What is Obsessive Compulsive Disorder or OCD?

Preface

Recently, I came to know that apart from bipolar disorder, I have Obsessive Compulsive Disorder or OCD. I had heard about the illness before but was clueless about what it really was.

However, post a series of discussions with my psychiatrist & psychotherapist, I was able to comprehend and realized that it was kind of chronic in my case.

This blog should give you a brief idea (if not holistic) of what is OCD. How it impacts our daily life? What are its symptoms? and what are its causes and possible treatments?

What is Obsessive Compulsive Disorder or OCD?

For people who are victims of mental health conditions, or have good knowledge of it, for them, Obsessive Compulsive Disorder should be a well-known term. Millions of people around the world are affected by OCD every year, and thus it cannot be ignored; an awareness of this psychological illness is very much necessary.

Obsessive Compulsive Disorder, as the name suggests, is a mental health disorder where specific unwanted obsession(s) and compulsion(s) mar a person’s health and everyday life. In layman’s terms, a person with OCD, may not want to think or perform certain actions, but still ends up doing those things, as he/she has no control over his thoughts and urges. OCD is about repetitive thoughts and a keen interest in satisfying or suppressing those thoughts.

This does not mean that things like morning rituals, cigarette smoking, daily chores, etc. fall under the purview of this disorder. Obsessive-Compulsive Disorder affects its victims psychologically and negatively in one or more ways. People with this mental illness tend to spend most of their day dealing with unwanted obsessions and compulsions that ultimately hampers their normal life.

What do statistics say?

According to studies, over 1 million people in India are affected by Obsessive Compulsive Disorder every year. The lifetime prevalence of OCD is around 0.6% in India, while globally, it is estimated to be about 2-3%.

In the US, more than 2 million people are affected by OCD every year. This is at least 1% of their total population. In the UK, each year, 1.2% of the population is impacted.

Overall, people between the age of 15-44 years are the most affected by Obsessive Compulsive Disorder, and the age group of 18-25 years tops the chart. Studies also show that females are more prone to fall victim to Obsessive-Compulsive Disorder than males.

What are the symptoms of Obsessive Compulsive Disorder?

Considering the statistics, it is quite evident that Obsessive Compulsive Disorder affects a decent chunk of the world’s population. It should be a good enough reason for people to gain knowledge about the disorder and create awareness.

The symptoms of OCD can be summarized under the umbrella terms – Obsessions and Compulsions.

What are Obsessions in OCD?

Obsessions in OCD are related to fear, anxiety, and negative or irrational thoughts. The following are some of the obsessions that can be deemed as OCD symptoms. These obsessions can severely impair the quality of life in a person and can lead to negative consequences.

Continuously thinking about the negative experiences of the past like the death of a close person, failed relationship, any unwanted reaction, etc.
Obsession of the well-being of a loved one e.g., something wrong (like an accident) will happen when that loved one will step out of the house, or any other negative thoughts.
Thoughts of giving up on life.
Fear of showing awkward behavior in the social circle that may lead to embarrassment.
Having aggressive sexual thoughts towards the partner.
Having sexual thoughts about children.
Aggressive thoughts about hurting oneself or a loved one out of impulse.
Irrational thoughts of guilt e.g. the person could think that he/she could have saved the loved one from dying but could not do so (even if it was a natural death).
Fear of catching a deadly disease or getting contaminated.
Irrational thoughts of causing harm to others physically and emotionally.
Fear of doing something morally wrong all the time.
Obsessive superstitious thoughts.
Having doubts in a relationship all the time.
Thoughts related to doing things perfectly.

What are Compulsions in OCD?

Compulsions in OCD are mostly related to Obsessions. Compulsion is an action that a person is urged to take to control the obsession. Here, it is essential to note that compulsion is not something that a person would like doing; it is a negative term and can lead to severe distress among people. The following are some of the compulsions that are a direct consequence of the obsessions, and thus can also be deemed as OCD symptoms:

Continuously checking on a loved one while he/she is sleeping to ensure that the person is still breathing and is alive.
Checking on things like the lock on the door, gas stove, etc. multiple times for the sake of safety.
Washing hands, or bathing multiple times due to the fear of catching a disease.
Eavesdropping on partner and checking messages excessive number of times fearing that he/she might be cheating.
Reviewing any past incident/act multiple times to figure out what best could have been done in that particular situation.
Avoiding people so that you do not hurt them e.g., you might have an aggressive sexual urge that you cannot control and so you might not want to be around people.
Praying multiple times and in a particular manner when you think you have done something wrong.
Hiding any sharp objects like a blade or knife so that you do not hurt people.
Avoiding your partner as you would not be able to share your negative feelings and end up hurting him/her.
Repeating some activities a specific number of times due to superstition.

