What are obsessions?
- Obsessions are repetitive and persistent thoughts (e.g. of contamination), urges (e.g. to stab someone) or images (of violent or horrific scenes) that are experienced as intrusive and unwanted and that cause marked anxiety or distress.
- The person attempts to ignore or suppress such obsessions (e.g. avoiding triggers or using thought suppression) or to neutralise them with another thought or action i.e. by performing a compulsion
What are compulsions?
- Or rituals are repetitive behaviour (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the individual feels driven to perform to neutralise an obsession
- Compulsions are performed in response to obsessions (contamination)
- Aim is to reduce anxiety caused by the obsessions or else they will become ill
Symptoms of OCD
Certain themes between OCD
- Cleaning (contamination obsession and cleaning compulsion)
- Symmetry (symmetry obsessions and repeating, ordering and counting compulsions)
- Forbidden or taboo thoughts (aggressive, sexual, religious obsessions)
- Fears of harm to oneself and others
People with OCD experience marked anxiety even panic attacks when confronted with people, places, and things that trigger obsessions and compulsion and avoid such situations
Development and course of OCD
Onset is usually in adolescence
The course is chronic with waxing and waning symptoms, often complicated by comorbid mental disorders.
Ethiopathogensis
Biological/genetic factors
- Higher rate of OCD among relatives with OCD and higher concordance rate for monozygotic vs dizygotic twins indicate genetic predisposition
- Psychosocial factors - Childhood physical/sexual abuse and behavioural inhibition, negative emotionality; stressful events
Functional consequences
The time spent obsessing and doing compulsions and avoidance of situations that can trigger obsessions or compulsions cause distress and impairment in social, academic and occupational functioning.
- Obsessions about symmetry can’t email the timely completion of school or work projects because the project never feels “just right” - potentially resulting in school failure, job loss
- Skin lesions due to excessive washing
DD of OCD
- Body dystrophic disorder
- Eating disorder
- Other compulsive like behaviour - gambling, substance abuse
Treatment of OCD
Biological therapy
- SSRIS first line
- SNRI second line
Psychotherapy
- supportive family or group therapies
Sociotherapy/rehabilitation
- Severe symptoms and/or functional disabilities
Body dysmorphic disorder (dysmorphorphobia)
- The individual is preoccupied with perceived defects or flaws in his physical appearance and that are not observable or appear only slight to others.
- Concerns range from “unattractive” to looking ugly, deformed, “hideous”, “like a monster”
- excessive body hair, skin scars, pimples etc
Body focused repetitive behaviour disorders
- Characterised by recurrent body-to-focused repetitive behaviours (e.g. hair pulling, skin picking, nail biting, lip biting, cheek chewing) not triggered by obsessions
Trauma and stress-related disorders
- Exposure to traumatic or stressful event is the precipitant of trauma and stresor- related disorders
Post traumatic stress disorder and acute stress disorder
- PTSD and acute stress disorder are very similar and both disorders are reactions of the individual to a traumatic event
- Acute stress disorder being milder and briefer (less than month) reaction to the traumatic event
- Post traumatic being more severe and prolonged (more than month) reaction to the event
