Obsessive-Compulsive Disorder

Richard Kim

“I’m very OCD about it.” Doubtless, this is a phrase you have heard several times in your life and have perhaps said yourself. To many of us, the three letters “OCD” spark images of placing folders in a perfectly straight pile on our desks, or making sure that the duvet cover is aligned with the sides of the mattress to the nearest millimetre. And perhaps, to some extent, you might be right. But at the same time, you could not be further from the truth. 


Obsessive-Compulsive Disorder is a chronic disorder involving recurring thoughts, which might in many cases manifest as recurring actions. The name of the disorder is an effective way of visualizing this; “Obsessions” represent the intrusive and regular thoughts, while “Compulsions” represent recurring actions resulting from those thoughts. Examples of obsessions do include some of the stereotypical ones, albeit to a far greater extent than usually portrayed: one might have a constant fear of germs, or stress induced by everyday worries such as leaving the gas on. Examples of compulsions usually involve routines or rituals which those suffering from OCD enact in order to try to relieve their obsessions. If we were to use the examples I have provided for obsessions, compulsions resulting from those might be constantly washing hands to try to get rid of germs or avoiding human contact all together, or in the second example, routinely returning to your home to ‘make sure’ that the gas is turned off. To a small extent, we all do these kinds of things, but this becomes ‘Obsessive’ when it is regularly reoccurring, and mostly without logical basis. 


My description might make OCD seem like a difficult disorder to diagnose, and to an extent it is. Predictably, any diagnosis must be done by a licenced mental health professional, such as a psychiatrist, as one might expect, or a clinical social worker. The Diagnostic and Statistical Manual of Mental Disorders, or DSM, is an example, which is used often in the United States to classify mental disorders; according to the DSM, a person must suffer from obsessions, compulsions, or both, and that these cause significant distress to the patient: so much so that the compulsion rituals which they perform to try to alleviate these stresses are time consuming, in that they take up many hours. Indeed, a rough estimate of the severity of a patient’s OCD can be determined by their estimation of the amount of time they spend a day having obsessive thoughts and carrying out compulsive behaviours. For a more concrete determination of the severity of OCD, we must turn to the Y-BOCS, the “Yale-Brown Obsessive Compulsive Scale.” This scale disregards the specifics of the compulsion or obsession, but rather focuses on the extent to which they infringe upon everyday life, with the answer being a number from 0 to 4, with 0 representing a lack of the particular symptom, and 4 representing a severe presentation of it. An example of a question from the Y-BOCS is “How much of an effort do you make to resist the obsessive thoughts?”. An answer of 0 would signify that the patient “makes an effort to always resist, or symptoms [are] so minimal [that the patient] doesn’t need to actively resist.” However, an answer of 4 would signify that the patient “completely and willingly yields to all obsessions.” After asking all of these questions, the scores are added up, with separate subtotals for Obsessions and Compulsions being found, which can be added together to find the total score. Although interpretations of these scores differ, it is generally accepted that any score above 15 signifies a moderate level of OCD, with a maximum possible score of 40. 


Unfortunately, the cause of OCD is unknown, as is the case with many behavioural disorders. Some suspicions do exist however, with certain factors correlating with a higher risk of developing the disorder. A study published in Brain in 2007 demonstrated that endophenotypes, which are according to the authors of the study, “objective, heritable, quantitative traits hypothesized to represent genetic risk for polygenic disorders,” could help to further understand how OCD is caused and what signs can be found in those carrying the genes for it. A response inhibition task showed that not only did OCD patients have a delayed response relative to the control patients, but so did their relatives, who were unaffected by OCD. Furthermore, a correlation in terms of the distribution of grey matter was found, with the amount of grey matter in the orbitofrontal and right inferior frontal regions being lower than normal: this was an example of an endophenotype for OCD. Other theories for the causation of OCD exist, such as childhood trauma, bacterial infection, and certain drugs, however, a clear and substantial link is yet to be found. 


Given the lack of knowledge of the cause of OCD, there is therefore no easy solution to managing it. The most common form of treatment is CBT, or Cognitive Behavioural Therapy, with the more specific sub form being ERP, or Exposure and Response Prevention. In this, the patient is encouraged to trigger their obsessive thoughts but not carry out their compulsive actions in response to them, with the idea being that the patient could gradually learn to decrease the amount of distress felt when they do not carry out the compulsive action in response to obsessive thoughts, and to be able to tolerate that distress to an extent. An example of this would be touching a dirty object, then not washing the hand afterwards. Often, this therapy is combined with a course of medication, usually SRIs, or Serotonin reuptake inhibitors, which increase the levels of serotonin in the brain. Serotonin is a neurotransmitter, thus, by slowing down the reuptake of serotonin by the hSERT transporter, more neurotransmitter is available to carry messages across synapses in the neurons, allowing for better communication within the brain’s structure, and potentially alleviating some symptoms of OCD. 


Obsessive-Compulsive Disorder is not to be taken lightly and can often be a debilitating disorder to suffer from, whether that be through wasting hours of the day repeatedly washing your hands, being unable to leave your home and interact with other people, or through painful symptoms resulting from constant picking of your own skin. Often, mental health disorders are far more complex than many of us give them credit for, and it is more important now than ever before to be aware of the potential afflictions people might suffer from, so that we can help to recognise when our friends, family, or ourselves, might be affected.











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