9. Getting recovered takes time

How long does it take? As long as is necessary for a given individual. Speaking from experience, I would say that the average uncomplicated case of OCD takes from about six to twelve months to be successfully completed. If symptoms are severe, if the person works at a slow pace, or if other problems are also present, it can take longer. Also, some people need to work on the rehabilitation of their lives after the OCD is brought under control. Long-term OCD can take a heavy toll on a persons ability to live. It may have been a long time since they have socialized, held a job, or doing everyday household chores, etc. Some people have never done these things. Returning to these activities may add to the time it takes to finish treatment.

However long it takes, it is crucial to see the process through to the finish. There is no such thing as being “partially recovered.” Those who believe they can take on only those symptoms they feel comfortable facing soon find themselves back at square one. Untreated symptoms have a way of expanding to fill the space left by those that have been relieved. When explaining this to my patients, I liken it to getting surgery for cancer. I ask them, “Would you want the surgeon to remove it all, or leave some of it behind?” Or, put another way, it is not a game you can simply drop out of midway with your winnings and expect to keep them.

10. Relapse is a potential risk that must be guarded against

It has always been a favorite saying of mine that, “Getting well is 50 percent of the job, and staying well is the other 50 percent.” We have actually come full-circle back to Point #1, which tells us that OCD is chronic. This tells us that although there is no cure, you can successfully recover and live a life no different from other people. Once a person gets to the point of recovery, there are several things that must be observed if they are to stay that way. As mentioned in Point #7, the goal of proper therapy is to teach people to become their own therapists. It gives them the tools to accomplish this. One of these tools is the knowledge that feared situations can no longer be avoided. The overall operating principle is that obsessions must therefore always be confronted immediately, and all compulsions must be resisted. When people are seen to relapse, it is usually because they avoided an obsessive fear which then got out of hand because they went on to perform compulsions. Another cause can be an individual believing that they were cured and stopping their medication without telling anyone. Unfortunately, the brain doesn’t repair itself while on medications, and so when drugs are withdrawn, the chemistry reverts to its former dysfunctional state. Finally, some people may have fully completed their treatment, but have neglected to tell their therapist about all of their symptoms, or else they did not go as far as they needed to in confronting and overcoming the things they did work on. In pursuing treatment for OCD, it is vital to go the distance in tackling all of your symptoms, so as to be prepared for whatever you may encounter in the future.

It is vital to remember that no one is perfect, nor can anyone recover perfectly. Even in well-maintained recoveries, people can occasionally slip up and forget what they are supposed to be doing. Luckily, there is always another chance to re-expose yourself and so, rather than a person beating themselves up and putting themselves down, they can soon regain their balance if they immediately get back on track by turning again and facing that which is feared, and then not doing compulsions.

Finally, because health is the result of living in a state of balance, it is extremely important, post-therapy, to live a balanced life, with enough sleep, proper diet and exercise, social relationships, and productive work of some type.

Although obsessive-compulsive disorder (OCD) is a serious mental illness associated with high levels of disability, there are a number of OCD treatments that will significantly reduce OCD symptoms in two-thirds of affected people. For the remaining one-third of people not helped by standard OCD treatments, a number of alternative and experimental OCD treatments offer new hope.

Medication
There are a number of medications that have been approved by the Food and Drug Administration (FDA) for the treatment of OCD. Most of these drugs belong to a class of antidepressants called the selective serotonin reuptake inhibitors (SSRIs); however, one of these drugs, Anafranil, belongs to a class of drugs called the tricyclic antidepressants (TCAs). Although these medications are called antidepressants, they are effective in treating anxiety disorders such as OCD too. These drugs are thought to work by increasing the amount of serotonin that is available within the brain. Problems with serotonin may be a significant cause of OCD.

If you have tried standard OCD medication and not had success, augmentation therapy can help. Augmentation therapy is a strategy being used to improve the odds of relieving OCD symptoms when treating OCD with medication. Augmentation therapy involves using combinations of drugs, rather than a single drug, for maximum effect. Augmentation strategies could be especially effective for people who do not respond to standard treatment.

Psychological Therapy
Psychological therapy for obsessive-compulsive disorder is effective for reducing the frequency and intensity of OCD symptoms. The two main types of psychological therapy for OCD are cognitive-behavioral therapy (CBT) and a type of behavioral treatment called exposure and response prevention (ERP) therapy. Over two-thirds of people who complete either form of therapy for OCD notice a substantial decrease in the frequency and severity of their symptoms..Obsessive-Compulsive Disorders Research Paper

Although individual CBT for obsessive-compulsive disorder is very effective, it can also be very expensive. To cut down on costs, if you are receiving OCD treatment through a hospital or other healthcare settings, you are now very likely to have the option to receive group CBT for OCD symptoms. Although a group setting can initially be intimidating, there are actually many benefits to participating in group CBT for OCD.

If you have looked into CBT and ERP and they don’t sound like a match for you, take a look at Acceptance and Commitment Therapy (ACT). ACT is a relatively new psychological therapy for obsessive-compulsive disorder that has shown promise in the treatment of anxiety disorders, including OCD. The central philosophy of ACT is that anxiety is part of life and so it is our reaction to the experience of anxiety that can be the real problem.

Experimental Treatments
It has been estimated that between 25 and 40% of people will not respond to treatment options described above. Studies have suggested that treatments targeting specific circuits in the brain could be helpful in reducing OCD symptoms among those people who do not respond to first-line therapies. Deep brain stimulation may offer such a treatment.

