Obsessive-Compulsive Disorder

What are the main signs and symptoms?

Obsessive-Compulsive Disorder involves the presence of obsessions, compulsions, or both.

Obsessions are recurrent, intrusive, and persistent thoughts, images, or impulses that cause high levels of anxiety and doubt. They are not mere exaggerated concerns about "real-life" problems and are so uncomfortable that the person tries to suppress or neutralize them by performing some action or thought. The most common obsessions include:

• Contamination;
• Constant doubt;
• Health concerns;
• Aggressiveness;
• Sexuality.

Compulsions consist of repetitive behaviors (such as organizing, washing, checking) or mental acts (such as praying, counting, or repeating words silently). Compulsions are felt by the person as obligatory or necessary actions in response to obsessions or previously rigidly defined rules. Therefore, compulsions aim to reduce or avoid immediate distress caused by the obsession, but they can also aim to avoid a feared situation that may occur if they are not performed - even if the compulsion is not realistically related to the feared event (e.g., arranging items symmetrically to prevent harm to a loved one). The most common compulsions include:

• Checking;
• Washing or cleaning;
• Counting or repeating;
• Precise and symmetrical organization.

It's important to be alert to warning signs that may indicate the presence of this disorder:

• Very recurrent intrusive thoughts;
• "Obligatory" behaviors without apparent reason;
• The need to perform rituals;
• Headaches in the orbital areas (near the eyes);
• Sleep difficulties;
• High physiological and anxious activation;
• Distrust and insecure attachment to others;
• Difficulty being in the "here and now";
• Intolerance of uncertainty.

What are the possible causes and risk factors?

Biological Factors

Obsessive-Compulsive Disorder can result from neurobiological factors. For example, a part of our brain called the caudate nucleus may not be effective in transitioning from thought to action. Heredity is also an important factor, with this disorder being twice as prevalent in individuals with first-degree relatives who also have it.

Psychological Factors

Certain psychological traits can increase vulnerability to the development of this disorder. These include a tendency to internalize symptoms, negative emotionality, and behavioral inhibition during childhood.

Environmental Factors

Various environmental factors can increase risks, including exposure to adverse perinatal events (i.e., around the time of birth), premature birth, maternal smoking during pregnancy, childhood sexual or physical abuse, and other traumatic events.

Can it be associated with other disorders?

Individuals with Obsessive-Compulsive Disorder tend to have other difficulties, particularly related to anxiety (including Panic Disorder, Social Anxiety Disorder, Generalized Anxiety Disorder, and Specific Phobias). Also common are comorbidities with depressive disorders, impulse control disorders, and substance abuse disorders. People with Obsessive-Compulsive Disorder are at higher risk of tic-related problems. Finally, people with this disorder are more likely to have other disorders related to the obsessive-compulsive cycle, such as Trichotillomania and Excoriation Disorder.

What is the prevalence and mortality?

Obsessive-Compulsive Disorder is the 4th most prevalent psychological disorder, affecting 1 in 40 adults. In 65% of cases, symptoms appear before the age of 25, and only 15% develop it after the age of 35.

Research has found high rates of suicidal ideation (about 44%) and suicide attempts (about 14%) in individuals with Obsessive-Compulsive Disorder. Predictors of a higher risk of suicide include the severity of the disorder, the dimension of the symptom of thoughts felt as unacceptable, and the severity of depressive and anxious symptoms that may co-occur with this disorder.

How can psychotherapy help?

Research has shown the efficacy of psychotherapy, which can reach up to 80% in the treatment of Obsessive-Compulsive Disorder. Therefore, although it can be a disorder with the potential to cause significant suffering, the prognosis can be positive with proper guidance.

Within the Integrative Psychotherapy Approach we adopt, Cognitive-Behavioral Psychotherapy stands out as the branch with the most robustly supported research results. This approach aims to help the individual comprehensively in terms of their thoughts, emotions, and behaviors. Also useful for addressing Obsessive-Compulsive Disorder is the Four Steps Model, also known as "Brain Lock". This model helps the individual understand what happens in their brain during the obsessive-compulsive cycle, providing tools to break it and manage the initial discomfort associated with this break.

Mindfulness-Based Therapy is another very useful approach that allows the individual to acquire tools for "mindful attention". This approach reduces anxiety, promotes psychological flexibility, and the ability to enjoy the present moment.

Finally, a Family and Systemic approach allows us to identify, experience, and adjust the role of significant relational and family experiences and roles in the origin and maintenance of Obsessive-Compulsive Disorder.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association.

Forsyth, J.P. & Eifert, G.H. (2007). The mindfulness and acceptance workbook for anxiety. Oakland, CA: New Harbinger Publications.

Hyman, B.M. & Pedrick, C. (2010). The OCD workbook: Your guide to breaking free from obsessive-compulsive disorder (3rd ed.). Oakland, CA: New Harbinger Publications.

Schwartz, J.M. (1996). Brain lock: Free yourself from obsessive-compulsive disorder by New York, NY: Regan Books

Siegel, D. J. (2010). Mindsight: The New Science of Personal Transformation. New York: Bantam Books.

Steketee, G. (1999). Overcoming obsessive-compulsive disorder: A behavioral and cognitive protocol for the treatment of OCD. Oakland, CA: New Harbinger Publications.