Obsessive-Compulsive Disorder: symptoms and treatment

from Georgia Martin

To understand OCD (Obsessive-Compulsive Disorder), one must imagine being the constant target of disturbing, distressing and totally irrational thoughts stronger than us.

It’s not about just ruminating about when you’re anxious or worried, because DOCs are not about rational ideas or real situationsbut they are mental images totally detached from reality that cause uncontrollable anguish.

Any examples?

  • “If I imagine my brother being sick, he will be struck by a fatal disease”;
  • “even if I checked the gas, it is certainly open: everything will blow up because of me”;
  • “if I shake someone’s hand, I will contract some lethal virus”;
  • “I’m afraid of being able to poison someone, of being a violent monster”;
  • “I am strongly religious but I obsessively think about blasphemies, so I feel disgust for myself”.

It’s about distressing thoughtsfear, guilt, repulsion towards oneself, and are the so-called “obsessions”.

Obsessions, in turn, cause so much anxiety in the individual who is the victim, that he implements rituals to keep it at bay: they are the so-called “compulsions”.

These compulsive acts can be, for example, touching an object a certain number of times, or saying a specific phrase or prayer, or even washing your hands continuously or even checking the gas knobs hundreds of times.

Such repetitive gestures put the individual in one momentary state of tranquillity, as if the compulsive act cleaned up the anguish and fear that arose from the obsessive thought. However, the restlessness subsides only for a while, sometimes for a few minutes, until the next obsession, followed by yet another compulsive act to sedate it.

From this we can deduce how the day of a subject affected by OCD is tiring and full of fear and torment, all with his total awareness: the obsessive-compulsive subject, in fact, is not delirious, because he knows perfectly well that he is dealing with thoughts absurd and that cannot happen, but cannot tame them, like a prisoner in a mental prison of terrible images and meaningless rituals. The patient suffering from DOC, therefore, not only feels caged with his own anguish, but he blames himself, fearing that he is not normalthat I’m going crazy, that I simply can’t be like the others.

Types of obsessions

The types of OCD are varied, but they are all united by thoughts that the subject finds repulsive and deeply disturbing. Here are some types:

  • Control DOC: It is characterized by the fear of being able to harm oneself or others. An example is the repetitive check that the gas is closed, or that the door is locked, or that the machine is really off. Not just one check, or even two, but sometimes even hundreds, until you drop.
  • OCD from contamination: it is the fear of being infected with lethal viruses, or that this could happen to loved ones if you touch commonly used objects such as handles or pens. This leads to constant hand washing, frequent medical examinations, and avoiding situations in which it is possible to come into contact with others, thus leading to isolation.
  • DOC from order and symmetry: these are the obsessions of those who are unable to appease their anxiety if they see a crooked picture, or if they have a desk on which the objects are not arranged in a predetermined order of color or size. Or they consist in repeating a reading several times, for fear of not understanding its meaning under a certain number of revisions (just to name a few).
  • Superstitious OCD: in this case, the illogical fear that something terrible could happen to oneself or one’s loved ones is momentarily soothed by compulsions in the form of magical or numerical formulas. The superstitious DOC, in fact, is also called “magical thinking”.
  • aggressive DOCs: the subject in question is haunted by the terror of being seized with a fit and of being able to use violence against himself or his loved ones. This often leads these individuals to avoid contact with others, or to take measures to avoid hurting them (for example, making the passenger sit in the back so as not to be obsessed by the fear of being able to push him out of the car).

The causes of obsessive-compulsive disorder

The reasons why there are people in whom this personality disorder occurs are not entirely clear, and above all they are not unambiguous. Often a set of heterogeneous factors is encountered, as Dr. Pasquale Parise, Psychiatrist in Rome: «Doc is a pathology that seems to have a predisposition on a genetic basis: studies on homozygous twins show that the heritability of the disorder varies between 35 and 48%. Familiarity would also seem to play a role, therefore what can be explained through environmental factors, relationships with parental figures, attachment styles: it seems that family members of patients with OCD are 5 to 10 times more likely to get sick than the general population . From the stories of these patients, it seems that avery strict upbringing and parental care characterized by emotional coldness, severity and ambivalence of the parental figures, favor the onset of this pathology”.

OCD and therapy: how obsessions are treated

DOC is present in 3% of the world population, e it can manifest itself very soon. «The onset of a DOC generally occurs at a young age – specifies Parise – A symptomatology, even nuanced, can manifest itself from the age of 18/20, with control rituals, excessive attention to order, fear of being contaminated by dirt or diseases . In recent years, the incidence of this pathology among minors would seem to be on the increase».

Therapy is almost never a road taken immediately, as many patients are ashamed of their thoughts, and tend to ask for professional help only when the situation becomes untenable.

Nevertheless, timeliness in the treatment of OCD is essential to avoid as much as possible that it gets worse, invalidating the patient’s emotional life. “Immediately recognizing the signs of a probable DOC favors the identification of the right psychological therapy and, where necessary, also pharmacological, to intervene in the shortest possible time – explains Dr. Beatrice Peroniclinical psychologist in Milan – The advantages are that the cycle of obsessions and compulsions does not become chronic, in order to improve the patient’s quality of life».

So is OCD chronic? «It tends to become chronic – replies Peroni – However, there may be periods of remission, in which the subject is able to better control obsessive thoughts and compulsive rituals. This happens by making use of valid and prepared professionals to find the best way».

What can be the most suitable therapy? In addition to psychotherapy sessions – generally with a cognitive-behavioral approach – in the case of OCD it may be necessary to resort to specific drugs, as Dr. Parise: «A therapy often has to be continued even for years, in order to avoid recurrences. The most commonly used drugs are those capable of blocking the serotonin receptor (known as SSRIs), which have the effect of increasing serotonergic transmission in the Central Nervous System. It must be emphasized that the Therapeutic latency of these drugs is among the longest in pharmacology, and it can take from 4 to 8 weeks before seeing the therapeutic effects, unlike their antidepressant action which generally occurs between 2 and 3 weeks. Sometimes it can be useful to associate even low doses of antipsychotic drugs.

Once triggered, OCD is very unlikely to improve on its own. For this it is it is strongly recommended to consult a specialist who can evaluate the individual case and decide the path to take. Otherwise, the price to pay could be very high: when the Obsessive Compulsive Disorder is not addressed, it risks making the patient’s life hellish, completely overwhelmed in its vortex of obsessions and rituals which, occupying the whole day, they feed themselves and prevent him from carrying out normal daily activities.