Repetitive trans-cranial magnetic stimulation, or rTMS, has also received considerable attention as a possible alternative treatment to reduce OCD symptoms. However, to date, the evidence has been mixed with respect to whether rTMS is an effective treatment.

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Self Help
Although treatment for OCD usually entails consulting with a qualified mental health professional, there are a number of OCD self-help strategies that you can start using right now to help you cope with your OCD symptoms.

Given that stress is a major trigger of OCD symptoms, one of the best ways to cope is to learn and practice a number of relaxation techniques.

Finally, while most of us are familiar with the physical benefits of aerobic exercise, including reduced cholesterol levels and lowered risk of heart disease and diabetes, there is growing evidence that exercise can also reduce the symptoms of OCD.

Treating obsessive-compulsive disorder
Options include medication, psychotherapy, surgery, and deep brain stimulation.

Obsessive-compulsive disorder (OCD), which affects 2% to 3% of people worldwide, often causes suffering for years before it is treated correctly — both because of delays in diagnosis and because patients may be reluctant to seek help. One review estimated that, on average, patients with OCD take more than nine years to be diagnosed correctly, and 17 years to receive appropriate care.

Although OCD tends to be a chronic condition, with symptoms that flare up and subside over a patient’s lifetime, effective help is available. Only about 10% of patients recover completely, but 50% improve with treatment.

Challenges in diagnosis
As the name implies, OCD is characterized by two hallmark symptoms. Obsessions are recurring and disturbing thoughts, impulses, or images that cause significant anxiety or distress. Compulsions are feelings of being driven to repeat behaviors, usually following rigid rules (such as washing hands multiple times after each meal). When these symptoms interfere with work, social activities, and personal relationships, it is time to consider treatment.

It may be difficult to distinguish OCD from other psychiatric disorders with similar symptoms. In its updated guidelines, the American Psychiatric Association (APA) provides sample screening questions to better identify patients with OCD, as well as suggestions for differentiating OCD from other disorders. For example, obsessions in OCD typically involve an object or person other than the self, such as a fear of becoming contaminated or acting aggressively toward someone else, whereas ruminations in depression usually involve self-criticism or guilt about the past — and they are not usually accompanied by compulsive rituals. Obsessions in OCD usually are clearly defined, while those in generalized anxiety disorder may be vaguely preoccupied, for example, with nagging worries about bad outcomes..Obsessive-Compulsive Disorders Research Paper

Initial treatments
For initial treatment of OCD, the APA recommends cognitive behavioral therapy, drug therapy with selective serotonin re-uptake inhibitors (SSRIs), or a combination of the two.

Behavioral treatment. The most effective behavioral treatment for OCD is exposure and response prevention. In this therapy, patients encounter the source of their obsession repeatedly and learn ways to stop performing associated rituals until they are able to resist these compulsions. For a patient who avoids using silverware because it might be contaminated with germs, a clinician might direct the patient to pick up a fork and imagine the microorganisms — but to delay washing his hands.

Behavioral treatment alone may be an option for patients with mild symptoms of OCD or for those who don’t want to take medications. It may take three to five months of weekly sessions to achieve results. The goal is to gradually extinguish a conditioned behavior pattern. Little evidence supports the use of cognitive therapies unless they include a behavioral component.

SSRIs. Drug treatment may be tried first if behavioral therapy isn’t available or convenient, or if the patient’s symptoms are severe. Although the FDA has approved the tricyclic antidepressant clomipramine (Anafranil) for treatment of OCD, this medication may cause anticholinergic side effects such as dry mouth, blurred vision, constipation, delayed urination, and a rapid heartbeat. The APA therefore recommends starting with one of the SSRIs because their side effects may be better tolerated.

All of the SSRIs are equally effective, although individual patients may respond better to one than another, and it may take some trial and error to determine which one is best. Generally 40% to 60% of patients with OCD will experience at least a partial reduction in symptoms after treatment with an SSRI. However, many continue to have residual symptoms.

To treat OCD, SSRI doses are usually higher than those used for depression. It also takes longer for these medications to alleviate symptoms of OCD. While patients with major depression might take two to six weeks to respond to an SSRI, patients with OCD typically take 10 to 12 weeks to respond.

The most common side effects of SSRIs are gastrointestinal distress, restlessness, insomnia, and sexual dysfunction (such as reduced libido, erectile dysfunction, and inability to reach orgasm). Drug choice may also be swayed by a patient’s health profile and use of other medications. Paroxetine (Paxil), for example, is the SSRI that is most likely to cause weight gain and anticholinergic side effects; as such, the APA recommends against it as a first choice for patients who are obese, have type 2 diabetes, or suffer from urinary hesitancy or constipation.

Maintenance therapy. Many patients successfully treated for OCD will benefit from continuing medication indefinitely. A few medication discontinuation trials have been conducted in OCD patients, and most have found high relapse rates after SSRI withdrawal. It’s possible that lower doses can be used during maintenance treatment, but this is not clear. One way to reduce relapse is to combine drug treatment with exposure and response prevention therapy, so that when the drugs are withdrawn patients are better able to cope with environmental triggers..Obsessive-Compulsive Disorders Research Paper

When to consider a change. As a general rule, the APA recommends that clinicians and patients give the initial treatment enough time to work before considering a change. If 13 to 20 weekly sessions of behavioral therapy — or 10 to 12 weeks of drug treatment — have not sufficiently alleviated symptoms, consider a new strategy.

Additional treatment strategies
For patients whose symptoms have only been partially relieved by a first treatment, augmenting that treatment may be more effective than switching to a new one. Time makes this strategy a prudent one. Switching to another drug as mono therapy may take another 10 to 12 weeks to show results. Augmenting an SSRI with some other medication, on the other hand, can produce effects within four weeks.

