What Causes OCD?
To understand treatment options, it’s crucial to explore the causes of OCD. There’s no point in simply treating symptoms solely without addressing why they arise as otherwise, they’ll continue to manifest.
All mental health conditions are caused by a combination of biological and environmental factors to varying degrees. In terms of biological factors, one theory is that imbalances in neurotransmitters: these are chemicals which send messages to your brain to prompt action. The main one that has been studied is serotonin (“the serotonin hypothesisâ€), but some research indicates that dopamine, glutamate, and GABA contribute to the etiology of OCD as well.
What’s more, OCD and related conditions tend to run in families. However, studies have not found a single gene that leads to OCD, and rather, there are likely to be many different genes that are involved. Since there are some overlapping genes between different mental health conditions, you’re more likely to have OCD if you have another common co-occurring condition.
Additionally, brain differences are said to play a role. An article in the Psychiatric Types (Grant & Chamberlain, 2020) mentioned that there is evidence about differences in structure as well as function in both the orbitofrontal cortices and the caudate nucleus in the basal ganglia. These brain regions are involved with inhibition and control, which relates to how people with OCD struggle to disengage from obsessions and compulsions. Furthermore, there is evidence of structural and functional variations in areas of the brain apart from the “orbitofrontal loopâ€. This means that more research needs to be done to conclude that there are significant differences in brain structure and function between people with OCD and people without it.
Turning to non-biological theories, misinterpretation of your thoughts is said to perpetuate a cycle of maladaptive thinking involving obsessions and compulsions in response to them. Furthermore, stressful life events can result in OCD developing in people with a genetic predisposition developing it. Some proposed risk factors in an article by Medical News Today (Nichols, 2020) include childbirth, issues during pregnancy, trauma, brain injury, and acute illness.
In rare cases, children develop OCD as a result of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) which occurs when one’s immune system has an “overreaction to an infection, such as strep throat†(The International OCD Foundation, n.d.). Make sure this option is ruled out! Antibiotics are the best form of treatment for this, and other forms of first-line treatment can be used for symptoms of OCD that persist.
Managing Obsessions and Compulsions
As outlined by OCD UK, Obsessions and Compulsions frequently fall around the following categories: checking, contamination or mental contamination, ruminations, intrusive thoughts, symmetry, and orderliness. In terms of more specific obsessions, some include unwanted sexual thoughts, loss of control, religion, harm, or falling ill (without being contaminated). Often washing, repeating activities, mental reviews of things, and seeking reassurance are commonly seen characteristics of compulsions.
Checking itself is a compulsion but the obsession might centre around a concern of harm being caused if one forgets to do something like turning the stove off, switching electrical appliances off, or locking home doors.
Contamination refers to a concern about being unclean and in response, individuals often wash or clean excessively in settings such as medical centres, public washrooms, or crowds. Mental Contamination relates more to how negative experiences such as mistreatment or abuse—emotional, physical, sexual, or verbal—make a person obsess about feeling “dirtyâ€, and this results in similar compulsions to clean oneself.
Rumination is referred to by an OCD-UK article as a “train of prolonged thinking about a question or theme that is undirected and unproductiveâ€. Importantly, the article distinguishes ruminations from obsessive thoughts as not having “objectionable content†and a person indulges in rumination without ever finding a satisfactory conclusion to their conundrum. The topics that one ruminates about in the case of OCD might be existential, metaphysical, philosophical, religious, or spiritual in nature.
Intrusive thoughts in people with OCD are much more recurrent, distressing, and disturbing than for the average person. Moreover, they are almost always negative, encompassing areas such as violence, sex, and relationships among other things.
Finally, symmetry plus orderliness are about a desire for things to be perfect. People usually engage in compulsions to make things “just rightâ€â€”such as neat or spotless — to prevent something bad from happening.
With this background in mind, clearly, OCD can have a severe impact on an individual’s life. This highlights the importance of providing the right support to people with OCD.
