OCD: Causes, Diagnosis and Treatments

What is OCD?

Obsessive compulsive disorder (OCD) involves constant, uncontrollable emotions, feelings, or behaviours. These trigger irrational and unwanted compulsions, causing an individual to repetitively behave in a way they don’t want to. This can cause significant disruption to daily functioning as the individual cannot go on with their day until these irrational compulsions are satisfied and the worry is alleviated. In most cases, the individual with OCD is aware that their behaviours are irrational, but this does not mean they can stop them, making the experience particularly distressing.

Types of OCD

There are four main ways in which OCD manifests itself in behaviours:

• Contamination: This involves a fear of things that might be dirty or need to be cleaned. Contact with these things results in a strong compulsion to clean or 'decontaminate' oneself immediately.
• Checking: Door locks, alarm systems, hot implements and light switches are examples, or believing you have a medical condition or illness.
• Symmetry and ordering: This is the need for organisation and ordering in a certain way to satisfy unwanted emotions.
• Ruminations/Intrusive Thoughts: This involves an obsession with a certain thought or experience which can be violent or disturbing.

How is OCD Diagnosed

We can all have irrational thoughts and behaviours that are difficult to control, however these typically are not persistent and do not interfere with our everyday functioning. Therefore, to diagnose OCD, the NHS uses the International Classification of Disease (ICD 10) manual[1], which diagnoses based on the presence of recurrent, obsessional thoughts or compulsive acts.

Causes

• Serotonin Levels: OCD is a neurobiological disorder and studies have found genetic variants in the expression of serotonin can increase vulnerability to OCD[2]
• Genetics: research has found certain types of OCD have a genetic basis, meaning relatives of those with OCD are more vulnerable to developing the illness[3]
• Adverse life events: Studies show that traumatic events such as abuse in childhood make it more likely that an individual will develop OCD[4]
• Personality: Meticulous or anxious individuals are more likely to develop OCD[5]

Interventions for OCD

Exposure Therapy

• Exposure therapy is a type of CBT commonly used for treating OCD. It essentially involves not giving in to the unwanted compulsions, for example not washing their hands after thinking they are contaminated. This may involve the individual being guided by a therapist to extensively touch an item they believe is contaminated. The individual must learn that there is no consequence to not giving into the compulsion and doing the desired behaviours to satisfy it. Research shows it can be highly effective in alleviating compulsions, especially when paired with aspects of cognitive behavioural therapy[6].

Selective Serotonin Reuptake Inhibitors (SSRIs):

• SSRIs act to control the levels of serotonin in the brain and have been shown to be effective in reducing compulsions in OCD and offer a short-term solution[7]

References

[1] World Health Organization. (2004). ICD-10 : international statistical classification of diseases and related health problems : tenth revision, 2nd ed. World Health Organization. https://apps.who.int/iris/handle/10665/42980

[2] Sinopoli, V. M., Burton, C. L., Kronenberg, S., & Arnold, P. D. (2017). A review of the role of serotonin system genes in obsessive-compulsive disorder. Neuroscience & Biobehavioral Reviews, 80, 372-381.

[3] Nestadt, G., Grados, M., & Samuels, J. F. (2010). Genetics of obsessive-compulsive disorder. Psychiatric Clinics, 33(1), 141-158.

[4] Mathews, C. A., Kaur, N., & Stein, M. B. (2008). Childhood trauma and obsessive‐compulsive symptoms. Depression and anxiety, 25(9), 742-751.

[5] Rector, N. A., Richter, M. A., & Bagby, R. M. (2005). The impact of personality on symptom expression in obsessive-compulsive disorder. The Journal of nervous and mental disease, 193(4), 231-236.

[6] Vogel, P. A., Stiles, T. C., & G?testam, K. G. (2004). Adding cognitive therapy elements to exposure therapy for obsessive compulsive disorder: A controlled study. Behavioural and cognitive Psychotherapy, 32(3), 275-290.

[7] Bloch, M. H., McGuire, J., Landeros-Weisenberger, A., Leckman, J. F., & Pittenger, C. (2010). Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder. Molecular psychiatry, 15(8), 850-855.