Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder, affecting 2-3% of the population throughout life. Dr. Playà Busquets has more than 20 years of experience in the treatment of patients with this disorder, which is characterized by the presence of obsessions and/or compulsions.
Obsessions are ideas, images, mental impulses or concerns of an intrusive and unwanted nature, which repeatedly burst into the mental activity of the individual, causing the person suffering from them an attempt to resist them. They are usually perceived as one’s own thoughts, even though they are involuntary, senseless, unpleasant and often repulsive.
Most common symptoms of obsessive-compulsive disorder (OCD)
The most common symptoms of these patients in the Psychiatry consultation usually relate to:
- Repeated fears of killing a loved one;
- Concern about dirt, contamination and contagion;
- Recurrent thoughts of not doing things the right way;
- Worries about the shape and/or function of body parts;
- Blasphemous or sexually themed thoughts;
- Fear of losing or forgetting something;
- Feelings that certain things must follow a certain order or be in a certain place or position;
- Meaningless sounds, words, numbers or images. They usually cause a varying degree of distress or anxiety.
Compulsions are ritualized forms of behavior or mental acts (mental compulsions), which are repeated over and over again, in order to reduce the discomfort caused by obsessions. They usually provide incomplete and short-lived relief. They are generally recognized by the patient as meaningless and ineffective.
Characteristically, the patients with OCD, present in up to 30% of the cases, a disorder by motor tics. In addition, OCD is often associated with anxiety disorders (panic, social anxiety, generalized anxiety, specific phobia), and also with depressive disorder or bipolar disorder.
Causes of obsessive-compulsive disorder (OCD)
OCD affects between 2-3% of the population throughout life, occurring with equal frequency in males and females. The average age of onset is around 20 years of age, although 25% of cases start at the age of 14 years. Onset beyond 35 years of age is unusual (less than 5%). It is a disorder of chronic course.
Internalizing symptoms, increased negative emotionality and behavioral inhibition in childhood are possible temperamental risk factors. At the environmental level, physical and sexual abuse in childhood, as well as other traumatic events, have been associated with increased risk of developing OCD. Some children may suddenly present with obsessive-compulsive symptoms in the context of post-infectious autoimmune post-infectious group A beta-hemolytic streptococcus (PANDAS) syndrome.
At the genetic level, no specific genes implicated in OCD have been found. However, the rate of OCD in first-degree relatives of adults with OCD is 2 times higher than in the general population, and in those who initiate OCD during childhood the rate is up to 10 times higher.
Functional imaging studies confirm the existence of a decrease of metabolism in the head of the caudate nuclei at the base of the brain, as well as an increase of metabolism in the orbital frontal cortex, as well as the participation of the serotonergic, dopaminergic and glutamatergic neurotransmitter systems in the pathophysiology of OCD.
Psychologically, the relationship between obsessions and compulsions, as well as their self-reinforcing quality, are explained by the principles of learning theory. As obsessive thoughts are repeated, anxiety increases, and although compulsions temporarily reduce anxiety, patients soon become trapped in a positive feedback loop, in which compulsive behavior is self-reinforcing with temporary relief of anxiety.
Treatment of obsessive-compulsive disorder (OCD)
At the pharmacological level and as a first choice, serotonergic antidepressants are used. Higher doses are usually required than those used in other disorders, and it should be borne in mind that therapeutic action usually begins between 4-8 weeks, and that manifest efficacy may not be observed until 12 weeks have elapsed.
The psychological treatment of choice is cognitive behavioral therapy, with exposure-response prevention (ERP) strategies.
The association of pharmacological treatment with psychological treatment is the technique that allows the best results to be obtained in most cases.
In cases of treatment resistance, different serotonergic antidepressant drugs are usually combined, or potentiated with antipsychotics (dopaminergics) or other drugs.
When all of the above strategies fail, and in severe, highly disabling cases of OCD, functional neurosurgery (deep brain stimulation) or lesional neurosurgery (anterior capsulotomy, subcaudate tractomy, limbic leukotomy, anterior cingulotomy) may be indicated.