Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

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Abstract

Obsessive-Compulsive Disorder (OCD) is a mental disorder that causes compulsion and obsessive behavior that disrupts everyday life. The cause of the disorder is unknown, but some prognosis shows a genetic strain, environmental causes, and the brain’s structure and functioning. This paper looks at the population, prevalence, stigma, treatment, and the current and historical diagnosis and treatment of OCD. The study finds that around 2.2 million people in the United States have the disorder. The prevalence rate in adults is 2.3%, with females being higher than that of males. The occurrence of the disorder is, however, similar to both males and females. The treatment of OCD is by using medication like tricyclics, selective serotonin reuptake inhibitors (SSRIs), and other tested and proven drugs. There is also the use of cognitive-behavioral therapies that help change the response to the compulsions and urges. The treatment of resistant OCD is done by alternative micro therapies and augmentation, which involves various drugs and therapy. The paper finds a historical change in diagnosing and treating OCD from religious beliefs to cognitive and behavioral techniques used today.

Keywords: Obsessive-Compulsive Disorder (OCD), Stigma, Diagnosis, Cognitive and Behavioral Therapy

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a mental disorder that causes irrational thoughts and fears or a need to perform certain routines causing distress and impairs general functioning. People with OCD may have compulsions, obsessions, or both depending on their condition. Obsessions are the repeated thoughts, mental images, and urges that cause the person to have anxiety. These obsessions might include fear of contamination and symmetry and ordering where things have to be arranged in a certain way. It may also involve having thoughts that are violent to oneself or others and disturbing in nature. Compulsions are the repetitive behavior that the individual’s urges seek to fulfill in response to the thoughts. These compulsions may include excessive cleaning, arranging things in a particular order, and repeatedly checking whether the door or stove is off.

OCD can affect anyone, from children, adolescents to adults. Most people are diagnosed with the disorder in their teenage years, around the age of 19. The causes of OCD are generally unknown, but there are risk factors for genetics, environment, and brain structure and functioning. The occurrence of OCD is the same for both men and women. With the onset age being averagely 19 years, 25% of the cases occur before the age of 14, and of the adults affected, around 33% experienced symptoms in childhood. The United States has a reported case of 2.2 million people with the disorder, which accounts for 1 % of the population. The prevalence rate of the disorder among adults in the country is around 2.3%. The previous year’s prevalence rate was higher in females at 1.8% than in males at 0.5%.

Treatment of OCD

OCD can be treated in various ways, including medication management, cognitive behavioral therapy, and other alternative monotherapies. The two treatments can be done separately, but clinicians suggest combining the two treatments is more effective. The treatment of OCD by behavioral therapy is efficient, and several studies have validated this. The commonly known behavioral treatment is Exposure and Response Prevention therapy. This therapy involves the introduction of anxiety and obsession stimuli in a controlled environment. The patients are then prevented from engaging in these compulsions. This type of treatment allows the patients to develop a resistance to the compulsions that these stimuli present. This treatment enables the behavior of the patient to be modified in small progressive steps.

Medication management is the use of pharmaceuticals to treat the disorder and is also referred to as pharmacotherapy. This treatment involves administering drugs that inhibit the release of a specific chemical compound, especially serotonin. The tricyclic antidepressant, Clomipramine, was the most effective in inhibiting serotonin and thus proved essential in treating OCD. In a later introduction, selective serotonin reuptake inhibitors (SSRIs) were more effective than the tricyclics. So these drugs, Clomipramine and the SSRIs, are used to treat OCD according to the patient’s needs.

The two mentioned treatments are a standard treatment for OCD. However, there are severe resistant types of OCD that do not respond to these forms of treatment. Individuals who fail to respond to these treatments undergo different therapeutic strategies categorized into alternative monotherapies, invasive procedures, and augmentation strategies. Alternative micro therapies involve the combination of different medications to treat OCD.  For example, serotonin-norepinephrine dual-acting reuptake inhibitor venlafaxine has been tested to treat resistant OCD. There have also been suggestions that higher doses of SRIs managed through intravenous infusion provide better treatment results.

Stigma and Negative Stereotypes

Stigma is the discrimination of a person based on a characteristic of a condition that makes them different from other people in society. There are several types of stigmatization, including social, self, and professional stigmatization. Social stigmatization is the most common where is separated from society due to their condition or situation. Self-stigmatization arises from social stigmatization, making the affected individual to feel shame and eliminated, leading to more complications. Professional stigmatization comes from healthcare workers towards patients suffering from mental health conditions.

OCD is affected by stigma due to social attitudes and personal attitudes towards the condition. Self-stigmatization arises from fear of the unknown, especially before and during diagnosis. The stigma surrounding OCD includes people thinking that they are crazy and cannot be trusted with a job or parenting duties. Another stigma is that the person is violent or dangerous. The stereotypes surrounding OCD include that the individual is controlling and obsessed with cleanliness and that OCD affects only the privileged in society. These stigma and stereotypes are founded on the lack of knowledge and an understanding of the disease.

The stigma affects the individual’s ability to perform their responsibilities due to feelings of fear, shame, and seclusion. The stigma also affects the relationship between the individual and their family or friends. This misjudgment may arise from a lack of knowledge from friends and family, leading to stigma towards the individual. The miscommunication and misjudgment from family and friends would harm the individual affecting their recovery process. This stigmatization may also lead to more complications like depression to the individual.

Current versus Historical Understanding of OCD Including Diagnosis and Treatments.

OCD was considered as insanity or religious melancholy before the advent of psychosis studies. The features of obsession and compulsion were all centered on religious practices and beliefs. Much of the seventeenth and eighteenth-century medical knowledge was based on bodily fluids called humor. The treatment of OCD was also done according to this knowledge, and the treatment was mainly by bloodletting. This technique served to balance the body fluids in the body to eliminate the disorder’s humor. For OCD, the humor that was thought to cause the disorder was blood, hence bloodletting treatment. By the nineteenth century, physicians noticed the obsessions sand compulsions were not religious but sexual and fear of contamination. The notion changed from a problem with body fluids to emotional, mental, and intellectual viewpoints. Freudian theories got much attention during this time, as he theorized that emotions of love and hate affected the disorder. His theories persisted until the advent of cognitive and behavioral psychology.

After the start of cognitive and behavioral psychology, the treatment of OCD was mainly therapy, which became personalized according to the patient’s needs. Today the treatment of OCD is a combination of cognitive and behavioral therapy and medication to treat anxiety depression by suppressing certain chemicals’ release. Today’s diagnosis of OCD is made by clinical psychologists through various tests to determine the disorder’s degree and recommend proper treatment. There are those whose treatment can be done only with cognitive therapy, others by behavioral therapy, medication, or a combination of two or three techniques. The treatment varies from one day therapies to hospitalization. Those with mild OCD can receive therapy once a week or a couple of times a week while going on with their daily lives. Some need extra attention and might need to attend day programs to check their progress and to receive extra care. Then there are those with severe OCD who might need hospitalization to focus on their needs more time and attention. The treatment of OCD has evolved and will continue to evolve with the improvement in technology and pharmaceuticals.