Contents:
- What is obsessive-compulsive disorder?
- How widespread is it?
- What causes it and who can develop it?
- Types of OCD
- Treatment
- What should I do if I have symptoms?
- Self-help tips
- Guide for loved ones: what should I do if someone I love might have OCD?
What is obsessive-compulsive disorder?
Tulburarea obsesiv-compulsivă (TOC sau OCD în engleză) este o afecțiune de sănătate mintală care se caracterizează prin prezența obsesiilor și a compulsiilor ce interferează pe toate planurile cu viața persoanei diagnosticate.
Obsessions are thoughts, images or impulses that are intrusive, unwanted (contrary to the affected person’s values) and uncontrollable, causing distress. Compulsions are mental acts or repetitive behaviors(rituals) performed in order to lessen or prevent the anxiety caused by obsessions. These components form a vicious circle in which the person is trapped, from which escape is difficult (but possible with treatment):
Most people experience irrational thoughts at some point, but people with OCD cannot simply ignore them. This only makes them more frequent and, over time, can affect a person’s social and professional life.
The shame caused by obsessions and compulsions makes it difficult to seek professional help (it has been estimated that it takes an average of 12 years after the first symptoms appear for someone to seek help [1]). Yet it is important to understand that these symptoms are just signs of a treatable condition.
How widespread is it?
OCD has an average global prevalence of 2%. [2] In Romania, it has been estimated that 0.6% of people (about 120,000 currently) are living with OCD, but this figure is possibly underestimated [3]. The age of onset is generally from adolescence until the age of 25, but it can also occur up to the age of 14 (in 1 in 4 cases) and after the age of 35 (in very rare cases). Both genders can be affected, but the onset is on average earlier in males and they are more prone to blasphemous thoughts, whereas females are more likely to worry about contamination and aggressive thoughts (see section 4). [4]
What causes OCD and how does it develop?
The causes of OCD are not completely understood, but several studies suggest a genetic component and structural differences in the brain.
Environmental factors and stressful events can also contribute to triggering or even worsening the symptoms of OCD. For example, OCD can occur in vulnerable people following an event that has a strong impact on the person’s understanding of the world and their sense of responsibility in avoiding danger. [5]
Another, partly complementary, explanation for the onset of this disorder is the dysregulation of the serotonin system in the brain, suggested by the positive response to antidepressants in some patients. In some cases, an autoimmune form of OCD can be triggered in children by streptococcal infection. [6]
Types of OCD
OCD can occur in various forms, the most common of which are:
- Contamination obsessions: people with this form of OCD have excessive worries about spreading germs or contamination. These worries manifest as a strong aversion to dirt or the presence of infectious agents, accompanied by compulsions to cleanliness, excessive hand washing, avoidance of objects and spaces considered contaminated;
- Obsessions about perfection: affected people have obsessions about symmetry, alignment or order. The compulsive component is related to the resolution of imperfection and includes repeating the same actions in search of a ‘right’ feeling that everything is ‘okay’;
- Obsessions in the form of repeated self-doubt: people experience irrational thoughts about potential dangers that may arise as a result of actions that have not been performed ‘perfectly’. Compulsion manifests itself by repeatedly checking these actions (for example, if the door is locked, if the stove is closed);
- Hoarding obsessions: the person finds it hard to throw away items that may be insignificant to others, because they fear they will need them in the future;
- Obsessions with religious content: this form of OCD is also known as scrupulosity and is manifested by intrusive thoughts related to religion (e.g. blasphemous thoughts, obsessions about the possibility of going to hell) and morality. The compulsions that occur in this case may be: praying repeatedly, seeking reassurance from a priest, pastor, etc., about the person’s morality, avoiding situations/places that may produce the intrusive thought;
- Aggressive thoughts: this category of symptoms is based on the fear of causing harm to oneself or someone else. People who have symptoms like these may have violent thoughts or, for example, intrusive worries about hitting someone with a car or stabbing someone as a result of losing control;
- Sexually themed obsessions: in this case, there is excessive worry about being a pedophile, a rapist, being attracted to a family member, or having other deviant sexual thoughts; or obsessive thoughts about one’s sexual orientation, especially fear of same-gender attraction (which society has labeled immoral even though it is perfectly normal).
It’s important to note that some people experience compulsions only on a mental level, with a form of OCD called Pure O. This form is usually manifested by repetitive and prolonged going through obsessive thoughts, “turning them over and over”, a process called rumination.
