Obsessive Compulsive Disorder (OCD) is a form of anxiety disorder which is characterized by both compulsions and obsessions. The obsessions are experienced in form of recurrent, unwanted and disturbing images, thoughts, or impulses which usually pop into the minds of individuals causing them a lot of distress and anxiety (Hyman & Pedrick, 2009). This results in compulsions which are repetitive intentional behaviors that are done in a bid to reduce the anxiety brought about by the obsessions. The onset of the disorder is earlier among men than among women (Jakes, 1996).
In addition, the condition is more common in whites than in blacks and social class does not influence development of the condition (Jakes, 1996). In children, Strep throat is known to trigger onset of the condition or worsen the condition (Jakes, 1996). This is a case of autoimmunity where the antibodies produced to fight streptococci attacks basal ganglia. There are several ways in which the disease is manifested and an individual could have either a single manifestation or multiple manifestations.
One grouping of OCD is referred to as checkers and individuals who fall under this category have compulsions to keep on checking things which could be locks, doors, and appliances in order to prevent potential disasters. They do this because they are afraid of disasters befalling themselves and others due to something they do or they do not do (Hyman & Pedrick, 2009). Another manifestation is in form of washers and cleaners. Individuals who fall under this category have the tendency to repeatedly keep on showering, washing their hands, and cleaning the surroundings.
This is because they are afraid and worried about contamination by germs and dirt (Hyman & Pedrick, 2009). Orderers form another manifestation of OCD where individuals under this category feel compelled to do things in a given, exact way. For example an individual would be obsessed with arranging clothes in a given way. The other group is known as pure obsessionals and individuals in this group keep on having repetitive thoughts which could be in form of counting, praying, or repetition of certain words (Hyman & Pedrick, 2009).
These compulsions result from troubling intrusive thoughts and images where they think and see themselves harming or endangering others and this leaves them horrified (Hyman & Pedrick, 2009). Another grouping of individuals with OCD comprises of individuals with scrupulosity. People under this category are obsessed with moral and religious issues and will compulsively pray or engage in religious services. The last manifestation is in form of hoarders where individuals in this category will collect things which others consider as trash or junk.
In most cases, these individuals cannot explain why exactly they collect the items and they usually tend to develop an attachment to these items such that they cannot throw them away (Hyman & Pedrick, 2009). The cause of the condition is thought to be genetic but environmental factors do modify its manifestation. Researchers believe that multiple genes are involved in its transmission from generation to generation and these genes are responsible for modifying brain function (Hyman & Pedrick, 2009).
When these genes are inherited, they cause variations in brain structure, circuitry, and neurochemistry and this inclines one to develop OCD. According to research statistics, the rate of OCD among family members where one individual has the condition is higher than among members of families where no relative has the condition (Hyman & Pedrick, 2009). In addition, for majority of the people where the condition appears in childhood, there is usually a blood relative with the condition leading to confirmation that genetic factors are involved. Apart from genetics, environmental factors also play a role in the development of the condition.
If individuals who are genetically predisposed to development of the condition are subjected to factors in the environment that stress them, then they are more likely to develop the condition. These stressing factors include childhood neglect, family stress, death, physical trauma, psychological trauma, illness, and divorce (Hyman & Pedrick, 2009). In addition, people who are genetically predisposed to development of the condition can develop the disease as they go through major transitions in life which could be adolescence, marriage, retirement or parenthood.
Studies have shown that serotonin is involved in the development of OCD (Hyman & Pedrick, 2009). Serotonin is a neurotransmitter which enables communication between brain cells. In people with OCD, brain imaging reveals abnormalities in some areas of the brain and these are usually the basal ganglia, the cingulate gyrus, the thalamus, and orbital cortex (Hyman & Pedrick, 2009). These are the brain areas that are involved in the following: processing of information received from the world, sorting of this information based on importance, they enable one to concentrate on tasks being undertaken, and they also alert one to danger.
