Obsessive Compulsive Disorder: Understanding and Interventions

By Wasim Kakroo

JUST imagine what would happen if your mind were hooked on a certain thought or image and no matter what you did, this thought or image was replayed in your head over and over again. These thoughts or images aren’t what you desire – they feel like an avalanche. Along with the thoughts or images, come the powerful anxious feelings. It feels like you’re in danger when you’re anxious. Anxiety is a feeling that instruct-ts you to respond, react quickly, defend yourself, and DO SOMETHING, anything. On the one hand, you may know that the fear you are feeling is illogical and unreasonable, yet it nevertheless seems very real, powerful, and true.

The mental health condition known as Obsessive Compulsive Disorder (OCD) is a mental disorder in which the person’s brain produces false alarms about situations that are not at all threatening because its warning mechanism isn’t operating properly. In OCD, your brain tells you that you are in danger when in reality you are not in any sort of danger. Those who suffer from this illness desperately want to escape from the thoughts or images and associated paralysing, never-ending anxiety and in their attempt to do so, they fall trap to various unhealthy mental and physical behaviors such as repetitive checking, repetitive washing, undoing, avoidance etc.

How will I be able to tell whether I have OCD?

OCD can only be diagnosed by trained clinical psychologists/psychiatrists.

They’ll be on the lookout for four things:

• The individual has obsessions.
• The obsessions produce anxiety
• He or she get engaged in compulsive behaviors.
• Obsessions and compulsions consume a lot of time and prevent the individual from doing things they consider important and valuable in their life (working, going to school, etc.)

What are Obsessions?

• Recurring thoughts, images, or urges that feel out of the person’s control.
• The person does not want to have these thoughts.
• He or she finds these thoughts, images or impulses unsettling and unwelcome, and he or she is generally aware that they are illogical.
• They are accompanied by negative emotions such as fear, disgust, uncertainty, or a sense that things must be done “exactly perfectly.”
• They consume a lot of time and get in the way of the person’s important activities of daily life (socializing, working, going to school, etc.).

Common obsessions may include: Fear of contamination, Fear of losing control, perfectionism, repetitive aggressive thoughts or images, unwanted sexual thoughts or images, unwanted antireligious thoughts etc.

What are compulsions?

• Repetitive behaviors or thoughts that a person participates in to counteract, neutralise, or eliminate their obsessions and lessen down the  feelings of anxiety.
• People with OCD are aware that this is simply a temporary solution, but in the absence of a better coping mechanism, they rely on the compulsion as a means of temporary relief.
• It may also include avoiding circumstances that stimulate their obsessions.
• Time-consuming and create hindrances for the person’s valuable activities in daily life (socializing, working, going to school, etc.).

Common compulsions may include: Repetitive washing and cleaning, repetitive checking, repeating actions unnecessarily, mental compulsions, etc.

At what age does OCD first appear?

OCD may develop at any age, from childhood through adulthood. Although OCD can strike at any age, there are two age groups in which it often manifests. The first occurs between the ages of 10 and 12, while the second is between late adolescence and early adulthood.

Is OCD a hereditary condition?

According to research, OCD runs in families and that genes are likely to have a part in the disorder’s development. However, it appears that genes are only partially to blame for the disease. Nobody knows what additional variables could be at play, but researchers consider variables such as such as sickness or everyday life stressors as factors which could trigger the activation of genes linked to OCD symptoms.

Some researchers believe that OCD that develops in preschoolers is distinct from OCD that develops in adults. For example, a recent analysis of twin studies found that genes have a bigger role to play in childhood OCD (45-65 percent) than in adulthood OCD (45-65 percent) (27-47 percent).

Is OCD a brain disorder?

According to research, OCD is caused by issues in communication between the frontal lobe (the front part of brain) and some deeper parts of the brain. Serotonin is a chemical transmitter used by these brain regions. Images of the brain at action also reveal that with the help of either serotonin medications (also known as Serotonin Specific Reuptake Inhibitors, SSRIs) or cognitive behaviour therapy (CBT), the brain circuits implicated in OCD can become more normal in significant percentage of people affected with OCD.

There are no lab or brain imaging tests that can be used to diagnose OCD. The diagnosis is determined by observing and evaluating the person’s symptoms.

