Psychological Disorders
Obsessive Compulsive Disorder (OCD)
- Introduction
Imagine the following scenario: It is bedtime and you are lying on bed. However, sleep continues to elude you because you are worried about intruders, who might sneak in during the middle of the night to commit crimes of the nastiest kinds. Despite the safety of Singapore and presence of security guards, you remain unconvinced. A thousand questions begin to flood your thoughts. Did you remember to lock the door? Yes, you probably did, but you are far from certain. The risks of not doing so are too much to bear. Then, you get up from bed, and head towards the door to check the lock. Imagine this process repeatedly over the course of the night and a depiction of Obsessive-Compulsive disorder comes to mind.
Obsessive-Compulsive Disorder (OCD) is an anxiety disorder and it is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Patients suffer from the tension and worry brought about the obsessive thoughts and is subsequently compelled to drive them away by performing repetitive behaviors, known as compulsions. Healthy people also have rituals, such as checking if the stove is completely off several times before leaving the house. Unfortunately, for OCD patients, performing these so-called "rituals" provides only temporary relief before the patient is overwhelmed with intrusive thoughts again. Furthermore, not performing the rituals can cause exaggerated anxiety.
- Symptons
People with OCD are usually plagued by persistent, unwelcome thoughts or images, followed by the urgent need to engage in certain rituals to drive these thoughts away. For example, they could be obsessed with unhygienic conditions such as germs or dirt, and, in turn, develop a compulsion to wash their hands over and over. In the example mentioned above, the patient – who is obsessed with intruders – has resorted to lock and relock his door many times before going to bed.
- Risk Factors and Causes
The etiology of OCD remains unclear, although several lines of evidence have shown support for the following theories. Some reports have linked OCD to head injuries and Tourette's syndrome, while others have suggested a biological aspect to the causation of OCD. For example, it has been linked to abnormalities with the neurotransmitter serotonin. This relationship is consistent with the observation that many OCD patients benefit from the use of selective serotonin reuptake inhibitors (SSRIs).
- Treatment
As with many other anxiety disorders, the effects of treatment are usually maximized when medications are used in conjunction with psychotherapy. The mainstay of medications involves antidepressants, especially those that act on the serotoninergic system, namely fluoxetine and paroxetine (Prozac). However, antipsychotic drugs such as haloperidol can also be effective when the obsessions and compulsions are too bizarre. One of the most well established cognitive-behavioral techniques is called "Exposure and Response prevention". In this therapy, the patient is gradually exposed to the object of fear, such as dirt. Consequently, he or she is taught to develop healthy coping strategies to prevent the performance of rituals until anxiety is reduced.