For people who have this condition, these brain areas work overtime, and they focus on ideas and thoughts that are intrusive which under normal circumstances would be filtered out (Hyman & Pedrick, 2009). There are several signs and symptoms that characterize OCD. Though the objects of obsession vary slightly from individual to individual, the manifestations of the disorder are usually the same. One of these is obsession and compulsions which usually take more than an hour each day and which interferes with the individuals’ normal lives (Domino, 2007).
The obsessions are usually recurrent and the patients usually try to ignore the thoughts or they neutralize these thoughts with compulsions. The individuals with these compulsions and obsessions usually have no other mental disorders (Domino, 2007). The compulsions are also repetitive and deliberate and they are aimed at neutralizing the obsessive thoughts. There are usually no specific tests for this condition and diagnosis is usually based on presence of the above signs and symptoms after which differential diagnosis is made (Lippincott Williams & Wilkins, 2008).
After OCD is confirmed, several tests are done to determine severity and nature of the compulsions and obsessions. They include the Maudley obsessional compulsive inventory, the Yale brown Obsessive compulsive scale, and Leyton obsessional inventory (Domino, 2007). There is need for differential diagnosis in people suspected to have this condition. Distinguishing this condition from other disorders such as mood disorders, other anxiety disorders, impulsive spectrum disorders, Padua inventory, obsessive compulsive personality disorders (OCPD), impulsive spectrum disorders, and delusional disorders can be challenging.
Accurate diagnosis requires a careful evaluation of an individual’s history. There is need to differentiate depression caused by OCD from that caused by others factors. It is also important to differentiate between OCD and trichotillomania where in trichotillomania just like in OCD individuals get relief out of pulling their hair but have no obsessive thoughts (Hollander & Stein, 1997). Another condition requiring differential diagnosis is schizophrenia which is also characterized by obsession and rituals though the rituals in schizophrenic individuals are usually purposeless (Hollander & Stein, 1997).
In addition, other symptoms of schizophrenia are absent. Since some OCD patients also experience panic attacks, this can make OCD to be confused with panic disorder. However, OCD panic attacks are secondary to obsessional fears (Hollander & Stein, 1997). Differential diagnosis between OCD and OCPD is also required since OCPD patients exhibit symptoms that are similar to those of OCD such as preoccupation with orderliness and perfectionism (Hollander & Stein, 1997).
However, in OCPD there is no obsession and compulsions. Borderline personality disorder may also be confused with OCD as patients also experience strong feelings and thoughts about certain issues. There are several approaches that are employed in the care of OCD patients. The treatments used include behavioral therapies, medications and cognitive behavioral therapy. Medications used are selective serotonin reuptake inhibitors and they include sertraline, paroxetine, cilatopram, and fluvoxamine (Domino, 2007).
Medications are usually combined with cognitive behavioral therapy. The behavioral therapies usually include exposure therapy and ritual prevention therapy. For ritual prevention, the patients are helped to resist urges to engage in compulsive behavior for long while in exposure therapy individuals are subjected to the factors that compel them to behave compulsively and then helped to resist the urges (Hollander & Stein, 1997).
Cognitive behavioral therapy involves helping the patients to change their negative thoughts and behaviors. At other times, cognitive behavioral therapy is administered to a group. Response to treatment varies with age where medications are less effective in children and adolescents while adults respond well to treatment with a combination of cognitive behavioral therapy and medications (Hollander & Stein, 1997). References Domino, F. J. (2007). The 5-minute clinical consult. Philadelphia, PA: Lippincott Williams &
Wilkins. Hollander, E. & Stein, D. J. (1997). Obsessive compulsive disorders: diagnosis, etiology treatment. London: Informa health care Hyman, B. C. & Pedrick, C. (2009). Obsessive compulsive disorder. Minneapolis, MN: Lerner Publishing Group, Inc. Jakes, I. (1996). Theoretical approaches to obsessive compulsive disorder. New York, NY: Cambridge University Press Lippincott Williams & Wilkins. (2008). Nurse’s 3-minute clinical reference. Philadelphia, PA: Lippincott Williams & Wilkins.
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