By: Iris Zhao
What is OCD?
Obsessive-compulsive disorder (OCD) is a mental condition characterized by recurrent intrusive thoughts (obsessions) that compel individuals to engage in repetitive behaviors or mental acts (compulsions) aimed at reducing the anxiety these thoughts provoke (American Psychological Association, n.d.; Cleveland Clinic, n.d.; Mayo Clinic, 2023). These obsessions and compulsions can severely interfere with a person’s daily tasks, responsibilities, and interpersonal relationships. It is also important to acknowledge that it is possible for OCD to involve only obsessive thoughts or only compulsive behaviors, rather than a combination of both (Mayo Clinic, 2023).
Risk Factors
Research has not identified the exact cause of OCD however, there are certain factors that may contribute to the risk of developing OCD.
Family history: People with a biological relative, including parents or other family members diagnosed with OCD, may raise the risk of developing the condition. Through learning, obsessive fears and compulsive actions may develop as an individual observes family members with the condition. Specific genes associated with OCD have yet to be found.
Stressful life events: Past studies have identified that if individuals have gone through early traumatic or stressful experiences, such as neglect or abuse, the risk for OCD may increase. The reaction to these events may cause the intrusive thoughts, rituals, and distress seen in OCD.
(Cleveland Clinic, n.d.; Mayo Clinic, 2023)
Obsessions in OCD
OCD obsessions are unwanted, intrusive, persistent thoughts that keep coming back, or urges and mental images that are intrusive and cause intense anxiety (Mayo Clinic, 2023). Most people with OCD are aware that these thoughts are excessive and irrational. However, the distress that one feels from these intrusive thoughts cannot be alleviated by logic (Cleveland Clinic, n.d.; Mayo Clinic, 2023).
Examples of obsession symptoms:
- Fear of touching objects others have touched due to worries of contamination
- Fear of losing or discarding something important
- Extreme concern for order, neatness, symmetry, or perfection
- Aggressive or horrific thoughts about losing control and harming yourself or others
- Unwanted thoughts, including aggression, or unpleasant sexual or religious images
- Staying away from situations that may cause obsessions, such as hand shaking
(American Psychiatric Association, n.d.; Cleveland Clinic, n.d.; Mayo Clinic, 2023)
The most common obsessions in people with OCD involve contamination, dirt, or illness and uncertainties about carrying out specific tasks (e.g., worrying about whether you switched off the oven before leaving the house) (American Psychological Association, n.d.; Kanner & Isaacs, 2022).
Compulsions in OCD
OCD compulsions are repetitive behaviors or mental acts that a person feels inclined to perform in response to alleviate the distress caused by an obsession. Compulsions could be excessive responses that are directly related to an obsession one has (American Psychiatric Association, n.d.).
Examples of compulsion symptoms:
- Excessive hand washing or showering
- Repeated cleaning of objects
- Counting in certain patterns
- Silently repeating a prayer, word, or phrase
- Arranging things in a specific or ordered way
- Repeatedly checking locks, switches, appliances, doors, etc.
- Frequently seeking approval or reassurance
(American Psychiatric Association, n.d.; Cleveland Clinic, n.d.; Mayo Clinic, 2023)
The most common compulsions often seen in people with OCD include repetitively washing their hands due to fear of germs or checking the door many times due to doubts about their safety (Kanner & Isaacs, 2022).
People with OCD often avoid particular people, places, or situations they know will cause them distress. The avoidance of these things may greatly impair their ability to function in daily life and can be detrimental to their mental and physical health (American Psychiatric Association, n.d.).
Diagnosis
OCD can begin at any age, but it typically begins in the young adult years. Symptoms can become mild, moderate, or more severe over time, but they generally get worse when a person is under extreme stress.
The general steps in diagnosing someone with OCD involves a psychological evaluation that is conducted about one’s thoughts, feelings, and behavior patterns. This is followed by a physical exam to determine if there are other issues or related complications that may have caused the symptoms.
It is important to work with your doctor to get the accurate diagnosis and treatment because diagnosing someone with OCD can be challenging as symptoms may be very similar to those of anxiety disorders, depression, schizophrenia, or other mental health disorders.