What are some of the most prevalent roadblocks to effective treatment?

According to studies, it takes an average of 14 to 17 years for persons with OCD to receive proper therapy.

• Some people prefer to conceal their symptoms out of fear of shame or stigma. As a result, many persons with OCD do not seek assistance from a mental health professional until years after their symptoms first appear.
• Because there was a lack of public knowledge of OCD until recently, many patients were unaware that their symptoms were indicative of a treatable condition.
• Cultural and religious explanations of the symptoms of OCD which many at times lead to mistreatment of this mental health condition.
• Some health practitioners’ lack of adequate training frequently results in incorrect diagnoses. Before getting an accurate diagnosis, some people with OCD symptoms would see multiple doctors and thus it may lead to severity of symptoms.
• Finding local therapists who can properly treat OCD is difficult.
• Inability to pay for proper psychiatric and/or psychotherapeutic treatment.

How successful are OCD treatments?

For the procedure to be successful, one or more of the following four elements should be included in the treatment of most persons with OCD:

A CBT intervention-Exposure and Response Prevention (ERP), 

a properly trained therapist, 

medication, 

and family support and education.

Majority of research suggest that around 70% of OCD patients will improve from either medication or cognitive behaviour therapy (CBT). Patients who respond to medication often have a 40-60% decrease in OCD symptoms, whereas those who respond to CBT typically experience a 60-80% reduction in OCD symptoms. However, in order for the therapies to function, patients must take their medications on a regular basis and actively participate in CBT on weekly basis for atleast two months.

Unfortunately, studies reveal that at least 25% of OCD patients decline CBT, and up to half of OCD patients stop taking their medications owing to side effects or other factors.

How long do these medications take to work?

It’s crucial not to stop taking your medicine until you are not directed to. It usually is a course of 6 months to 2 years (to be decided by the psychiatrist). Many patients have no beneficial benefits during the first few weeks of treatment, but subsequently notice a significant improvement.

The major issue with just taking medications to treat OCD is that if you aren’t receiving CBT, you may not even know if the medication is working. Some people respond to medication without CBT/ ERP, however if OCD has become a habit or a way of life, such patients can have difficulty in understanding how OCD has affected their lives.

One way to look at it is that the medicine may assist to fix the chemical or neurological problem in the brain, but you’ll need Cognitive Behaviour Therapy to help you change the habits that have been established in your lifestyle. As a result, I as a clinical psychologist suggest CBT/ERP for all OCD patients irrespective of the severity of their symptoms. This increases the likelihood of receiving a better response. Medicines can bring a quick relief to a person’s symptoms compared to CBT/ERP, however, CBT/ERP has better impact on lessening the chances of relapse. Thus using combined therapeutic approach (i.e., pharmacotherapy and psychotherapy) is always better than monotherapy alone and the patient may recover with lesser chances of relapse.

What can you do if any of your family members has received the diagnosis of OCD?

Here are a few things you can do:

1. Learn about OCD.

The first step is education. The more you understand, the more equipped you will be to assist someone who suffers from OCD.

• Read OCD literature
• Attend OCD support groups
• Conduct internet research

2. Learn to identify and eliminate “Family Accommodation Behaviors.”

Family accommodation behaviors are the behaviors that families engage in that exacerbate OCD symptoms. The demands of OCD have a continuous impact on families. According to research, how a family responds to OCD symptoms may assist to feed OCD symptoms. The more family members understand about their own reactions to OCD and how they affect the person with OCD, the more empowered they are to make a difference! Here are a few instances of these negative behaviours:

• Taking part in the behaviour: You take part in your family member’s OCD behaviour along with them. For instance, when they wash their hands, you feel you should wash your hands as well.
• Assisting with avoidance: You assist your family member in avoiding things that cause them distress. For instance, washing their clothes for them so that it is done correctly.
• Assisting with the behaviour: You provide services to your family member that allow them to engage in OCD activities. Purchasing large quantities of cleaning supplies for them, for example.
• Altering Family Routines: For example, you may vary the time of day you shower or when or how often you change your clothes.
• Taking on additional duties, such as driving them somewhere when they could normally drive themselves.
• Changing leisure activities: For example, a family member may persuade you not to leave the house without them or out of fear of contracting COVID-19 infection. This has an impact on your interest to go to the movies, eat out, spend time with friends, and so on.
• Making adjustments at work: For example, you cut back on hours at work to care for a family member.

