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Obsessive-Compulsive Disorder (OCD)

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In this third rendition of my cognitive impairment series I will be seeking to understand the causes, biology and treatments of OCD.

I've taken an interest in this particular disorder mainly because of its pervasiveness. Growing up, I've heard the letters "OCD" being thrown around, and while I had a general understanding of what that means, I never really took the time to read into what being OCD means outside of the stereotypical compulsion for neatness and order. 

Why are some people OCD? 

Am I OCD?

Are there different forms of OCD?

these are some of the questions which have riddled my brain since primary school. So to finally put an end to this enigma, I shall finally do my due diligence and read into the topic of OCD.

Obsessive-Compulsive Disorder (OCD)

OCD is a common chronic disorder in which a person has uncontrollable recurring thoughts (obsessions) and or behaviour(compulsions) that he or she feels the urge to repeat over and over. This definition was immediately striking to me as it illuminated that there were 2 separate and independent components of OCD, the obsessive part and the compulsive part.

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The obsessive part
This is characterized by persistent, unwanted thoughts, mental images or urges that generate feelings of anxiety, unease or disgust. Hence I think the "obsessive" part of OCD is the mental aspect and urge to do something.
Common obsessions may include: fear of contamination, obsessions with symmetry, intrusive thoughts about religion set or harm.  This broadened my horizons to the different trigger factors of OCD behavior that is not just limited to a need to keep things neat and tidy like I had previously believed.

The compulsive part
These are the repeated actions of routines that occur in response to obsessions. I think a great analogy for this is actually like a sneeze. The obsessive component would be the urge to sneeze triggered by things like allergies or pollen. Hence the compulsive component would be allowing yourself to sneeze without trying to hold it in. 
Common compulsions may be themselves categorized into bodily and non-bodily focussed actions. Non-bodily focussed actions may include Excessive handfasting, cleaning, arranging things, counting and  seeking reassurance. While bodily focussed compulsions include skin picking, nail biting, leg shaking and other ticks which all form into the spectrum of OCD. Having said that however, I believe an important distinction has to be made here. Just because a person performs such actions does not necessarily mean they have OCD, only if it's done in excess taking into consideration their profession and lifestyle. For example, a librarian arranging books on a shelf for an hour may not necessarily have OCD as this task falls under the preview of their job scope. However if one who was not a librarian were to do the same with no obligation, then this may be considered a compulsion.

Causes and risk factors

So what causes OCD? Is it a genetic predisposition or is it a factor of our environment growing up? Well the answer is actually both.

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Genetic factor
So actually, there is some genetic relation with the likelihood of OCD. A study conducted showed that identical twins are more likely to both have OCD. Additionally, individuals with OCD are more likely to have 1st degree family members with the same condition. Hence this seems to point us in the direction that there is a certain inheritance "risk gene" connected to the likelihood of developing OCD.

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Environmental factor
More predominantly, OCD comes as a symptom of environmental factors such as childhood abuse or stress inducing events similar to that which causes PTSD in soldiers but to a lesser degree. This may include academic stress, social stress or even family stress. Hence it is theorized that OCD is developed as a coping mechanism for when dealing with stressful or traumatic experiences.
 

Diagnosis of OCD

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There is always an inherent difficulty with diagnosing mental disorders because of its subjective nature. This is even more so for a common and often mild disorder like OCD where the symptoms can often be misdiagnosed or downplayed because of its pervasiveness.

However, one form of a diagnostic test would be the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) which essentially measures an individual's compulsions to determine if they have OCD or not. 

The biology behind OCD

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Genetic approach

Well, genetically speaking there are certain genes like gene 9, COMT and SERT which seem to correlate with the development of protein though the exact mechanism behind this is still unknown. So while there is a definitive genetic link, the relation between the genes and the development of OCD is still largely unknown. As mentioned earlier, based on twin studies and family studies, there is a strong heritability of OCD which further strengthens the genetic link. 

 

Neural approach

Tangentially related to the genetic approach, changes in genes could impact the functioning of neural systems which in turn lead to the development of OCD symptoms.

For example, one theory puts forward the idea of low serotonin levels being a contributing factor to OCD. Serotonin is a known natural mood stabilizer that regulates levels of anxiety, hence low levels/ quick removal of serotonin from synaptic systems before the neurotransmitter is able to inhibit the respiration of an action may result in obsessive thoughts in an individual.