Common Treatments
According to Burchi et al., (2018), though symptoms often reappear with remission rates of 32 -70%, recovery is a realistic goal! As with most mental health conditions, people can learn to cope with long-term symptoms and experience a better quality of life with the right professional support measures. This might include therapy and counseling by experts, or pharmacological interventions. Importantly, a combination of psychotherapy psychological therapy, and medication has been proven to be more effective than either option alone.
Expert advice suggests that medication is often an effective first line of support which is likely due to the fact that they target biological causes to reduce symptoms. A psychiatrist with expertise in supporting people with OCD might prescribe selective serotonin reuptake inhibitors (SSRIs) which are newer generation antidepressants that can help to correct serotonin imbalances in the brain.
Each person is unique, which means that one might respond to one medication better than the next, and some might not respond to standard treatment after adequate trials of multiple medications: usually 4 - 6 weeks. This is called treatment resistance. For treatment resistance, last resort options that are still being evaluated include Brain Surgery, Gamma Knife, Deep Brain Stimulation, and Transcranial Magnetic Stimulation. Remember to always consult an expert who can guide you as to which course of the treatment would be best suited for your symptoms.
Other treatment options being explored include ERP in group formats or over videoconferencing, and Acceptance and Commitment Therapy (ACT). For people with more acute symptoms, traditional outpatient sessions might not be sufficient, so they might opt for: intensive outpatient treatment, day programs, partial hospitalization, residential treatment, or inpatient treatment in the most severe cases.
The Physical and Emotional Symptoms
Though often overlooked, the mind and body are intertwined, which means there are physical manifestations of mental health issues. OCD is said to usually present with “sensory experiences†(Letzter, 2017) which are likened to semi-hallucinations. People experience “physical†itches to engage in compulsive behaviors until they find relief, rather than just psychological ones.
The Anxiety & Depression Association of America (ADAA) states that individuals with OCD interpret physical sensations in their bodies as being extremely valuable and informative. Crucially, these physical urges and thoughts caused by OCD might not necessarily be real!
Apart from this, there are likely to be outward indicators that a person is struggling with obsessions and compulsions. For example, constantly washing your hands can make them extremely red and painful. Moreover, if not signs visible on your body, there might be things you do that are signs of OCD such as often being late to things because of compulsions you are unable to disengage from. These signs may be noticeable to family members or friends, and the individual facing these symptoms may notice that dealing with these thoughts and behaviors is time-taking for oneself.
When it comes to emotions, obsessions and compulsions are naturally likely to cause a great deal of anxiety, low mood, stress, and feelings of inadequacy. This is because often nothing will ever meet a person’s unreasonable standards as the obsessions persist despite attempts to alleviate the distress caused by them through compulsions. People with OCD frequently have other mental health conditions like Depression or Generalized Anxiety Disorder.
Dealing with Obsessive Compulsive Disorder Through Therapy
The International OCD Foundation recommends a form of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP) Therapy for OCD, stating that 70% of people will find medication or ERP helpful. These two options of effective treatments have the strongest evidence base.
Psychotherapists/therapists/counselors are usually the ones to provide psychotherapy. ERP involves exposure to triggers for your obsessions—images, objects, situations, or thoughts—and response prevention of your compulsion in response to the trigger. ERP is about facing the things that are causing you anxiety, and eventually, your anxiety reduces to the perceived threat.
7 Cups is an online platform with several mental health professionals including OCD specialists ready to support your recovery. Once you are connected with a professional, you can message your therapist throughout the week without setting up an appointment. Your therapist will work on offering guidance as well as support for addressing any concerns which you may have.
In summary, OCD is a serious mental health condition that can be extremely debilitating in an individual’s life. There are a myriad of ways that obsessions plus compulsions can manifest, and these OCD symptoms are caused by a variety of biopsychosocial factors. OCD treatment options such as medication or ERP can help a person live in their day-to-day life despite challenges. Please seek support if you need it as it is a treatable condition just like any other physical or mental health condition.