(Mayo Clinic, 2023)
Epilepsy and OCD
There has been a long-standing association between OCD and epilepsy in past research. The reason why OCD may be linked to epilepsy is still unclear however, current research remains convincing. The most proposed theories suggest a kindling effect where seizures that are localized to one area of the brain stimulates another area, such as the limbic region, leading to emerging clinical features of obsessional and compulsive behaviors in people with epilepsy. Researchers have also found that obsessional personality characteristics are more likely to manifest in epilepsy because OCD may be a form in which new thoughts intrude into the epileptic patient’s awareness at the onset of a seizure. Additionally, it had been found that some patients with OCD symptoms had structural abnormalities in the brain.
(Kanner & Isaacs, 2022; Kaplan, 2010; Kaplan, 2011; Kim et al., 2020)
Although there are many speculations based on past studies, the reasons behind the association between epilepsy and OCD still requires more research (Kaplan, 2011).
Treatment
OCD can be alleviated through short-term or long-term treatment depending on how severe symptoms may be. The most common treatments include:
- Psychotherapy: Cognitive behavioral therapy (CBT), exposure and response prevention (ERP), and acceptance and commitment therapy (ACT) are common forms of therapy that helps to evaluate and understand your thoughts and emotions. Through these forms of therapy, you are able to learn healthier ways of coping with your symptoms, how to resist the urge to perform a compulsion, and learn to accept obsessive thoughts as just thoughts that have no power over you (American Psychiatric Association, n.d.; Cleveland Clinic, n.d.)
- Medicine: Antidepressants approved by the Food and Drug Administration (FDA) followed by other psychiatric medications prescribed by a doctor may help to control the obsessions and compulsions symptoms of OCD (Mayo Clinic, 2023).
Past research has also demonstrated that people with epilepsy and severe OCD may benefit from deep brain stimulation (DBS) treatment as a last resort, if non-invasive treatments fail. DBS may help to reduce the intensity and frequency of obsessions and compulsions, as well as control epileptic seizures for those with epilepsy and severe OCD (Kaplan, 2011).
Conclusion
Obsessive-compulsive disorder (OCD) is currently regarded as a distinct mental health condition, although it was once categorized as an anxiety disorder. People with OCD typically have persistent, unwanted thoughts and obsessions that lead them to perform excessive and repetitive actions in order to reduce the distress caused by those obsessions. However, this condition can usually be treated with therapy and medications depending on how mild or severe symptoms are. A long-acknowledged association between OCD and epilepsy have also been discussed although research remains
References:
American Psychiatric Association. (n.d.). What Is are Obsessive-Compulsive and Related Disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder
American Psychological Association. (n.d.). Obsessive compulsive disorder. American Psychological Association. https://www.apa.org/topics/ocd
Cleveland Clinic. (n.d.). OCD (Obsessive-Compulsive Disorder): Symptoms & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9490-ocd-obsessive-compulsive-disorder
Mayo Clinic Staff. (2023). Obsessive-compulsive disorder (OCD) – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432
Kanner, A.M., Isaacs K.L. (2022). Obsessive-Compulsive Disorder as a Symptom. Epilepsy Foundation. https://www.epilepsy.com/complications-risks/moods-behavior/ocd
Kaplan P. W. (2010). Epilepsy and obsessive-compulsive disorder. Dialogues in clinical neuroscience, 12(2), 241–248. https://doi.org/10.31887/DCNS.2010.12.2/pkaplan
Kaplan, P. W. (2011). Obsessive–compulsive disorder in chronic epilepsy. Epilepsy & Behavior, 22(3), 428-432. https://doi.org/10.1016/j.yebeh.2011.07.029
Kim, S. J., Lee, S., Ryu, H. U., Han, S., Lee, G., Jo, K., & Kim, J. B. (2020). Factors associated with obsessive-compulsive symptoms in people with epilepsy. Epilepsy & Behavior, 102, 6 https://doi.org/10.1016/j.yebeh.2019.106723