Augmentation options. One option is augmenting an SSRI with an anti psychotic. Drug choices include first- or second-generation anti-psychotics, but the evidence is stronger for the newer drugs. Studies indicate that 40% to 55% of patients with OCD, after failing to respond to a first treatment, do improve when an anti psychotic is added to an SSRI — although residual symptoms may remain. If one anti psychotic doesn’t work, the APA recommends trying another.

Bear in mind that an anti psychotic used to augment OCD treatment should be prescribed at the lower end of the dosing range. At high doses — or when prescribed alone — anti-psychotics may worsen OCD symptoms.

Another option is to augment an SSRI with clomipramine. However, several SSRIs are metabolized by the same cytochrome P450 enzymes as clomipramine, and therefore may interact in a way that can cause heart problems in some patients. Before prescribing clomipramine with an SSRI, the APA recommends considering a screening electrocardiogram in patients who are older than 40 or who have heart disease. It may also make sense to avoid prescribing fluvoxamine (Luvox), fluoxetine (Prozac), and paroxetine, SSRIs that increase blood levels of clomipramine.

Switching to a new drug. If treatment with an SSRI does not work, consider switching to another SSRI or another type of drug. The APA estimates that 50% of patients with OCD who do not respond to one SSRI will respond to another one. However, the response rate may decrease as a third or fourth SSRI is tried. Other less well-studied options include switching to a non-SSRI antidepressant, such as venlafaxine (Effexor) or mirtazapine (Remeron).

Neurosurgery or brain stimulation
Roughly 10% of patients with OCD will get worse in spite of treatment. Patients who suffer severe and incapacitating symptoms despite multiple medication trials may be eligible for brain surgery or deep brain stimulation. (Electroconvulsive therapy and transcranial magnetic stimulation have not proven effective in treatment of OCD.)

Both surgery and deep brain stimulation remain investigational, partly because researchers are still trying to identify the proper brain targets. These options are usually held in reserve for patients with the most treatment-resistant OCD. Typically patients who opt for these strategies have debilitating symptoms and have tried other treatments for 10 years without success.

Ablation. Neurosurgery for OCD involves the destruction (ablation) of small amounts of brain tissue. Procedures include anterior capsulotomy, limbic leucotomy, cingulotomy, and gamma-knife radiosurgery. These approaches differ in the precise brain area targeted and the amount of tissue destroyed. Studies report that 35% to 50% of patients with OCD who undergo neurosurgery improve. Risks include seizures, personality changes, and more transient side effects associated with surgery and anesthesia.

Deep brain stimulation. In this technique, a surgeon implants electrodes in the brain and connects them to a small electrical generator in the chest. Deep brain stimulation does not permanently destroy neural tissue, as surgery does; instead, it uses electricity to modulate the transmission of brain signals.

It’s not clear why this technique works, and there is no consensus about the right targets — although researchers are working to clarify both issues. In 2008, an international collaboration of four institutions reported results of deep brain stimulation of the best-studied brain area — the junction of the ventral capsule and ventral striatum — in 26 patients. Although most patients continued to have residual symptoms, their scores on clinical instruments such as the Yale-Brown Obsessive Compulsive Scale indicated that on average, OCD intensity declined from severe to moderately severe. As the surgeons performed more operations and better refined the brain target, more patients improved: one-third of the first group of patients improved, compared with 70% in both the second and third groups..Obsessive-Compulsive Disorders Research Paper

Obsessive compulsive disorder (OCD) is an anxiety disorder that affects two to three percent of the population (more than 500,000 Australians). It usually begins in late childhood or early adolescence. People with OCD experience recurrent and persistent thoughts, images or impulses that are intrusive and unwanted (obsessions). They also perform repetitive and ritualistic actions that are excessive, time-consuming and distressing (compulsions). People with OCD are usually aware of the irrational and excessive nature of their obsessions and compulsions. However, they feel unable to control their obsessions or resist their compulsions.

Symptoms of OCD – obsessions
Obsessions are usually exaggerated versions of concerns and worries that most people have at some time. Common obsessions include:

fear of contamination from germs, dirt, poisons, and other physical and environmental substances
fear of harm from illness, accidents or death that may occur to oneself or to others. This may include an excessive sense of responsibility for preventing this harm
intrusive thoughts and images about sex, violence, accidents and other issues
excessive concern with symmetry, exactness and orderliness
excessive concerns about illness, religious issues or morality
needing to know and remember things.
Obsessions may be constantly on a person’s mind. They may also be triggered by physical objects, situations, smells or something heard on television, radio or in a conversation. Obsessive fears usually move beyond a specific trigger – for example, a bottle of coolant – to include anything that might look like it or have been near it, such as cars, car keys, a puddle on the road, supermarket shelves and petrol stations.

Obsessions can change in nature and severity and do not respond to logic. Obsessional anxiety leads to vigilance for possible threats, and a compelling need for certainty and control. Obsessions can produce feelings ranging from annoyance and discomfort to acute distress, disgust and panic.

