Obsessive Compulsive Disorder (OCD). OCD Signs, Symptoms, Comorbidity and Insight
The main features of this illness are obsessions and compulsions. Obsessions are certain thoughts, doubts, images or urges that occur in one’s mind. These are unwanted, repetitive by nature. Most people with OCD realize that obsessions are senseless, irrational, or excessive, but they are unable to ignore or suppress them. They would attempt to resist and control them, but would not succeed. Obsessions cause significant distress and anxiety to the sufferers and as a result cause interference in their day to day functioning.
Compulsions are repetitive acts that the person is driven to carry out in spite of knowing that they are meaningless, unnecessary or excessive. Compulsions are usually in response to obsessions. For example, a person with an obsessive fear of contamination washes hands repeatedly in order to ensure that his or her hands are clean. The person attempts to resist repeated hand-washing, but gives in to the urge so as to relieve himself or herself of the anxiety or discomfort. Persons with OCD often perform certain acts repeatedly to avoid some dreaded event or to prevent or undo some harm to themselves or others. For instance, touching the floor even number of times to prevent an accident that one fears might occur to family members. They are aware most of the time that the activity is not connected in a logical or realistic way with what was intended to be achieved, or that it may be clearly excessive (as in the case of hand-washing compulsions), but cannot control them as they reduce anxiety, at least transiently. Some compulsions can be in the form of elaborate ‘rituals’. Rituals are a particular sequence of actions, which the person is compelled to carry out. On either changing the sequence or missing out one of the actions, anxiety increases driving the person to repeat the set of actions all over again. This would lead to spending considerable time in carrying out even a simple routine activity such as washing hands.
Obsessive-compulsive disorder (OCD) is a common mental illness. Earlier it was considered as a rare illness, but studies have now shown that 2-3% of the population have OCD at some point in their life. Though OCD is a common illness, many who suffer from this illness do not seek treatment
Some common obsessions:
- Fear of getting dirty, contaminated or infected by persons or things in the environment.
- Blasphemous thoughts.
- Thoughts of harming or killing others or oneself.
- Recurring thoughts or images of sexual nature.
- Fear of blurting out obscenities.
- Fear of developing a serious life-threatening illness.
- Preoccupation to have objects arranged in a certain order or position.
Some common compulsions:
- Repeated hand-washing, taking unusually long time to bathe, or cleaning items in the house.
- Ordering or rearranging things in a certain manner.
- Checking locks, electrical outlets, gas knobs, light switches etc. repeatedly.
- Repeatedly putting clothes on, then taking them off.
- Counting over and over to a certain number.
- Touching certain objects in a specific way.
- Repeating certain actions, such as going through a doorway.
- Constantly seeking approval (especially children).
OCD is a common mental disorder, and is often disabling. In addition, a majority of patients with OCD are at high risk of having one or more co-morbid (co-existing) psychiatric illness. Anxiety disorders (up to 30%) and depression (up to 60%) are the common co-morbid conditions reported in most studies of OCD.
The most common concurrent psychiatric disorders were major depression (30-55%), social phobia (11-23%), generalized anxiety disorder (GAD) (18-20%), simple phobia (7-21%), panic disorder (6-12%), eating disorder (8-15%), tic disorders (5-8%) and Tourette’s syndrome (5%).
In addition to anxiety and depressive disorders, a fascinating group of conditions called obsessive-compulsive spectrum disorders are also found to be highly co-morbid with OCD. These include Tourette’s syndrome and other tic disorders, Hypochondriasis, body dysmorphic disorder, trichotillomania, and eating disorders. These disorders are considered to be related to OCD because of similarity in clinical picture (morbid preoccupations and compulsive behaviour), high rate of comorbidity, and somewhat similar treatment response. It is extremely important to identify and treat coexisting psychiatric conditions because untreated co-morbid conditions could contribute to poor treatment response and prognosis. Studying comorbidity also helps in understanding the possible etiological relationship between the disorders.
Co-morbid psychiatric disorders are common in OCD. Depressive and anxiety disorders are the most common co-morbid conditions in OCD.