Do I have OCD

If you have ever asked yourself this question, you may be a person who likes to check and control things, is very tidy, tends to fret over trifles, or has a strong need for everything to be under control. However, you should not be unnecessarily alarmed, as being meticulous can be normal (and I would add helpful in most cases).

Also, not all repetitive worries or behaviors are evidence that the person may be diagnosed with obsessive-compulsive disorder.

What is OCD?

Obsessive-compulsive disorder (OCD) is defined by the presence of intrusive, persistent and recurrent thoughts that we call obsessions, as well as the performance of repetitive, unnecessary and bizarre behaviors, in turn called compulsions.

• Obsessions are ideas, images and even impulses that burst into the patient’s stream of consciousness without the patient wanting them and that he/she is not able to eliminate them.
• These obsessive ideas become entrenched and therefore lead to a continuous rumination on them, that is, they are not fleeting ideas but last and generate concern and fears in the person. Even, according to the content of these thoughts, the affected person can experience shame and a great uneasiness that in turn increases his discomfort.
• The person suffering from OCD does not lose the sense of reality and perceives the absurdity, the overvalued and the disproportionate of his ideas, but in spite of it he cannot eliminate them.
• In an attempt to conjure up these thoughts, compulsions may appear, which I have already mentioned were repetitive behaviors, totally unnecessary and gratuitous. Initially, their execution would reduce the anxiety associated with the obsessive ideas, but this benefit is limited, and soon after, or at the very moment of performing them, the patient realizes how unnecessary and unwise these maneuvers are, but again finds that he/she is unable to stop doing them.

With respect to the type of obsessions and compulsions, the ones that appear most frequently are:

1. Contamination, contagion and cleanliness. One suffers from the possibility of becoming infected or falling ill. This type of thoughts usually entails cleaning and washing compulsions up to the point of being injured by abrasive products, or avoiding contact with people or passing by certain places (near a wastebasket or a container).
2. Doubt obsessions. Doubts refer both to the performance of acts and to one’s own thoughts. In the first case, the clearest examples would be if the taps have been turned off, the gas has been turned off or the switches have been turned off, and therefore rituals are performed to check these objects (up to dozens of times). Doubts referring to one’s own thinking or even about one’s own feelings are when the patient obsessively wonders about a subject (whether he really loves his partner, or whether a conversation has said the right thing). This type of thinking also leads the patient to a dead end of restlessness and discomfort.
3. Obsessions of order and symmetry. In an unhealthy way, the placement of things is checked, so that everything is in a certain order. Likewise, in this type of patients the execution of the simplest of routines is performed as an almost sacred ritual.
4. Impulse phobia. In this case, the patient wonders – obsessively, of course – about the possibility of an inappropriate behavior that has suddenly popped into his head.

Are its causes known?

Its etiopathogenesis (i.e. the causes and mechanisms that lead to this dysfunction) has not been fully identified, although there are multiple neurobiological studies, involving alterations in the central nervous system:

• Structural and functional neuroimaging studies implicate involvement in brain areas such as the prefrontal cortex, basal ganglia, insula and posterior cingulate cortex.
• Genetic and neurochemical studies implicate the involvement of monoamine-type neurotransmitters (basically serotonin and dopamine) and more recently the role of glutamate has been emphasized.

Who suffers from it and how serious is it?

Obsessive-compulsive disorder affects 1.5-2.5% of the general population. Although its frequency is lower compared to that of anxiety disorders as a whole or depressive disorders, it must be taken into account that it is a very disabling condition.

The incidence by sex is slightly higher in women than in men (53-47%). It should be noted that since patients tend to “hide” their symptoms because they are ashamed of their own ideas, it is estimated that an average of seven years usually elapses between the onset of the disorder and the first consultation. The intensity of the clinical picture can vary, and logically the greater the intensity, the worse the prognosis.

Also, OCD can occur sporadically, intermittently or continuously, and in the course of the disease it is common to superimpose depressive episodes, since the limitations it produces in the lifestyle and quality of life of the affected person are important.

What is the treatment for OCD?

The most effective treatment for obsessive-compulsive disorder consists of pharmacotherapy, usually antidepressants that increase serotonergic function alone or in combination with anxiolytic drugs or drugs that act on dopamine regulation.

The combination of psychopharmacological treatment and cognitive-behavioral oriented psychotherapy provides the greatest benefit in alleviating symptoms and reducing superimposed compulsive behaviors.