Symptoms of OCD – compulsions
Compulsions can be behavioural (actions) or mental (thoughts). Compulsions are repetitive actions that are often carried out in a special pattern or according to specific rules. Compulsions are usually performed to try and prevent an obsessive fear from happening, to reduce the anxiety the obsessive thought creates, or to make things feel ‘just right’..Obsessive-Compulsive Disorders Research Paper

Common compulsions include:

excessive hand washing, showering and tooth brushing
excessive cleaning and washing of house, household items, food, car and other areas
excessive checking of locks, electrical and gas appliances, and other things associated with safety
repeating routine activities and actions such as reading, writing, walking, picking up something or opening a door
applying rigid rules and patterns to the placement of objects, furniture, books, clothes and other items
touching, tapping or moving in a particular way or a certain number of times
needing to constantly ask questions or confess to seek reassurance
mentally repeating words or numbers a certain number of times, or concentrating on ‘good’ or ‘safe’ numbers
replacing a ‘bad thought’ with a ‘good thought’.
Usually compulsions become like rituals; they follow specific rules and patterns, and involve constant repetitions. Compulsions give an illusory sense of short-term relief to anxiety. However, they actually reinforce anxiety and make the obsessions seem more real, so that the anxiety soon returns.

OCD can have a profound effect on a person’s life
Compulsions and obsessions may take up many hours of a person’s day and can interfere with family and social relationships. They can also have a negative effect on education and employment.

As OCD becomes more severe, ‘avoidance’ may become an increasing problem. The person may avoid anything that might trigger their obsessive fears. OCD can make it difficult for people to perform everyday activities like eating, drinking, shopping or reading. Some people may become housebound. OCD is often compounded by depression and other anxiety disorders, including social anxiety, panic disorder and separation anxiety.

People with OCD are often acutely embarrassed about their symptoms and will put great effort into hiding them. Before the disorder is identified and treated, families may become deeply involved in the sufferer’s rituals, which can cause distress and disruption to family members.

Causes of OCD
The causes of OCD are not fully understood There are several theories about the causes of OCD, including:

Compulsions are learned behaviours, which become repetitive and habitual when they are associated with relief from anxiety.
OCD is due to genetic and hereditary factors.
Chemical, structural and functional abnormalities in the brain are the cause.
Distorted beliefs reinforce and maintain symptoms associated with OCD.
It is possible that several factors interact to trigger the development of OCD. The underlying causes may be further influenced by stressful life events, hormonal changes and personality traits.

Treatment for OCDTreatment for OCD can include:
• psychological treatments such as cognitive behaviour therapy
• anxiety management techniques
• support groups and education
• medications.

Psychological treatment such as cognitive behaviour therapy can improve symptoms, and this improvement is often maintained in the long term.

Cognitive behaviour therapy
Cognitive behaviour therapy aims to change patterns of thinking, beliefs and behaviours that may trigger anxiety and obsessive compulsive symptoms. This therapy uses education to promote control over symptoms. The education includes information that helps to expose myths about the causes of OCD.

Part of the therapy involves gradually exposing the person to situations that trigger their obsessions and, at the same time, helping them to reduce their compulsions and avoidance behaviours. This process is gradual and usually begins with less feared situations. The exposure tasks and prevention of compulsions are repeated daily and consistently until anxiety decreases. Over time, this allows the person to rebuild trust in their capacity to manage and function, even with anxiety. This process is known as exposure and response prevention (ERP).

Cognitive behaviour therapy should be undertaken with a skilled, specialist mental health professional. Over-use of alcohol, drugs and some medications may interfere with the success of this type of treatment..Obsessive-Compulsive Disorders Research Paper

Anxiety management techniques for OCD
Anxiety management techniques can help a person to manage their own symptoms. Such techniques can include relaxation training, slow breathing techniques, mindfulness meditation and hyperventilation control. These techniques require regular practice and are most effective if used together with a cognitive behaviour therapy treatment program.

OCD support groups and education
Support groups allow people with OCD and their families to meet in comfort and safety, and give and receive support. The groups also provide the opportunity to learn more about the disorder and to develop social networks.

Medication for OCD
Some medications, especially antidepressants that affect the serotonin system, have been found to reduce the symptoms of OCD. This medication can only be prescribed by a medical practitioner.

Side effects of antidepressants may include nausea, headaches, dry mouth, blurred vision, dizziness and tiredness. These effects often decline after the first few weeks of treatment. If your side effects are severe or last for a long time, you should discuss this with your doctor.

It usually takes several weeks for medication to deliver any effects. When reducing or stopping medication, the dose should be reduced slowly under medical supervision.

Research has shown that children with rheumatic fever who develop Sydenham’s chorea are at higher risk of OCD, so early treatment with antibiotics may reduce the chances of future obsessive thinking.

Hospitalisation for OCD
Assessment and treatment in hospital can be helpful for some people, particularly when symptoms are severe. A stay in hospital may last from several days to a few weeks.

Self-help tips for people living with OCD
There are many ways that you can help yourself in addition to seeking therapy. Some suggestions are:.Obsessive-Compulsive Disorders Research Paper

Refocus your attention (like doing some exercise or playing a computer game). Being able to delay the urge to perform a compulsive behaviour is a positive step.
Write down obsessive thoughts or worries. This can help identify how repetitive your obsessions are.
Anticipate urges to help ease them. For instance, if you compulsively check that the doors are locked, try and lock the door with extra attention the first time. When the urge to check arises later, it will be easier to re-label that urge as ‘just an obsessive thought’.
Set aside time for a daily worry period. Instead of trying to suppress obsessions or compulsions, set aside a period for obsessing, leaving the rest of the day free of obsessions and compulsions. When thoughts or urges appear in your head during the day, write them down and postpone them to your worry period – save them for later and continue to go about your day.
Take care of yourself. Although stress doesn’t cause OCD, it can trigger the onset of obsessive and compulsive behaviour or make it worse. Try to practice relaxation (such as mindfulness meditation or deep breathing) techniques for at least 30 minutes a day.
Everyone experiences intrusive, random and strange thoughts. Most people are able to dismiss them from consciousness and move on. But these random thoughts get “stuck” in the brains of individuals with OCD; they’re like the brain’s junk mail. Most people have a spam filter and can simply ignore incoming junk mail. But having OCD is like having a spam filter that has stopped working – the junk mail just keeps coming, and it won’t stop. Soon, the amount of junk mail exceeds the important mail, and the person with OCD becomes overwhelmed. So why does the brain of individuals with OCD work this way? In other words, what causes OCD?

