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OCD refers to an anxiety disorder typified by experiencing frequent obsessions and compulsions, which inhibits the capability of the sufferer to function socially and occupationally because of the excess time that the symptoms consume, intense fear or other distresses associated with the disorder. The intrusive thoughts results in intense fear, nervousness and anxiety, which are combated by engaging in repetitive behaviors, compulsions and obsessions (Abramowitz, 2009). Conventionally, there are four types of OCD, which are aggressive, sexual or religious obsessions that are related with constant checking of compulsions; obsessions relating to symmetry that are associated with repeating compulsions; obsessions of contamination that are normally associated with cleaning compulsions; and hoarding. Obsession is an impulse or a thought that persists and results in extreme anxiety. Obsessions cannot be resisted by the person suffering from OCD irrespective of their irrationality. For instance, an obsession can involve constant worries about cleanliness and safety. Compulsion refers to a repetitive behavior that the OCD sufferer engages in, they are mainly because of obsessions. Obsessions can cause compulsions such as repeated arranging of things, hand washing, checking things and skin picking. The behaviors of OCD sufferers are paranoid and psychotic in nature. OCD ranks fourth in terms of prevalence, in the US, 1 in every 50 adults are diagnosed with the disorder. OCD also affects children and adolescents, which increases the likelihood of being propagated to adulthood. Approximately 33 percent of adults suffering from the disorder were propagated from childhood, which indicates its continuum across an individual’s lifespan (Butcher & Mineka, 2007). This research paper discusses the etiology, causes, prognosis and treatment of Obsessive Compulsive Disorder.
Etiology of OCD
Numerous theories have been suggested to explain the causation factors of OCD. Despite the fact that biological theories have been given the emphasis, cognitive-behavioral and psychodynamic theories have also made significant contributions towards explaining the causes of the disorder.
Biological theories that explain the cause of OCD link the disorder with a circuit in the brain that has the task of regulating human behavioral aspects such as sexuality, bodily excretions and aggression. The circuit has the task of relaying information from orbifrontal cortex to the thalamus. Upon the activation of the circuit, impulses are established that forces an individual to engage in specific behavior in response to the impulse. For instance, a person may wash hands after visiting the restroom in order to remove germs. After performing the suitable behavior, the impulse originating from the brain circuit reduces and the person stops washing his hands. According to biological theories, if a person has OCD, the brain has trouble turning off and ignoring the impulses generated from the circuit. This results in repetitive behaviors (compulsions), and irrepressible thoughts (obsessions). In the above example, the brain may experience difficulties in turning off the thoughts associated with contamination after visiting the washroom, resulting in repetitive washing of hands. In support of the biological theories, obsessions and compulsions associated with the disorder are linked to sexuality, contamination and aggression, which are the thoughts that this brain circuit is tasked with controlling. Furthermore, neuro-imaging research has affirmed that there is abnormal activity in the brain circuit among people suffering from OCD. People suffering from this disorder show abnormal brain activity in various parts of this brain circuit (Nolen-Hoeksema, 2007).
The cognitive-behavioral theories of OCD suggest that if a person is suffering from the disorder, then one is not able to ignore the unexpected thoughts that he/she experiences in the course of the day. Furthermore, such a person feels that he/she must control these thoughts and knows that they are dangerous. For instance, one might hold the belief that having these unexpected thoughts implies that he/she is going crazy, or that he/she may engage in the feared behavior. Since these thoughts are considered dangerous, such a person is likely to remain vigilant. Constant noticing of these thoughts serves to prove the dangerousness associated with the bizarre thoughts. This establishes a vicious circle that forces the individual to engage in constant monitoring of these thoughts. If the individual is trapped in the circle, it is difficult and impossible to focus on other activities apart from the distressing thoughts, which in turn results in an obsession. Compulsions are perceived as learned processes. For example, a person is likely to wash hands after visiting the washroom as a response to the feeling of contamination. This in turn decreases the anxiety and reinforces the repetitive behavior of washing hands. As a result, every time a person experiences obsession, the person engages in compulsion as a method of reducing anxiety (Pallanti, 2008).
According to psychodynamic theories of OCD, obsessions and compulsions are indicators of unconscious conflicts that a person is trying to hold back or resolve. The conflicts are formed when an unconscious wish is at conflict with the acceptable behavior. The psychodynamic view of OCD further suggests that increasing the awareness of these conflicts can help in reducing the symptoms of OCD; there is little scientific proof that affirms this (Rachman, 2002).
