SHARES
“I keep on having a constant nagging thought, wondering whether the oven was turned off, even after checking once and many times after. This keeps on disturbing me, urging me to check the oven repeatedly.”
It’s not uncommon to have random intrusive thoughts from time to time. For most of us, it’s easy to get rid of such thoughts and move on, allowing the brain’s stream of consciousness to move in a different direction. However, that’s not the case for people with obsessive compulsive disorder or OCD.
What is Obsessive Compulsive Disorder (OCD)?
Obsessive compulsive disorder is one type of anxiety disorder with characteristic obsession and compulsion that greatly affects a person’s life negatively.
The obsessions are intrusive, repeating irrational thoughts or images. These would involve mainly the need for perfect cleanliness, symmetry or aggressive urges of affirmation.
Obsessions cause anxiety and drive repetitive behaviors known as compulsions, in order to ease the obsessive anxiety. For the most part, common compulsions include constant cleaning, checking, counting, praying, etc.
The obsessions and compulsions are time consuming, unwanted and greatly affect one’s daily life.
There are 2 types of OCD :
with insight– where the affected persons are aware that their thoughts and behaviors are irrational. However, they feel powerless to stop them; And
without insight- the afflicted persons think that the OCD belief are probably true.
Those with insight have a better prognosis than those who have poor or absent insight.
How Does OCD Happen?
Normally, we are able to detect danger and know when we are safe. This is because there is a neural pathway in our brain, known as supraorbital-cingulate- thalamic circuit (SOCT circuit) that is responsible for this danger/safety detection mechanism.
However, in the case of OCD, this mechanism does not work properly and in severe cases, goes haywire. It sends the “false alarm” when there is no danger and fails to signal real safety until the compulsions are carried out, and then the cycle repeats itself. Moreover, in the long run, these behaviors only worsen the OCD conditions due to a process called negative reinforcement. That means, it further reinforces the bran’s anxiety trigger and makes its safety signaling weaker.
Photo by Philippe Roland Wust from Flickr
Treating OCD
Cognitive Behavioral Therapy(CBT)
If not treated promptly, OCD will develop into depression that exaggerates the pain and complicates treatment. Fortunately, obsessive compulsion disorder responds well to cognitive behavior therapy (CBT), a non-medical treatment. CBT is normally the first line of treatment. It changes the brain activity like the way medications do but has less side effects and lower relapse rates. The therapy involves a method named exposure and response prevention (ERP).
In order to feel safe when threatened, people with OCD normally would carry out safety seeking compulsions – avoidance (avoiding anxiety triggering stimulus), escape (doing a ritual to neutralize the anxiety), and reassurance seeking (repeatedly asking questions to confirm that nothing bad has happened).
During ERP therapy, a series of sessions led by a healthcare professional let the sufferers experience and process psychologically the triggered anxiety, until it resolves on its own. Over time, sufferers learn to face their anxiety without having to resort to compulsions. In tandem, the obsession intensity decreases, enabling the patient to eventually break free.
Medications
Medication can be used to treat OCD though it may not be as effective as CBT. Also, it carries much higher risk of relapse and side effects. The medication, selective serotonin reuptake inhibitors, helps control the obsession and compulsion. These include citalopram (Celexa), fluoxetine(Prozac), and escitalopram (Lexapro).
Neuromodulation
In rare cases when therapy and medications fail, neuromodulation may be an option. It involves a device to change the electrical activity in certain part of the brain.
Photo by Lalit Sahu from Flickr
Conclusion
It is distressing to see a person, especially if he or she is a loved one, continue to perform nonsensical repetitive behavior or OCD. To help us overcome and understand better, we need to educate ourselves about obsessive compulsive disorder and know what can be done to overcome it. Getting help from a healthcare professional is essential for recovery.
References:
1. Lazarus C. Understanding OCD [Internet]. Sussex Publishers, LLC. 2015. (Available from: https://www.psychologytoday.com/us/blog/think-well/201511/understanding-ocd; last accessed on 2020 Sept 24)
2. Obsessive-compulsive disorder (OCD) [Internet]. WebMD LLC. 2020. (Available from: https://www.webmd.com/mental-health/obsessive-compulsive-disorder#1; last accessed on 2020 Sept 24)
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by Chang Xian
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