Are you obsessed?
“You are going on a long vacation… The cases are packed, you got in your car... As you start the car, you think "What if I didn't turn all the lights off? Did I leave any windows open?"
Does this scenario sound familiar to you? Imagine spending a typical day continuously worrying about such issues and constantly double checking yourself and all you do..."
This is a very general description of the trouble an obsessive compulsive disorder patient goes through. There are many people with superstition, who worry about or are suspicious of the smallest things. Many people may have various obsessions and worries such as excessive cleanliness, tidiness; hoarding things or money; paying too much attention to symmetry; checking the door/cooker, etc. People may feel like they have to do these even if they may seem ridiculous. Most of the time these don't cause serious lost time or trouble. Not everyone with these symptoms is considered sick. Only when these ideas and actions become excessive and negatively impact the person's lifestyle and daily functionality can we start to talk about Obsessive Compulsive Disorder (OCD).
OCD is an anxiety based disease. People with this disorder have unwanted, compulsory and usually not pleasant thoughts (obsessions). Most of these people are aware their obsessions are illogical, but cannot stop having these thoughts anyway - which causes unease. At this point, in order to reduce these thoughts and problems patients develop ritualistically repetitive actions (compulsions). In this regard, OCD is defined as "a psychiatric disorder that has repetitive obsessions or compulsions that cause significant disruption in the person's functionality as well as obvious discomfort and that waste a serious amount of the person's time (longer than 1 hour per day)." Obsession and compulsive behavior may be observed together or patients may complain from only obsession or only compulsion. Symptoms of OCD may be light or severe. Patients may control their obsessions or compulsions for short times; they may go to work or school. However, as OCD becomes more severe, it begins to take over an individual’s life and, in order to conduct their rituals, people fail to fulfill their daily routine activities.
We can group the symptoms of this disorder under four main topics:
1) Contamination: This is the most frequently observed. Patients continuously think thye will be contaminated with urine, feces, dust or microbes. They believe this contamination goes from person to person, object to object. In order to decrease the trouble caused by this, patients clean obsessively or tries to avoid cleaning all together.
2) Doubt: Patients believe that they didn't do or forgot to complete some activities or neglected them. For example, they can never be sure if the door was locked or the cooker was turned off. This causes checking compulsions. Patients check the cooker, tap, door multiple times.
3) Thoughts of sexual or violent actions: Patients feel that either they or a loved one will be attacked, murdered or molested.
4) Symmetry-Normativeness: Patients in this group are obsessed with the way objects and furniture are placed. They notice the smallest changes in the "order" of things and try to correct the disrupted order.
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Characteristics of Obsessions and Compulsions:
Both obsessions and compulsions can be in form of ideas. However, generally obsessions are ideas and compulsions are behavior.
Obsessions(idée fixe, fixation):
They are thoughts, ideas, urges and decisions that the patient finds illogical but that cause anxiety and problems. The patients state they find these ideas and stimuli absurd and they are bothered immensely by these but they don't have control over them. Obsessions bring on disgust, fear, suspicion or anxiety. They try to suppress or ignore unpleasant thoughts and urges and try to get rid of them with other thoughts or actions. Some of the most frequently observed obsessions are:
• Thoughts of being contaminated by blood, saliva, microbes or semen or contaminating one's surroundings,
• Thoughts of harm to self or loved ones,
• Fear of losing control and acting violently,
• Repetitive and uncontrolled sexual thoughts,
• Excessive dealing in religion and ethical values, etc.
Compulsions:
They are repetitive behaviors (washing hands, putting things in order, checking things, etc.) or mental actions (prayer, counting, silently repeating words, etc.). The purpose of these actions and behaviors is not to bring joy or pleasure but to decrease the trouble associated with obsession or to prevent the feared event or situation. Compulsions are excessive and have no logical connection with what they aim to do. Compulsions may sometimes take up the entire day of patients with severe OCD. Some of the most frequently observed obsessions are:
• Cleaning: Washing hands or bathing for hours, repetitively cleaning house. There are many patients who go through a bar of soap a day from washing hands frequently or do their washing up using bleach.
• Repetition: Performing repetitive actions in order to counteract obsessive thoughts or problems experienced. A patient who fears something bad will happen to his loved ones may get rid of this thought by repeating an action twice (such as going back and walking the same route again while walking down the road).