On the other hand, there are also compulsions in the OCD spectrum that are not necessarily accompanied by obsessions or thoughts: excessive pulling of dead skin(dermatillomania), excessive nail biting, hair pulling, and other repetitive body-focused behaviors.
In addition to the above-mentioned types, some people suffer from relationship-related OCD (e.g. suspicions about a partner), existential or philosophical OCD (e.g. intrusive and anxious thoughts about the meaning of life, death, identity, reality or metaphysics), postpartum OCD (e.g. thoughts about the safety of the baby). You can read more about these subtypes of OCD on the International OCD Foundation page.
Treatment
Although obsessive-compulsive disorder is a chronic condition, it has been shown that by using effective treatment, symptoms can be greatly reduced, so that the person feels in control of their obsessions and compulsions, rather than the other way around.
The treatment method differs from person to person, so it is important that everyone finds the one that suits them best with a professional, depending on their needs and the severity of the condition at the time treatment starts.
Treatment for OCD may include:
- Medication: it can only be prescribed by a psychiatrist and has a role in relieving the symptoms of OCD, but often psychotherapy is also needed for long-term results.Antidepressants, specifically serotonin reuptake inhibitors (SSRIs ), are the first line of medication for OCD. They are effective in most cases, but if there is no reduction in symptoms, atypical antipsychotics (mainly used to treat schizophrenia) can be used in combination with antidepressants. Usually, the dose needed to treat OCD is higher than that used for depression, but some people are sensitive to side effects even when the medication is given in low doses. It is therefore very important to consult your psychiatrist for any changes to your medication or if there are side effects that are too strong.
- Psychotherapy. In OCD, the main problem is rather the behavior manifested as a reaction to the inability to tolerate the anxiety generated by the obsessive thoughts than the thoughts themselves. Therefore, in psychotherapy, the work is on removing these behaviors and acquiring tolerance to anxiety.The most effective form of therapy in treating obsessive-compulsive disorder is cognitive-behavioral. Specifically, in treating OCD, exposure & response prevention (ERP) therapy is used to reduce the anxiety caused by the presence of obsessions without having to perform a specific ritual.ERP practice consists of exposure to the anxiety-provoking situation, followed by prevention of the usual OCD response(compulsion or avoidance). Exposure is done gradually, starting with situations that cause little discomfort and then increasing the level of anxiety to which the person is exposed. There are also situations in which exposure cannot be realized directly, such as for obsessions related to a certain disease, in which case the therapist resorts to imaginary exposure, by creating various scenarios that provoke the state of excessive worry.
- External support: many people with this condition find support in support groups, as they reduce feelings of isolation and provide an opportunity to socialize with people going through the same situation. The family also has a very important role to play, as OCD behaviors can spill over to others, and informing family members about this is an essential part of the recovery process, so that they learn how to better manage the situation.
- Self-help strategies: it is important for the sufferer to better understand their diagnosis, identify their behaviors and adopt a plan to manage their symptoms.
What should I do if I have symptoms?
If you think you may have some of the signs and symptoms of OCD listed above, it is important to seek help. The first step is to see your family doctor, who can then give you a referral to see a psychiatrist. He or she will give a diagnosis and then devise a treatment plan that’s right for you. Although it is very tempting to identify with descriptions of OCD on the internet, avoid self-diagnosing yourself before talking to your psychiatrist!
In addition to the medication prescribed by your psychiatrist, it is very important to start a psychotherapy program to help you cope with compulsive behavior. Your psychiatrist may be able to refer you to a psychologist who offers services covered by the National Health Insurance House (click here to find a map including services covered by the NHIS and a more detailed guide on how to access them).
Self-help tips
It is by no means easy to live with OCD and feel that you can’t control your own thoughts and behaviors. However, as well as getting help from a professional, there are a few things you can do to help you cope better:
- Accept the thoughts you have, without trying to change them or compulsively committing to understanding their meaning ( mindfulness practice can help with this – see also our article);
- Learn to accept uncertainty and gradually reduce the need to seek reassurance from friends, family or the internet;
- Try to reduce stress: stressful situations make OCD symptoms worse, so it is important to find ways to manage stress. Practice relaxation techniques, such as breathing exercises and grounding in the present moment;
- Make lifestyle changes: make sure you get enough sleep, eat protein-rich foods and avoid alcohol and drugs;
- Try talking to a family member or friend about your feelings or join a support group.
Guide for loved ones: what should I do if someone I love might have OCD?
As well as getting help from a professional, it is important for a person with this disorder to get support from those around them.
