Obsessive Compulsive Disorder

This debilitating disorder is distressing not only for the person suffering from the symptoms, but for their family and friends who must watch the bizarre behaviours and try to be understanding. Obsessive compulsive behaviour (OCD) is characterised by obsessions (undesirable, recurrent, disturbing thoughts) and compulsions (repetitive or ritualized behaviours). The unwanted obsessions cause severe anxiety producing feelings of dread, worry, and apprehension and certain behaviours are performed compulsively in an attempt to lessen this anxiety. Although they may realize that their obsessions are excessive and their behaviour is unreasonable, they may feel powerless to control either.

Obsessive compulsive behaviour has been recognized for some time but its cause is still not fully understood. However there appear to be several factors involved an interaction of neurobiological factors and environmental influences, as well as cognitive processes. Symptoms of OCD are seen in association with some other neurological disorders such as Tourette's syndrome, trichotillomania (the repeated urge to pull out scalp hair, eyelashes, eyebrows or other body hair), body dysmorphic disorder (excessive preoccupation with imaginary or exaggerated defects in appearance) and hypochondriasis (the fear of having--despite medical evaluation and reassurance--a serious disease).

OCD also includes eating disorders such as anorexia nervosa. Nurture starved children may seek reassurance in food related rituals, as feeding is the first form of nurturance.

Causes:

1) Genetics

Although there is no clear genetic evidence, OCD tends to run in families and there is a 25% chance of a sufferer having a blood relative who also has it. OCD patients respond well to specific medications that affect the neurotransmitter serotonin which suggests the disorder has some neurobiological basis.

2) Family relationships

There is some evidence that a particular type of dysfunctional parenting may be a trigger for the development of OCD, in predisposed individuals. In this model, one parent (often the mother) may be emotionally abandoned with unmet needs. They may often be in distress with physical, emotional or mental health problems. The other parent (usually the father) is often perceived as emotionally inaccessible and detached or focused on issues outside the family. A role reversal develops, wherein the child becomes overly responsible resulting in an angry, deprived child who lacks a sense of identity. The child develops self soothing rituals to take the place of inadequate parenting.

If a child is seriously ill (requiring hospitalization), or seriously neglected and their parents are therefore perceived as helpless, the child may see this as abandonment and will 'replace' their parents with obsessive defenses. They may regard their illness as an indication of parental failure.

3) Infection

A streptococcal infection of the throat is known to occasionally result in the body confusing healthy cells with the infection and causing cellular damage.  If this has happened with the brain, the body's infection fighting system can attack the outside of nerve cells in the Basal Ganglia part of the brain with the result that OCD symptoms occur.  However, these symptoms don't seem to last very long and the occurrence of this 'infection OCD' seems to be very rare. If OCD results from a strep throat infection, the symptoms seem to start quickly, within one or two weeks.

4) Environment

Some researchers believe that learned behaviours in childhood, e.g. excessive cleaning or a preoccupation with neatness and order, can also result in the development of OCD, where there is a biological predisposition.

Signs and Symptoms:

OCD obsessions are repeated, persistent, unwanted ideas, thoughts, images or impulses that appear involuntarily and that appear to be senseless. Typical obsessions revolve around:

• Fear of contamination or dirt
• Repeated doubts
• Having things orderly and symmetrical
• Aggressive or horrific impulses
• Sexual images

Compulsions are repetitive behaviours that the sufferer feels driven to perform. These repetitive behaviours are meant to prevent or reduce anxiety or distress related to the obsessions. Rules or rituals will be created to help control the anxiety felt when having obsessive thoughts. Typical compulsions revolve around:

• Washing and cleaning
• Counting
• Checking
• Demanding reassurances
• Repeating actions over and over
• Arranging and making items appear orderly

The obsessive and compulsive rituals develop as an attempt to stay in control and balanced but also in order that the sufferer is able to avoid dependence upon others, who have proved 'unreliable'. Behavioural self control often becomes more important than friendships or family, resulting in a propensity for social isolation.

Treatment:

Effective treatment usually combines several or all of the following:

• Invite dependency - other people must become important and valuable
• Unmask the rituals through psychotherapy
• Medication if the OCD is severe
• Regulation of the anxiety through therapy and medication
• Behaviour modification techniques

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