• Checking: Checking the door, electricity or gas several times for fear of fire or other damage to one's home.
• Hoarding: Saving lots of useless things. For example, some people may not be able to throw out useless things such as old newspapers, empty jars or boxes despite not having enough storage space. "Dump Homes" that make their appearance on the news lately are good examples of this.
• Counting: Counting the stones on the sidewalk while walking or reading license plates; repeating daily chores for certain times. For example, putting on and taking off clothes or not going back to the same place more than a certain amount of times are both frequently observed in patients in this group.
• Completion: Patients with this compulsion repeat a series set of behaviors until they reach perfection. For example, some patients with cleaning obsession clean the sink, tap and soap - generally a certain number of times - first before washing their hands; then wash their hands a certain number of times and repeat the entire procedure.
• Excessive order and tidiness: Wishing everything to be symmetrical or arranging everything in a certain order.
Onset of OCD, its prevalence and its causes:
OCD generally starts during early teenage years but canalsobe observed during childhood. Two thirds of the patients start showing symptoms before they are 25 years old. Less than 15% of the cases were observed to have started after age 35. Average onset age is 20; for men it is 19 and for women, 22. If the disorder starts during childhood, it is observed more frequently in male children than in female children. However, as the age progresses, depending on the increase of frequency in girls, the gap closes and during adulthood the disorder is observed equally frequently for both sexes. Its lifelong prevalence is around 5.9%. Often, it commences at a low level of severity, but develops into a more serious and chronic disorder over time. The fulmination is generally associated with stress.
As with most other psychological disorders, the occurrence of Obsessive Compulsive Disorder is caused by the combination of various factors instead of a single reason. Genetic tendency is considered in the formation of the disorder. Although no genes have been found to be associated with causing OCD, there is a higher risk of OCD occurrence in the close relatives of OCD patients. The symptoms are not always the same within the family. For example, the mother may show checking compulsions while the daughter may have cleaning compulsions. Biologically speaking, this disorder is stated to occur due to a drop in serotonin (chemical transmitter) levels in the brain. Additionally, family problems or stressful situations may not directly cause but may inflame the existing disease.
Treatment of OCD:
OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, personality disorder, attention deficit disorder or other anxiety disorders. Due to these accompanying disorders and the patient's tendency to hide the problem make diagnosis and treatment difficult. Therefore, people with OCD start treatment years after they start showing symptoms. The primary aim of the treatment is to treat the existing disorder and then prevent its recurrence.
There are three main methods of treatment in this regard:
• Cognitive-Behavioral Treatment: In this approach the patient is subjected to the feared object or thought either directly or by way of imagery. The aim here is to confront obsessions and try to overcome them or at least prevent them from hindering the patient's life.
• Psychodynamic Psychotherapy: This long-term treatment requires intense therapy and aims to research and remove the psychodynamic roots of the disorder.
• Pharmacologic: Recent studies have shown that medication that affects levels of the neurotransmitter serotonin greatly reduce symptoms of OCD.
The treatment is long-term and difficult on the patient. It is very important for patients to educate themselves on their disorder. The patient needs to control his anxiety during the treatment, which can be impossible at times. Suddenly quitting treatment following an intense program is absolutely advised against. It is beneficial to share any problems associated with the treatment with the doctor. For example, if after recovery the symptoms are observed again and cannot be controlled using cognitive-behavioral methods; if there are unexpected medicine side effects; if other psychological disorder symptoms are observed, such as depression or anxiety disorder or if there is a significant life event such as losing a loved one that may negatively effect the patient, a psychiatrist must immediately be consulted.
People living with patients who suffer from OCD have a lot on their plate as well. The burden is on these people's shoulders to explain to the patient that this is in fact a treatable disorder and a doctor visit is in order. It is extremely important to stand by and support the patient during the long drawn-out treatment. Discussing their symptoms or trying to change their way of thinking only helps to increase the patient's discomfort. The aim of behavior therapy is not to remove the obsessive thoughts but to ensure the patient is at peace with these thoughts. Therefore, if the patient's loved ones' approach is contradictory to this; it may hinder treatment or in fact increase OCD symptoms.