Using neuroimaging technologies in which pictures of the brain and its functioning are taken, researchers have been able to demonstrate that certain areas of the brain function differently in people with OCD compared with those who don’t. Research findings suggest that OCD symptoms may involve communication errors among different parts of the brain, including the orbitofrontal cortex, the anterior cingulate cortex (both in the front of the brain), the striatum, and the thalamus (deeper parts of the brain). Abnormalities in neurotransmitter systems – chemicals such serotonin, dopamine, glutamate (and possibly others) that send messages between brain cells – are also involved in the disorder.

Although it has been established that OCD has a neurobiological basis, research has been unable to point to any definitive cause or causes of OCD. It is believed that OCD likely is the result of a combination of neurobiological, genetic, behavioral, cognitive, and environmental factors that trigger the disorder in a specific individual at a particular point in time. Following is a discussion of how those factors may play a role in the onset of OCD.

A study funded by the National Institutes of Health examined DNA, and the results suggest that OCD and certain related psychiatric disorders may be associated with an uncommon mutation of the human serotonin transporter gene (hSERT). People with severe OCD symptoms may have a second variation in the same gene. Other research points to a possible genetic component, as well. About 25% of OCD sufferers have an immediate family member with the disorder. In addition, twin studies have indicated that if one twin has OCD, the other is more likely to have OCD when the twins are identical, rather than fraternal. Overall, studies of twins with OCD estimate that genetics contributes approximately 45-65% of the risk for developing the disorder.

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A number of other factors may play a role in the onset of OCD, including behavioral, cognitive, and environmental factors. Learning theorists, for example, suggest that behavioral conditioning may contribute to the development and maintenance of obsessions and compulsions. More specifically, they believe that compulsions are actually learned responses that help an individual reduce or prevent anxiety or discomfort associated with obsessions or urges. An individual who experiences an intrusive obsession regarding germs, for example, may engage in hand washing to reduce the anxiety triggered by the obsession. Because this washing ritual temporarily reduces the anxiety, the probability that the individual will engage in hand washing when a contamination fear occurs in the future is increased. As a result, compulsive behavior not only persists but actually becomes excessive.

Many cognitive theorists believe that individuals with OCD have faulty or dysfunctional beliefs, and that it is their misinterpretation of intrusive thoughts that leads to the creation of obsessions and compulsions. According to the cognitive model of OCD, everyone experiences intrusive thoughts. People with OCD, however, misinterpret these thoughts as being very important, personally significant, revealing about one’s character, or having catastrophic consequences. The repeated misinterpretation of intrusive thoughts leads to the development of obsessions. Because the obsessions are so distressing, the individual engages in compulsive behavior to try to resist, block, or neutralize them.

The Obsessive-Compulsive Cognitions Working Group, an international group of researchers who have proposed that the onset and maintenance of OCD are associated with maladaptive interpretations of cognitive intrusions, has identified six types of dysfunctional beliefs associated with OCD:

1. Inflated responsibility: a belief that one has the ability to cause and/or is responsible for preventing negative outcomes;

2. Overimportance of thoughts (also known as thought-action fusion): the belief that having a bad thought can influence the probability of the occurrence of a negative event or that having a bad thought (e.g., about doing something) is morally equivalent to actually doing it;

3. Control of thoughts: A belief that it is both essential and possible to have total control over one’s own thoughts;

4. Overestimation of threat: a belief that negative events are very probable and that they will be particularly bad;

5. Perfectionism: a belief that one cannot make mistakes and that imperfection is unacceptable; and

6. Intolerance for uncertainty: a belief that it is essential and possible to know, without a doubt, that negative events won’t happen..Obsessive-Compulsive Disorders Research Paper

Environmental factors may also contribute to the onset of OCD. For example, traumatic brain injuries have been associated with the onset of OCD, which provides further evidence of a connection between brain function impairment and OCD. And some children begin to exhibit sudden-onset OCD symptoms after a severe bacterial or viral infection such as strep throat or the flu. Studies suggest the infection doesn’t actually cause OCD, but triggers symptoms in children who are genetically predisposed to the disorder.

Stress and parenting styles are environmental factors that have been blamed for causing OCD. But no research has ever shown that stress or the way a person interacted with his or her parents during childhood causes OCD. Stress can, however, be a factor in triggering OCD in someone who is predisposed to it, and OCD symptoms can worsen in times of severe stress.

In sum, although the definitive cause or causes of OCD have not yet been identified, research continually produces new evidence that hopefully will lead to more answers. It is likely, however, that a delicate interplay between various risk factors over time is responsible for the onset and maintenance of OCD.

Obsessive-compulsive disorder (OCD) is a very serious mental illness that can have a far-reaching impact on a person’s life. This condition causes persistent, troubling thoughts or obsessions. These vary by individual but may include thoughts of harming someone, violent images, or fears of being contaminated by germs. The thoughts are nearly impossible to stave off and cause significant distress.

OCD also causes compulsions, which are repetitive, ritual-like behaviors that a person performs to mitigate the distress of the obsessions or to prevent them from coming true. Compulsions may include counting objects, excessive hand washing, or checking and rechecking things, like door locks. Obsessions and compulsions cause distress and significant impairment. They take up time and take focus away from other areas of a person’s life.