How Obsessive Compulsive Disorder impacts a person’s daily life?

It should be quite obvious by now that OCD can cause significant distress and disruption in a person’s life. A victim of Obsessive Compulsive Disorder is generally not able to take an active part in day-to-day activities like household work, office work, interacting with family, etc. as he/she is caught in a vicious cycle of obsessions and compulsions. The quality of life, relationships, and social reputation can get severely impacted as part of this illness.

As per the studies, a person suffering from OCD has a good chance of also contracting depression and anxiety disorders. It is kind of obvious because the person in OCD tends to deal with uncontrolled and unwanted obsessions and compulsions.

What are the various causes of Obsessive Compulsive Disorder?

The specific cause of OCD in people is still not precisely known. Several studies and theories have come up over the years, but, there is still a void when it comes to predicting the exact cause of OCD.

The following are some of the theories around the cause of OCD in a person:

Genetic or hereditary issues
Hormonal changes
Chemical imbalances in the brain
Any activity inculcated by the parents during childhood because they were themselves obsessed about a certain thing
Any past experiences that have led to unwanted obsessions and compulsions over a period of time.

Are Depression and OCD correlated?

The correlation between depression and OCD is a popular topic of discussion. But, before diving into the subject, let me first share my personal experiences related to my depression and OCD.

I was initially diagnosed with Major Depressive Disorder (MDD) a couple of years back. My condition was so bad that I used to spend the whole day in bed and have a minimal diet. I had started skipping the office and avoided calls from my family. Sometimes I felt numb, other times I used to have extreme thoughts about death and suicide. After some sessions with the psychiatrist, I came to know that my depression was chronic, and has been a part of me for over a decade.

Living with Obsessive Compulsive Disorder

Post the diagnosis of MDD, I was put on anti-depressants. In the next few months, I started feeling a bit better, but the episodes of dark thoughts, panic attacks, and numbness were still frequent. I was somehow not able to deal with them efficiently. It was then I decided to go with psychotherapy based on the suggestion from my psychiatrist. I went through a process called CBT (Cognitive Behavioural Therapy) and based on the analysis, my psychotherapist concluded, I have OCD.

Symptoms

The following were the symptoms and most of them still hold true today:

In my school days, I used to review and check the question paper multiple number times and try to calculate the marks to see if I would pass or not. I used to do this umpteen times in a day. I used to make myself believe that I would pass considering the worst-case scenario. This obsession & compulsion used to hamper most daily activities.
During childhood, I often used to check on my loved ones when they were sleeping to ensure that they were still breathing. I still have the same obsession.
I used to and still believe in some cases that doing a certain thing “odd” number of times is bad. So, I make sure I do it an “even” number of times. But then, I get stuck with the thought that I might not have done the thing in the right way, and ultimately end up repeating the activity.
When any member of my family gets admitted to the hospital, I always have this feeling he/she would not come back home alive. This is based on some of my past experiences.
I used to and still sometimes have frequent thoughts and dreams of death (not only specific to me or my family). I have become so obsessed that I tend to create an environment of these irrational thoughts in my head and live in it every day. I generally listen to dark songs to counter the thoughts and to relieve the pain, but then the reality is that by listening to those dark songs, I am just embracing the pain.
I avoid getting into a relationship as I feel I will hurt my partner due to my negativity.

How CBT helped me?

CBT helped me open up about my obsessions, fears, and I learned how to control the urges to a certain extent. I had multiple discussions with both my psychiatrist and psychotherapist, and both of them clarified that in my case, depression and OCD were not correlated. My depression and OCD symptoms did not overlap to the extent that they could be correlated. In fact, they are separate entities that have been walking with me for a long time. The depression in me was due to a completely different reason.

I have gone through many forums to learn about the relationship between OCD and depression and found that based on the studies, in most cases, OCD and MDD are correlated. Often, there are cases where the symptoms of MDD in a person are seen post the onset of OCD symptoms. This is because OCD leads a person to think and act on unwanted stuff, thus leaving him/her distressed and prone to developing MDD. Having both OCD and MDD at the same time is generally a serious issue and could also be life-threatening in some situations. Immediate help from a mental health professional should be taken in such cases.

What is the treatment for Obsessive-Compulsive Disorder?