3. Learn what to do if a member of your family refuses therapy.

• Bring OCD-related literature, videos, and/or audio recordings into the house. Offer the material to your OCD family member or deliberately put it about for them to read/listen to on their own.
• Give words of encouragement. Tell the person that with proper treatment, the majority of people have a considerable reduction in symptoms. Tell them there is help available and there are others with the same problems. Suggestions include going to support groups, talking to an OCD buddy through online support groups, or speaking with a specialist at a local OCD clinic.

How does OCD affect lives of children and adolescents?

OCD affects a significant proportion of children and adolescent and thus understanding the disorder’s unique impact on their life is critical to ensuring that they receive the best treatment possible. The following are some of the most prevalent OCD difficulties in children and teenagers:

1. Disrupted Routines: For children and teenagers, OCD may make daily living extremely tough and unpleasant. They feel that if they don’t get their morning rituals perfect, the rest of the day will be a disaster. They also feel that they must complete all of their obsessive routines before going to bed in the evenings. Because of their OCD, some children and teenagers stay up late and are typically weary the next day.
2. School Issues: OCD can impact homework, classroom attentiveness, and school attendance. If this occurs, you must be a strong advocate for your child. Under the Individuals with Disabilities Act (in case the disability crosses 40%), you have the right to request adjustments from the school that would help your kid succeed.
3. Physical complaints: Children might get physically unwell as a result of stress, poor diet, and/or a lack of sleep.
4. Social relationships: Their friendships are affected by the stress of hiding their rituals from peers, time spent with obsessions and compulsions, and how their friends react to their OCD-related activities.
5. Self-Esteem Issues: Children and teenagers fear that they are “crazy” because their thinking differs from that of their peers and family. Their self-esteem may be harmed as a result of their OCD, because it has caused them shame or made them feel “bizarre” or “out of control.”
6. Anger Management Issues: This is due to the parents’ refusal (or inability!) to comply with the child’s OCD-related demands. Even when their parents establish appropriate boundaries, children and teenagers with OCD might become nervous and irritable.
7. Additional Mental Health Issues: Children and teenagers with OCD are more prone than those without the illness to have additional mental health issues.

Other disorders can sometimes be treated with the same medication that is used to treat OCD. When a youngster takes anti-OCD medication, depression, other anxiety disorders, and Trichotillomania may improve. Attention Deficit Hyperactivity Disorder, tic disorders, and disruptive behaviour disorders, on the other hand, may need additional treatments, including medicines that are not specific to OCD.

Treatment of OCD in Children and Teenagers:

Cognitive-Behavioral Therapy and/or medicines:

Experts believe that for children with OCD, cognitive-behavioral therapy (CBT) is the best treatment option. Children and adolescents with OCD who work with a trained CBT therapist realise that they, not OCD, are in command. Young people can learn to do the opposite of what their OCD instructs them to do by progressively addressing their anxieties in small steps (exposure), rather than succumbing to the rituals by using a CBT approach called exposure and response prevention (ERP) (response prevention).

ERP enables them to discover that their concerns are unfounded, and that they may become accustomed to the frightening sensation, much as they could become accustomed to cold water in a swimming pool. A teenager, for example, who touches items in his room to ward off bad luck will eventually learn to leave his room without touching anything. He may be apprehensive about doing this at first, but as he becomes more accustomed to it, the fear fades. He also discovers that nothing horrible occurs. When children understand how exposure and habituation work, they may be more ready to put up with the initial anxiety that comes with ERP because they know it will get worse before it gets better. Parents must participate in their child’s treatment as well, under the supervision of the therapist.

In addition to CBT, therapists have many other therapeutic modalities available to them that they can use depending on the need in the case.

Medicines may also be needed in cases where the severity of symptoms is beyond moderate level.

• The author is a licensed clinical psychologist by profession and works as a child and adolescent mental health therapist at IMHANS-K and can be reached at [email protected]

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