OCD can be successfully managed with good treatment. Residential care with ongoing therapy can help patients face the thoughts they fear and learn to control them while also managing and reducing compulsions. Antidepressants, stress management, social support, and self-care can also help. Causes of OCD are not fully understood, but research has uncovered many facts about how this disease develops and who is more susceptible.

Genetics and Family History
As with most mental illnesses, family history is the biggest predictor for whether or not someone will develop OCD. Studies of families and twins show that there is a strong genetic association for OCD. The risk of having the condition is much higher for those who have a first-degree relative—parent, child, or sibling—and even higher for those who have an identical twin with OCD. An individual who has an identical twin with the condition has 80 to 87 percent chance of also having OCD.

The family history connection strongly suggests that there is a gene or group of genes associated with the development of OCD. However, no studies have yet been able to pinpoint any part of the DNA that corresponds to the condition. Because people with OCD respond well to treatment with antidepressants that target the brain chemical serotonin, there may be genes associated with serotonin that play a role in OCD development..Obsessive-Compulsive Disorders Research Paper

OCD and Brain Chemistry and Structure
Most mental illnesses have been tied in some way to the chemicals in the brain or to alterations in activity or structures in the brain. Neurotransmitters, the chemicals that are used as signaling molecules between neurons, play a big role in many conditions, like depression, anxiety disorders, and OCD. Changes, deficiencies, or other abnormalities in these chemicals certainly play a role in many mental illnesses. Brain chemistry has long been an area of study for researchers trying to determine what causes OCD.

Serotonin is a prime candidate for a potential cause or contributing factor to OCD. Antidepressant medications that increase the amount of serotonin in the brain, called SSRIs, work well for most people with OCD. This may mean that a deficiency in serotonin contributes to OCD, although it is probably not the single cause for any one person with the condition.

With imaging scans of the brain, researchers have been able to determine that there are three areas or structures in the brain that are more active in people with OCD. This further indicates that brain abnormalities are implicated as contributing causes. The three areas of the brain that are overactive are:

The caudate nucleus. This part of the brain is associated with filtering thoughts and managing habits. When OCD is well managed with treatment, activity in this area goes down.
The prefrontal orbital cortex. This area is associated with managing appropriate social behaviors. Decreased activity here leads to lowered inhibitions, but increased activity can cause social anxiety and worries about cleanliness or acting inappropriately.
The cingulate gyrus. Located in the center of the brain, this region is thought to regulate how a person reacts to troubling thoughts and obsessions. Over-activity here may trigger compulsive behaviors.
The most recent OCD research has implicated yet another brain chemistry factor that could explain the condition. Researchers working with laboratory mice investigated a protein called SPRED2. Found in all cells in the body, it is especially concentrated in the brain. When the protein was eliminated from the mice, it triggered compulsive and excessive grooming. The researchers hope that by targeting this protein and the chemical pathways it triggers, they can develop a better treatment for OCD.

OCD and Trauma
Brain chemistry, activity, and structure are known to underlie the development of OCD, but what causes the abnormalities in the brain are not known. While genetics almost certainly play a role, specific genes have not been found, and it is not understood why some people with a family history of the condition will develop it while others will not.

One explanation is that there are other risk factors that contribute to OCD. Trauma, for instance, seems to be a risk factor that makes it more likely someone will develop OCD, especially if that individual also has a family history of the condition. Trauma in childhood may be particularly damaging and may include neglect, abuse, sexual assault, bullying, witnessing violence, being in a serious accident, or many other frightening experiences.

Trauma in adulthood may also trigger OCD. Studies of adults with both OCD and post-traumatic stress disorder (PTSD) found that the compulsions of OCD are used to mitigate distress caused by memories of trauma. When patients received treatment for OCD and the related behaviors decreased, the PTSD symptoms worsened. Studies have also found that people sometimes develop OCD after a traumatic event, and that when they do the symptoms are often more severe. This research suggests that trauma can definitely play a role in causing OCD..Obsessive-Compulsive Disorders Research Paper

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The Role of Stress in the Development of OCD
Stress may also play a role in OCD, although whether or not it can actually cause the condition is not known. There is evidence that OCD onset is more likely during a period of high stress in a person’s life. This does not mean, however, that stress causes OCD, but it may trigger its onset in someone predisposed to the condition, or it may worsen symptoms in someone who already has it. The explanation may be that during times of stress, a person is more susceptible to irrational fears and obsessive thoughts and worries.

Streptococcal Infection in Kids and OCD
In some cases of OCD, disease may trigger its onset. The mechanism is not fully understood, but experts believe streptococcal infections can trigger symptoms of OCD, or an early onset of the condition, in children who are already predisposed to it. When this happens a child may be diagnosed with PANDAS, which stands for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. The infection triggers an autoimmune response that affects the brain in some way, triggering OCD.

The diagnosis of PANDAS is given when a child begins to exhibit signs of OCD immediately after an infection, if that child never had such symptoms before. It may also be diagnosed if the child had some symptoms of OCD but they get much worse right after an infection. Streptococcal infections that may trigger PANDAS include strep throat and scarlet fever. PANDAS may occur in children between the age of about three and the onset of puberty. Signs of PANDAS in children may vary by individual, but typical symptoms include:.Obsessive-Compulsive Disorders Research Paper

Any OCD symptoms
Signs of a tic disorder, including vocal or movement tics
Moodiness and irritability
Separation anxiety
Hyperactivity and inattention
Difficulty sleeping
Bed wetting
Joint pain
Changes in motor skills
Causes of OCD are still not fully understood, but researchers have developed a fairly clear picture of what happens in the brain of someone with this condition. They have also determined that there are strong risk factors for OCD, including family history and trauma. Regardless of what causes OCD, the repercussions of living with this condition can be serious.