The first step in supporting someone with OCD is to educate yourself on the subject so you can better understand the person next to you. When it comes to mental illness, a key aspect is how we express ourselves. Telling a person things like, Stop washing your hands or Just calm down, nothing bad will happen, is not a solution and certainly will not stop the person from practicing compulsive behavior. We need to understand that OCD symptoms are not just a fad, they are very real and extremely distressing for the person experiencing them.
Next, it is very important not to engage in compulsive behaviors yourself (for example, giving repeated reassurances or even checking things repeatedly at your loved one’s request). While it may seem to help them at the moment, in reality it only serves to maintain the compulsive behavior.
Instead, offer them support and encourage them to seek specialized help if they have not already. Be empathetic and patient in your daily life and, last but not least, take care of your own mental and physical health so that you can continue to be a source of support.
Useful resources in Romanian:
Psychotherapist Gabriel Dinu from GândeșteSănătos.ro: https://www.youtube.com/watch?v=431oPVr2Sm0
Article about OCD: http://carmenileapsiholog.ro/tulburarea-obsesiv-compulsiva/
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Useful resources in English:
+ Channels or videos on YouTube
OCD & Anxiety Mental Health Courses: https://www.youtube.com/channel/UCO7EghiGzi6Wxpia_hRP1lg
Canal OCD & Anxiety: https://www.youtube.com/channel/UC3ClvnrcrC-3wr27fz_HlIQ
Channel of a Certified Peer Support Specialist in OCD: https://www.youtube.com/c/ChrissieHodgesPureOCDAdvocate/videos
TED Talk “OCD – Starving the monster “: https://www.youtube.com/watch?v=AZZIxyY23IA
TED-Ed “Debunking OCD myths “: https://www.ted.com/talks/dr_natascha_m_santos_debunking_the_myths_of_ocd/transcript?language=ro
Instagram page of a psychotherapist specializing in OCD: https://www.instagram.com/obsessivelyeverafter/
+ Books
Bruce M.Hyman, Cherlene Pedrick (2010). OCD Workbook:Your Guide to Breaking Free from Obsessive Compulsive Disorder.New Harbinger Publications; 3rd edition. Link: https://www.pdfdrive.com/the-ocd-workbook-your-guide-to-breaking-free-from-obsessive-compulsive-disorder-e157834125.html
Dr. Simon Enright, Managing Obsessive Compulsive-Disorder. Department of Clinical Psychology Berkshire Healthcare NHS. Link: https://cypf.berkshirehealthcare.nhs.uk/media/168487/managing-ocd.pdf
Eliza Burroughs, M.C., R.P et al. (2015). Obsessive-Compulsive Disorders,A Handbook for Patients and Families. Link: https://sunnybrook.ca/uploads/1/departments/psychiatry/ocd-information-guide-2015.pdf
Jon Hershfield & Tom Corboy (2013). The Mindfulness Workbook for OCD – A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioral Therapy. Link: https://www.pdfdrive.com/the-mindfulness-workbook-for-ocd-a-guide-to-overcoming-obsessions-and-compulsions-using-mindfulness-and-cognitive-behavioral-therapy-e158206308.html
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Bibliography:
1. OCD Action: OCD In Brief. Link: https://ocdaction.org.uk/learn-about-ocd/ocd-in-brief/
2. Sasson Y, Zohar J, Chopra M, Lustig M, Iancu I, Hendler T. Epidemiology of obsessive-compulsive disorder: a world view. J Clin Psychiatry. 1997;58 Suppl 12:7-10. Link: ttps://www.psychiatrist.com/wp-content/uploads/2021/02/13305_epidemiology-obsessive-compulsive-disorder-world-view.pdf
3. Florescu et al., The Romanian Mental Health Study: main aspects of lifetime prevalence and service use of DSM‐IV disorders. Manag Health 2009;3:22–30. Link: http://journal.managementinhealth.com/index.php/rms/article/viewFile/30/104
4. Torresan RC, Ramos-Cerqueira AT, Shavitt RG, do Rosário MC, de Mathis MA, Miguel EC, Torres AR. Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder. Psychiatry Res. 2013 Sep 30;209(2):186-95. doi: 10.1016/j.psychres.2012.12.006.
5. https://www.lidiastoica.ro/tulburarea-obsesiv-compulsiva/
6. Factsheet despre PANDAS: https://iocdf.org/wp-content/uploads/2014/10/PANDAS-Fact-Sheet.pd
