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Obsessive Compulsive Disorder (OCD)

OCD is a psychiatric condition, where the person gets irresistible repeated thoughts or sensations to do the things over and over again. Few of the common things are: repeated hand washing, checking the door, clean the dishes again and again after they are done, clean the house/garage, counting the same thing, eating disorders, sexual obsessions, biting nails, pulling hair, collecting the stuff from dumpster and fill the house that are not useful for anybody. Sensations are called obsession, that irresistibility is called compulsive.

Types:
  • Primarily obsessional: Recurrent and persistent thoughts, urges
  • Primarily compulsions: Repetitive behaviors like hand washing, counting, and checking…
  • Both: Both of the above things together
Pathophysiology:

In OCD, altered neurotransmitter function gives different patterns in their brain scan. Serotonin activity goes down and dopamine function goes up, and there is altered glutamate pathway.

Causes:
  • Temperamental: Greater internalizing symptoms, higher negative emotionality, and behavioral inhibition in childhood
  • Environmental: Physical and sexual abuse in childhood and other traumatic events have been associated with an increased risk for developing OCD
  • Genetic and physiological: The rate of OCD with first degree relatives is higher when the first degree relative got OCD in his or her childhood than in adult. DRD3 gene form may contribute for the development of OCD.
Symptoms:
  1. Repeated checking of door locks
  2. Hand washing
  3. Repeated cleaning
  4. Hair pulling
  5. Skin picking
  6. Nail biting
  7. Sexual obsessions like kissing, touching
  8. Body focused repetitive behaviors
  9. Turn off turn on switches

Most of the time these symptoms associated with anxiety and fear.

Diagnosis:

Psychiatrist will give the diagnosis when the person satisfies the criteria as per DSM V. Obsessive-compulsive personality disorder presents as an extensive pattern of preoccupation with perfectionism, orderliness, and interpersonal and mental control, at the cost of efficiency, flexibility and openness. Symptoms must appear by early adulthood and in multiple contexts. These obsessions or compulsions must be time consuming or cause impairment in social, occupational functioning.

Management:
  • Behavioral therapy
  • Cognitive behavioral therapy
  • Medication treatment: SSRIs, tricyclic antidepressants, atypical antipsychotic drugs
  • ECT: Electroconvulsive therapy
  • Alternate therapy: Counseling, reiki, nutritional help