It is important for anyone struggling with OCD to understand that there is hope through treatment. With dedicated therapy, often best conducted during an extended stay in residential care, medications, self-care, and positive support, the prognosis for living with OCD and managing symptoms is good.

When rules and established procedures do not dictate the correct answer, decision making may become a time-consuming, often painful process. Individuals with obsessive-compulsive personality disorder may have such difficulty deciding which tasks take priority or what is the best way of doing some particular task that they may never get started on anything.

They are prone to become upset or angry in situations in which they are not able to maintain control of their physical or interpersonal environment, although the anger is typically not expressed directly. For example, a person may be angry when service in a restaurant is poor, but instead of complaining to the management, the individual ruminates about how much to leave as a tip. On other occasions, anger may be expressed with righteous indignation over a seemingly minor matter..Obsessive-Compulsive Disorders Research Paper

People with this disorder may be especially attentive to their relative status in dominance-submission relationships and may display excessive deference to an authority they respect and excessive resistance to authority that they do not respect.

Individuals with this disorder usually express affection in a highly-controlled or stilted fashion and may be very uncomfortable in the presence of others who are emotionally expressive. Their everyday relationships have a formal and serious quality, and they may be stiff in situations in which others would smile and be happy (e.g., greeting a lover at the airport). They carefully hold themselves back until they are sure that whatever they say will be perfect. They may be preoccupied with logic and intellect.

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work, or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Symptoms of Obsessive-Compulsive Personality Disorder

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)
Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
Is unable to discard worn-out or worthless objects even when they have no sentimental value
Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
Shows significant rigidity and stubbornness
Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes, and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year..Obsessive-Compulsive Disorders Research Paper

Obsessive-compulsive personality disorder is approximately twice as prevalent in males than females, and occurs in between 2.1 and 7.9 percent of the general population.

Like most personality disorders, obsessive-compulsive personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in their 40s or 50s.

How is Obsessive-Compulsive Personality Disorder Diagnosed?
Personality disorders such as obsessive-compulsive personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood, or genetic tests that are used to diagnose obsessive-compulsive personality disorder.

Many people with obsessive-compulsive personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis for obsessive-compulsive personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Causes of Obsessive-Compulsive Personality Disorder
Researchers today don’t know what causes obsessive-compulsive personality disorder, however, there are many theories about the possible causes. Most professionals subscribe to a psychological model of causation — that is, the causes are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children..Obsessive-Compulsive Disorders Research Paper

Treatment of Obsessive-Compulsive Personality Disorder
Treatment of obsessive-compulsive personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see obsessive-compulsive personality disorder treatment.

Obsessive-compulsive personality disorder (OCPD) is a mental health condition that influences a person’s thoughts, feelings and behaviors, and disrupts the lives of those around them. Although the condition may not be as well-known as obsessive-compulsive disorder (OCD), OCPD is much more common. It is one most common disorders with as many as 7.9 percent of the population having the condition.

Because it is not well-known, many people do not realize they or their loved one has the disorder. Since people may not be as familiar with OCPD as other conditions, it is necessary to recognize the symptoms and signs of the condition to receive the proper diagnosis and treatment.

What Is Obsessive-Compulsive Personality Disorder?
OCPD is a personality disorder, meaning it produces a long-term effect on an individual’s experiences and behaviors. Personality disorders also:

Affect many aspects of a person’s life
Are inflexible and challenging to treat
Usually begin during adolescence or early adulthood
Are consistent over time
Create distress and significant life impairment
For context, there are dozens of mental health diagnoses and only ten personality disorders. The American Psychiatric Association (APA) groups OCDP with a cluster of personality disorders like avoidant personality and dependent personality because they share common features.

Someone with OCPD focuses intensely on orderliness and control. They may talk about following rules and making sure everything is fair. Many people might view someone with OCPD as a perfectionist or describe them as particular or anal.

People with OCPD typically believe that the way they act is the right way, and anyone who disagrees is wrong and foolish. They are often unwilling to let others take responsibility for a task because no one could ever complete it as well as they could..Obsessive-Compulsive Disorders Research Paper

On the other hand, if the right answer is not apparent in any situation, someone with OCPD will overthink and overanalyze the situation before making a decision. In some cases, they will not even attempt a task that is unclear and move on to something else.

Signs and Symptoms of OCPD
The APA sets forth eight symptoms and signs of OCPD for mental health professionals to use in diagnosis and treatment. The signs of obsessive-compulsive personality disorder include:

A focus on details, organization or schedules above everything else
A degree of perfectionism that interferes with everything from major projects to normal, daily tasks
Being overly focused on work and productivity so that leisure time, hobbies and friends are ignored
A sense of being overly rigid and inflexible about matters of right and wrong linked to morals, ethics and values
Struggling to throw away old, worn-out or worthless items even when there is no sentimental attachment
An inability to assign or delegate assignments to others
Hoarding money and being stingy with spending to prepare for future disasters
Being stubborn and stuck in their actions and thinking
Some of these symptoms overlap with OCD. However, someone with OCD will be more locked into a pattern of obsessional thinking followed by compulsive behaviors that serve to reduce worries and fears..Obsessive-Compulsive Disorders Research Paper

OCPD and Relationships
Maintaining a lasting, happy relationship with someone who has OCPD can be difficult. Aspects of the disorder that make relationships difficult include:

A focus on completing activities rather than forming relationships
Viewing others as inferior or unable to live up to their expectations
Fun activities being treated as serious matters
A lack of affection
People with OCPD may have appropriate relationships with their employees or subordinates but will struggle with peers or romantic interests. They may hold back affection and come off as cold and formal.

