Obsessive-Compulsive Disorder (OCD) is a mental health disorder in which a person has recurring thoughts [obsessions] leading to certain, repeated behaviours [compulsions]. The exact, underlying mechanisms leading to this debilitating condition remain unknown. Please take a moment to read this article and help researchers understand the multiple factors contributing to different mental health disorders.
Opens the door.
Gets out of the house.
Locks the door.
For some it does not end there.
Opens the door.
Gets out of the house.
Locks the door.
Unlock the door.
Lock the door.
Unlock the door.
Lock the door.
Some will repeat these steps over and over again. They know they have locked the door, but they have recurring thoughts [obsessions] leading them to certain behaviours [compulsions] they are urged to repeat over and over again.
Gets back home.
Runs to the bathroom.
Goes to the living room
Runs back to the bathroom
[To] Wash their hands again, and again, and again.
These are two of the many compulsions observed in individuals with Obsessive Compulsive Disorder (OCD).
According to the International OCD Foundation, around 1 in 100 adults is diagnosed with OCD. It is a common, chronic and long-lasting disorder characterised by obsessions and compulsions. Obsessions are often divided into four categories: fear of germs or contamination, unwanted forbidden or taboo thoughts involving religion, harm or sex, aggressive thoughts towards others or self, and having things symmetrical or in a perfect order whilst compulsions include excessive cleaning and/or handwashing, and compulsive counting, among others.
While many of us enjoy things being ordered in a certain way these behaviours are ordinary until they start interfering with and affecting one’s quality of life, functioning, and relationships. The debilitating symptoms of the disorder make it a disabling condition, especially now, during the pandemic, that behaviours and actions OCD sufferers are encouraged to control and minimise are behaviours and actions preventing the spread of a virus and contributing to personal and societal protection.
While the exact mechanisms leading to the OCD phenotype remain unclear, functional imaging has revealed that hyperactivity in four brain areas – the orbitofrontal cortex, the anterior cingulate cortex, the thalamus, and the striatum – may be associated with the observed actions and behaviours resulting from the individual’s obsessions and compulsions. All aforementioned brain areas are involved in functions such as decision-making, impulse control, response inhibition, morality, reinforcement, motivation, and reward perception, among others.
Misregulation or impairments – functional (in the relationship between brain activity and mental functions), or structural (in brain areas associated with a particular cognition or behaviour) – are likely to disturb the brain’s programmed actions and connections and result in suboptimal responses. Inevitably research is of notable importance – understanding the pathophysiology of disorders will, in turn, aid the prevention, detection, treatment and prognosis of crippling conditions.
To this day the management of OCD has been based on pharmacological and/or psychological therapies. Going down the pharmacological treatment route, the most common choice is the use of Serotonin Reuptake Inhibitors (SRIs) or Selective SRIs (SSRIs). Several randomised control trials (RCTs) have evaluated the efficacy of such pharmacological options and observed that modifications and increases in the balance of serotonin levels – a neurotransmitter involved in regulating function and influencing emotions, mood, memory, and sleep – may soothe some of the enfeebling and enervating OCD symptoms.
Others may opt for psychological treatments – usually Cognitive Behaviour Therapy (CBT), or Exposure and Response Prevention (ERP) therapy. CBT uses three main principles when it comes to managing OCD symptoms. The first one is based on perspective learning theory – neutral stimuli can become negatively reinforced compulsions via classical conditioning. Patients are thus encouraged to practice escape/avoidance behaviours which eliminate any cues prior to development of habituation.
The second allows individuals with OCD to understand that obsessions are often the result of otherwise typical intrusive images or thoughts which become misinterpreted in what we could call a vicious circle of underlying character flaws or predictive of subsequent catastrophes; individual responsibility in preventing harm may be interpreted as the need to develop certain rituals and behavioural responses in a quest of reducing anxiety, seeking safety, minimising harm or, even responsibility.
Finally, CBT is based on the notion that OCD obsessions and compulsions may be associated with individual intolerance of uncertainty (an inability to endure to aversive responses resulting from a perceived lack of salient cues, and maintained by the associated perception of uncertainty), less confidence in accuracy of memory, and an extraordinary importance in controlling thoughts.
Individuals with diagnosed OCD will often partake in ERP therapy which enables them to tackle maladaptive beliefs, e.g. ‘I will contract an illness by using public toilets’ by exposing them to the stimulus that evokes such obsessive thoughts and motivating them to refrain from engagement in compulsions. Although exposure to the triggering stimulus will naturally provoke anxiety at first, stimulus habituation will aid the anxiety to subside with negative associations also abating over time.
Systematic reviews and meta-analyses have shown that both pharmacological and psychological therapies – and often a combination of the two – are beneficial, however several measurements and mechanisms remain poorly understood. Questions such as ‘Will client C adhere to treatment?’, ‘Which factors influence OCD treatment outcome?’, ‘What is the OCD pathophysiology?’ among many others remain unanswered and the need to facilitate research is great.
Although experts from different fields joined forces a long time ago in a quest of answers, without public engagement there will be great delays in understanding diseases, developing therapies, preventing and managing symptoms, and personalising treatment. Especially now, with the world fighting a deadly virus and people being asked to practice rituals otherwise deemed as obsessive – ‘Wash your hands’, ‘Don’t touch your face’, ‘Sanitise surfaces before you sit down’ – some of us may feel that it is excessive, some of us may feel more prepared, and for some this has prompted harrowing anxiety. And questions rise – Were patients that had completed ERP or CBT sessions more prepared to cope, or do they feel profoundly overwhelmed – especially if their obsessions are contamination-related? What about patients relying on SRIs or SSRIs – is their medication still helping them?
The need to expedite mental health research is cardinal. We need to fight any associated stigma, develop treatments tailored to individual needs, observe and tackle any effects significant life events may have on disorder symptomatology in order to both prevent but also manage debilitating conditions. Research advance starts with us – from our desire to spare a few minutes to complete a questionnaire, to participating in a clinical trial – the options are endless and the benefits to society are significant. Start today – have a look at some of the available research opportunities, choose a topic that interests you and make a difference.
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