Obsessive Compulsive Disorder may or may not be completely cured and can also be a lifelong thing. Based on the patient’s history, with an optimal line of treatment, it can surely be controlled. The treatment process is always dependent on the diagnosis and severity of the illness. There are multiple options for treating OCD available out there today that can help control the OCD symptoms if not completely cure them.

Non-medication options

It is always recommended to go for the natural treatment for neurotic disorders rather than going with medicines because they have their side effects. In the case of a psychotic disorder, medication is almost required.

Psychotherapy

Psychotherapy is generally advised to people suffering from major depressive disorder (MDD), but it can be as useful for people suffering from OCD. It was during the psychotherapy sessions that I was diagnosed with Obsessive Compulsive disorder.

Cognitive Behavioral Therapy or CBT is a very popular term in psychotherapy. Here, the psychotherapist tries to understand the patient’s psychological ailment, apprises the patient about it and its impact on his/her daily life, and finally drafts the further line of treatment.

The psychotherapist will ask the patient to open up about his/her anxiety or fears that otherwise he/she is not able to share with anyone else. He/She will then make the patient go through a series of questions and situations, and based on the behavioral patterns, will conclude on the underlying cause of OCD.

After a few sessions of psychotherapy, the patients generally become completely aware of their illness. They can comprehend that the things they have been thinking and considering real, are only inside their head. The sessions may also include ERP (Exposure Response Prevention) therapy, where the patient is made to go through a series of activities to understand and overcome their fears/obsessions.

It can be said that CBT and ERP help the patient to understand how OCD is negatively affecting his/her daily life. The psychotherapist, post the diagnosis, will guide the patient on how to work on controlling and reducing his/her symptoms. Please note, CBT and ERP are gradual processes and take time to reap benefits. Therapy should not be stopped in between unless advised by the mental health professional.

Exercises and Meditation

It is a universal fact that inculcating physical exercise and meditation in daily life is beneficial. It not only keeps your body active but also helps in fighting various mental disorders. Deep breathing exercises and meditation can help a person control his/her erratic behavior and emotions. Running and jogging releases certain chemicals in the body that help in reducing stress, anxiety, and tension. Therefore, physical exercise can also help in controlling the symptoms of MDD and OCD.

For good results, both physical exercise and meditation should be a part of your daily life.

Medication options

Serotonin Reuptake Inhibitors

Psychiatrists are qualified doctors and prescribe medicines for mental disorders, while psychotherapists/psychologists, work with therapy. They may/may not prescribe medicines(if a psychologist is not a qualified doctor, he/she can’t prescribe medicines). Often, psychotherapists who prescribe medicines are also psychiatrists.

Doctors, generally prescribe antidepressants in Obsessive Compulsive Disorder, and specifically SSRIs (Selective Serotonin Reuptake Inhibitors). Serotonin is a chemical that regulates mood, thoughts, energy, etc., but it also has many other vital functions.

Serotonin, a neurotransmitter, is released for carrying specific signals in the brain and is reabsorbed by the nerve cells once the signal is transmitted.

SSRIs help in inhibiting serotonin reabsorption which thus increases the chemical’s volume and maintains the required balance in the brain. This helps in combating depression, mood swings, stress, and anxiety.

Is there any proof that SSRI help in OCD?

Though there is no concrete proof of how SSRIs help in relieving the symptoms of OCD, studies show that most people tend to respond to SSRIs, and thus, they are widely used. For people who do not react to SSRIs, other advanced medication or methods can be prescribed by the mental health professional.

It should be noted that SSRIs or any other medication relating to mental disorders take time to show results. The medication should be taken regularly under the guidance of mental health professional. Also, the medication should not be abruptly stopped without the consent of the doctor, as it can have a negative impact and there is always a risk of relapse.

In recent years, multiple research has been conducted to predict if a person has OCD or not using brain scans. A few research have shown that a particular area of the brain – “cingulo-opercular network” behaves abnormally in the case of OCD. This area is related to alertness and relevant actions to be performed. This finding can prove to be crucial as more specific and better treatment options could be devised for OCD.

Conclusion

Most people think that OCD is not a big problem. It impacts our daily life, so there should be no doubt that it is a serious concern. The severity may vary though in different people. In some cases, Obsessive Compulsive Disorder can even lead to life-threatening situations (e.g., coupled with depression). Caution should be exercised in such cases.

Lastly, please note that this blog post is in no way a holistic guide for OCD, its causes, symptoms, and treatment. People should always reach out for professional’s help if they see OCD or any other mental-health-related symptoms in a person. Always, support and stand by the person going through any kind of mental distress. It might not be a concern to you, but for the affected person, his/her life might depend on your support and help.