When dating someone with OCPD, a person may rarely receive a compliment or any heartfelt communications. People with OCPD are more concerned with logic and rationality instead of emotions and feelings.

Causes of Obsessive-Compulsive Personality Disorder
The precise origins of OCPD are still not well-understood. Like other mental health conditions, the influence of various risk and support factors determine if and when the condition occurs.

Genetics and biological factors seem to contribute to the presence of OCPD since the condition tends to run in families. So, if a person has a close family member with OCPD, there is a better chance that the person will have the disorder as well.

In addition to the possible biological nature of OCPD, environmental influencers may contribute to the diagnosis, especially parenting styles. Someone may be at high risk for OCPD if the parents or guardians:.Obsessive-Compulsive Disorders Research Paper

Were not physically or emotionally available
Were overprotective
Were overly controlling
Doled out harsh punishments
The theories state that, in these situations, the OCPD perfectionism becomes a coping skill to get attention or avoid punishment. Once people respond favorably to the perfectionism, the trait grows.

OCPD Risk Factors
This condition may co-occur with other mental health disorders. People with higher stress or anxiety disorders have an increased risk of OCPD. Possible disorders linked to OCPD include:

Social phobia: fear of social situations
Specific phobia: fear of a particular place, item, animal, situation or another stressor
Obsessive-compulsive disorder
Mood disorders like depression and bipolar disorder
Eating disorders
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A person with this condition might have a strong relationship with alcohol and other drugs. On the one hand, they could avoid all substances due to the view that drugs and alcohol diminish their abilities and make them less perfect. On the other hand, the person may resort to substances as a negative coping skill to manage the intense pressures and disappointments that come with OCPD.

Diagnosing OCPD
Even though OCPD and OCD share similar names, diagnosing the conditions and telling one from the other is often simple. Typically, OCD will present with clear obsessions and compulsions which are not shown in OCPD. Someone may have both conditions co-occur in rare situations.

A mental health professional will review the person’s experience and compare it to the eight OCPD symptoms described early. To be diagnosed with OCPD, a person must have four or more of the specified symptoms..Obsessive-Compulsive Disorders Research Paper

One of the barriers to successful OCPD diagnosis is the person’s insight. Frequently, people with OCPD do not realize that their behaviors, thoughts or feelings are problematic. They will see issues with the other people in their life and label them as fools, lazy or unmotivated. In reality, it is the OCPD that creates unwanted issues.

With this lack of awareness, a person may resist the OCPD diagnosis or never even allow themselves to be evaluated. Subsequently, it is important to practice patience, understanding and honesty if you or a loved one have symptoms of OCPD.

Treatment for Obsessive-Compulsive Personality Disorder
As mentioned, the first obstacle to successful treatment for OCPD is getting the individual to acknowledge the issue and seek treatment. People may only submit to treatment when the condition threatens their job, relationship or social status. Perhaps, their spouse will threaten divorce if nothing changes.

Once a person agrees to treatment, psychotherapy will typically be the main form of treatment. There are two psychotherapy options, long-term or short-term. Long-term treatment is the best way to make significant, lasting changes to the person’s overall well-being, but there are some drawbacks:

Therapists may not have the skills to create change
The person may not have the finances or insurance coverage to pay for sessions .Obsessive-Compulsive Disorders Research Paper
The person may stay resistant and unwilling to change
Short-term psychotherapy will be an appropriate option in many situations. Short-term therapy can:

Reduce stress
Build new coping skills
Encourage new relationships and reinforce healthy ones
Teach assertive communication skills
The goal of any therapy for OCPD will be for the individual to tap into their feelings rather than staying focused on their thoughts.

A psychiatrist may offer medications to address low mood or symptoms related to OCD, but these drugs are usually for short-term use only. Similarly, group therapy sessions may not be helpful as the person may grow irritated by the group members.

How to Help a Loved One With OCPD
There are various steps you can take to help your loved one with OCPD.

Learn as much as you can about OCPD from trusted sources
Listen to your loved one to better understand their perspective
Offer love, encouragement and support
Practice clear, direct communication to express your needs and wants
Avoid expressions of anger or hostility
Set specific conditions and consequences on the relationship
Most importantly, realize that your ability to provide effective treatment to your loved one is limited. Encourage your friend or family member to participate in professional treatments for OCPD..Obsessive-Compulsive Disorders Research Paper

OCPD Support Groups
Support groups for OCPD are sometimes overlooked but remain helpful options for those who need additional services or struggle with professional treatments. OCPD support groups may not be plentiful, but you can find in-person support groups here.

If no groups are available in your area, consider an online OCPD support group that offers a variety of information and group possibilities. Whether online or in-person, these groups are usually open to people with OCPD as well as their family members.

OCPD Prognosis
There are many hardships a person with OCPD faces on the path to recovery. The condition becomes so ingrained into every aspect of the individual and creates poor insight and self-awareness. Professionals usually view personality disorders as long-term conditions, but there is always hope of recovery.

A person with a high level of insight will likely have a better prognosis. With more insight, a person can see how the condition affects their life and the lives of other people around them, which sparks motivation for change.

With a social support system, open-mindedness and consistent treatment, anyone with OCPD can progress, so the condition has a smaller effect on their life. Setting small, practical goals along the way is a great way to acknowledge progress towards a favorable prognosis.Obsessive-Compulsive Disorders Research Paper

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