Another would be in relationship to be basal ganglia which is responsible primarily for motor control, executive function and regulating emotions. When communication between this and other regions of the brain is disrupted, the disjuncture may result in obsessive thoughts and compulsive actions. This theory is actually tangentially related to Parkinson’s disease. It has been noted in studies that patients with Parkinson’s also have a higher incidence rate of OCD because of the nature of Parkinson’s disease which affects the basal ganglia in the brain. 

Lastly, another presenting theory which has gained credibility is excessive brain activity which has been observed in OCD patients. The frontal cortex, which is responsible for predicting future events and controlling impulses, saw excess activity, along with the hippocampal region which regulates unpleasant emotion. Hence in culmination these 2 neural abnormalities may manifest in OCD-like symptoms individuals.

Food for thought

I find it interesting to note that many brain disorders are somehow interlinked as those with one disorder are frequently diagnosed with many other associated disorders or conditions. For example, patients with DID often exhibit symptoms like depression, OCD and ADHD. Similarly, those with autism were also found to be more likely to exhibit ADHD or OCD traits. I would liken this to a running analogy actually. So for instance, if you experience knee pain whilst running, the cause may not necessarily be due to your knee. The root cause may be due to having imbalanced hips or poor running posture which places excessive stress on the knees. Hence although I do recognize that this is likely due to the fact that these disorders affect similar regions of the brain or have overlapping areas of impact, I still find it interesting to think about how having one disorder would make an individual more predisposed to more disorders.

Treatments

So, I do hesitate to label this as “treatments” as although OCD is a mental disorder and can be debilitating in extreme scenarios, the vast majority of individuals who have it are able to lead relatively normal lives, with many not even knowing that they have OCD. However, for the sake of completeness, I will cover some treatment methods provided for in the event of severe OCD where the obsessions or compulsions pose to negatively impact an individual's life and well-being. The first and primary treatment would be cognitive behavioral therapy. Second would be medications such as selective serotonin reuptake inhibitors (SSRIs). Lastly would be minimally invasive surgical procedures such as electroconvulsive therapy (ECT) and Deep brain stimulation (DBS).

References

  1. Aouizerate B;Guehl D;Cuny E;Rougier A;Bioulac B;Tignol J;Burbaud P; (n.d.). Pathophysiology of obsessive-compulsive disorder: A necessary link between phenomenology, neuropsychology, imagery and physiology. Progress in neurobiology. Retrieved February 18, 2022, from https://pubmed.ncbi.nlm.nih.gov/15130710/#:~:text=Obsessive%2Dcompulsive%20disorder%20(OCD),with%20washing%20compulsions%3B%20(3)

  2. Exploring the neurobiology of OCD: Clinical implications. Psychiatric Times. (n.d.). Retrieved February 18, 2022, from https://www.psychiatrictimes.com/view/exploring-neurobiology-ocd-clinical-implications

  3. A fun "eye test" for designers, part 2. Core77. (n.d.). Retrieved February 18, 2022, from https://www.core77.com/posts/68310/A-Fun-Eye-Test-for-Designers-Part-2

  4. A level psychology: Explaining OCD - youtube. (n.d.). Retrieved February 18, 2022, from https://www.youtube.com/watch?v=yxXx4Yz62vE

  5. Obsessive-Compulsive and Related Disorders. (n.d.). Understanding OCD. Obsessive-Compulsive and Related Disorders. Retrieved February 18, 2022, from https://med.stanford.edu/ocd/about/understanding.html

  6. Owen Kelly, P. D. (2020, November 9). The 5 types of obsessive-compulsive disorder. Verywell Mind. Retrieved February 18, 2022, from https://www.verywellmind.com/what-are-the-different-types-of-ocd-2510663

  7. Pogored. (2020, September 3). What's the difference between perfectionism and OCD? Cleveland Clinic. Retrieved February 18, 2022, from https://health.clevelandclinic.org/whats-the-difference-between-perfectionism-and-ocd/

  8. Psychological medicine. (n.d.). Retrieved February 18, 2022, from https://www.nuh.com.sg/our-services/Specialties/Psychological-Medicine/Pages/default.aspx

  9. The Recovery Village Drug and Alcohol Rehab. (2020, September 16). What OCD brain scans reveal: The Recovery Village. The Recovery Village Drug and Alcohol Rehab. Retrieved February 18, 2022, from https://www.therecoveryvillage.com/mental-health/ocd/related/ocd-brain-scans/

  10. U.S. Department of Health and Human Services. (n.d.). Obsessive-compulsive disorder. National Institute of Mental Health. Retrieved February 18, 2022, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd

  11. You are here: Home. OCDUK. (n.d.). Retrieved February 18, 2022, from https://www.ocduk.org/ocd/what-causes-ocd/

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