Obsessive Compulsive Disorder

Obsessions are repeated intrusive thoughts, impulses or images  the content of which contrasts with an individual’s  conscious needs, goals, and values. While these may be regarded as alien they do relate to the individual’s personal space. The stereotyped, excessive, irrational  and repeated nature of obsessions causes acute anxiety since the person is unable to stop them and recognizes them as their own. They are unable to stop them and the content is often re-pungent. Obsessions are difficult to control or ignore and a person may go to great lengths to avoid any triggers causing them. Common themes for obsessions are contamination of germs leading to illness, harm to self or others, blasphemy, improper relationships, fear of blurting out inappropriate things, counting, repeating and checking.

The anxiety build-up initially leads to avoidance and then the person engages in either logical or magical thinking or behavior which reduces the obsession. For instance fear of contamination may lead to excessive washing or distress when bathing of defecating. Blasphemous thoughts may lead to repeated prayers asking for forgiveness. Compulsions (or rituals) are repetitive behaviors, or mental acts, performed in response to the obsessions and to reduce the distress or anticipated consequence. There is a temporary respite of the anxiety but it only fuels the obsession to reappear causing a vicious cycle as shown above.

This is called Obsessive Compulsive Disorder or OCD which can be debilitating. Due to the feelings of shame and guilt associated with experiencing OCD symptoms, many individuals do not receive therapy or pharmacologic treatment until years after the onset of symptoms. . Lack of knowledge about the disorder, embarrassment from symptoms, and anxiety related to triggers can all contribute to the delay in patients seeking treatment.  Motivational interviewing techniques focus on empathizing with patients’ experiences and help them identify and change maladaptive behaviors by meeting them at their stage of readiness to change. Cognitive Behavior Therapy (CBT) aims to rectify distorted and maladaptive beliefs to achieve symptom reduction and improved functioning using techniques such as education, relaxation techniques, coping skills training, stress management, and assertiveness training. In Exposure and Response Prevention (ERP) individuals are guided to refrain from compulsive behaviors while gradually facing fear-provoking stimuli for prolonged periods of time. This reduces symptom severity and patients' resistance to treatment and also improves patient insight and compliance to medication. OCD is treated by cognitive-behavioral therapy, selective serotonin re-uptake inhibitors (SSRIs), serotonin-norepinephrine re-uptake inhibitors (SNRIs), and evidence-based neurological methods such as deep brain stimulation, Trans-cranial magnetic stimulation (TMS) or Electroconvulsive therapy (ECT).