Causes of OCD
There is a consensus among scholars that both psychological and biological factors cause the disorder. One of the primary causes includes chemical and brain dysfunction, which is discussed in the aforementioned biological theories of OCD. Researchers have also pointed out that genetic factors also contribute to the onset of OCD. There is the likelihood that people suffering from OCD will have a family member suffering from the disorder or the spectrum of disorders. An American study reported that 30 percent of adolescents suffering from OCD had an immediate family member depicting obsessive symptoms. Other research studies have suggested that if one parent suffers from OCD, then the probability of the offspring having the disorder ranges from 2% to 8 %. In addition, if the parent has immediate family members with obsessive problems, then the probability of the offspring having the disorder increases, while if the parent has no family history, then the chances decrease (Nolen-Hoeksema, 2007).
The third cause of ODC is streptococcal throat infection, which results in the body cells mistaking the healthy cells with the cells of the infection, which results in cellular damage. Strep throat infection is common among children and results in a quick start of the symptoms of the disorder. Depression is also known to result in OC symptoms, with the development of OCD worsening the stress levels. Life stressors can increase the probability of developing OCD during adulthood. An example of a life stressor includes being a rape victim during childhood (Butcher & Mineka, 2007).
Prognosis of OCD
OCD is notable by a slow onset of symptoms that may take years to develop to full-blown symptoms. However, there are cases where rapid symptoms may be observed, such as the case of traumatic events. Since OCD is secretive, there is a potential delay of about 10 years before the people suffering from the disorder can seek psychiatric attention. Even though the disorder is complex and associated with numerous risk factors and causes, having an understanding of the psychological factors that result in the OCD symptoms is vital in ensuring the effectiveness of treatment. When OCD is not treated, the symptoms increase to a level whereby the life of the person having the disorder is consumed, which inhibits their ability to sustain social relationships and function socially, occupationally, and educationally. Most people suffering from OCD have been reported to have thoughts of taking their own lives, with approximately 1 percent contemplating suicide. In relation to prognosis for particular symptoms, it is uncommon for any symptom to advance to a physically incapacitating level. Nevertheless, problems such as compulsive hand washing have the potential of resulting to dry skin, which can then break down skin. OCD cannot result in the development of other diseases. In addition, it is uncommon for OCD to be symptom free, imply the necessity of ongoing treatment. Approximately 50 percent of patients with the disorder report improvements with 10 percent recovering completely. It is only 10 percent of the patients get worse after therapeutic intervention (Nolen-Hoeksema, 2007).
A poor prognosis of the disorder is marked by yielding compulsions instead of resisting compulsions. Additional indications of bad prognosis include weird compulsions, childhood onset, beliefs that are delusional, an increase in overvalued ideas and personality disorders. These indicators pose the need for therapeutic intervention and hospitalization. On the other hand, a good prognosis is marked by excellent social and occupational regulations and episodic response to the symptoms. Cognitive distortions are the most common indicators of poor prognosis of the disorder; they include placing much importance on thoughts, overestimation of danger, inflation of responsibility, overrating the consequences of danger, the persistent need for certainty, and high levels of intolerance towards emotional discomfort. Psychological interventions and pharmacological treatments can result in a reduction of the disorder symptoms. There is a connection between OCD and higher levels of IQ (Butcher & Mineka, 2007).
Treatment of OCD
he first-line treatments for this disorder should include behavioral therapy/interventions, cognitive behavioral therapy (CBT), and the use of medications. The American Psychiatric Association affirms that psychodynamic psychotherapy is an effective approach to manage the symptoms of the disorder.
Behavioral treatment for OCD uses ritual prevention and exposure therapy. Ritual prevention is done by a mental health professional helping the patient to tolerate longer durations of resistance to the urge to carry out compulsive and obsessive behaviors. Exposure therapy on the other hand involves placing the person suffering from OSD in situations that are likely to increase his/her urge to engage in compulsive behaviors, after which behavioral interventions are deployed to help him/her to overcome the urge. Cognitive and behavioral intervention plays an integral role in changing their negative thinking styles and behavior that are linked with anxiety when suffering from OCD. Evidence suggests that exposure/response prevention is the most effective treatment for Obsessive Compulsive Behavior. It is widely agreed that using psychotherapy together with psychiatric medication improves the outcomes of treatment (Pallanti, 2008).
OCD can also be treated using medications such as selective serotonin reuptake inhibitors (SRRIS). These medications are used with the main objective of increasing the levels of neuro-chemical serotonin in the brain since OCD is characterized by low levels of serotonin in the brain. SRRIs function through selective inhibition of serotonin uptake at the brain synapse. The SRRIs also ensures that there are high levels of serotonin in the brain synapses. This helps in the activation of cells that were disengaged by OCD, which relieves of the symptoms (Nolen-Hoeksema, 2007).
In cases where medication and psychotherapy have failed to eliminate compulsive symptoms, electroconvulsive therapy and psychosurgery can be used. Psychosurgery involves making a surgical lesion in the brain. Approximately 30 percent of patients have benefited from psychosurgery. This method should be considered as the last option, after the failure of the above treatment therapies. Some of the psychosurgery techniques include deep brain stimulation and vague nerve stimulation (Pallanti, 2008).