OCD, a disorder that causes great suffering
Obsessive-compulsive disorder (OCD) is a disorder characterized by the presence of two related phenomena: obsessions and compulsions .
Obsessions are intrusive, repetitive, and unwanted thoughts, impulses, or images that cause significant distress. Compulsions are behaviors, both physical (which can be observed by others) and mental (which occur internally and are not observable), that are usually repetitive and that the person performs to reduce the distress caused by the obsessions or to prevent harm to themselves or others (often their loved ones). Sometimes, people with OCD feel compelled to perform actions in a rigid and stereotyped manner, following self-imposed rules (doing things in a certain order or a specific number of times), until they feel they are "right."
It's important to understand that having OCD is not the same as being a "maniac." We can all have occasional intrusive thoughts, habits, or self-imposed rules, but these don't cause significant distress if we don't engage in them, they don't occupy more than an hour a day, and they aren't repeated daily. In contrast, in people with OCD, the thoughts, images, or impulses, and the associated rituals, are very frequent, take up a large amount of their time, are accompanied by intense negative emotions (fear, disgust, guilt, etc.), and make it difficult for them to adapt and function in various areas of their lives (studies, work, family, friends, etc.).
Maria dels Àngels Giralt Ruiz
The most common obsessions and compulsions in adults are:
OBSESSIONS | COMULSIONS |
Pollution | Wash |
Harming oneself or others | Repeat, check, accumulate |
Aggressive | Check, ask |
Scruple/religiosity | Pray, count, repeat |
“Forbidden” thoughts | Ask, touch, check |
Symmetry | Sort and check, store |
Are there any causes for the development of OCD?
Studies show that in approximately 35% of people with OCD, the onset of symptoms is related to certain triggers. These triggers can be physical (such as certain infections, hormonal factors, or substance use) or life events that involve changes (both positive and negative for the individual).
Regarding physical factors , the sudden onset of obsessive symptoms, associated with other neuropsychiatric components such as tics and behavioral changes, has been observed in children and adolescents following an infection or inflammatory process. These types of processes are less common and are known as PANS (pediatric neuropsychiatric disorders of acute onset). In these cases, to defend itself against bacteria, or due to an altered immune response, the body generates antibodies that attack certain areas of the brain (basal ganglia), causing the appearance or worsening of obsessive symptoms or tics.
The thoughts, images, or impulses and associated rituals take up a lot of the person's time, are accompanied by intense negative emotions, and make it difficult for them to function in various areas of their life.
We also know that hormonal changes can affect the onset and course of OCD. It is common for girls with obsessive symptoms to experience the onset of the disorder in the year of their first menstruation (menarche). It is also relatively common for some women to begin experiencing obsessive symptoms during pregnancy or especially postpartum , or to experience a worsening of symptoms during different phases of the menstrual cycle (ovulation, menstruation). In these cases, if symptoms worsen significantly during menstruation, regulating the cycles with oral contraceptives can be attempted, and it will also be especially important to monitor the progression of OCD if the woman becomes pregnant.
Obsessive-compulsive disorder in the perinatal stage
Finally, some people describe the onset of obsessive-compulsive disorder after using certain drugs such as cannabis or cocaine . In these cases, it is essential to recommend complete abstinence from drugs.
Regarding changes in the environment , we know that OCD can sometimes appear after traumatic situations (life experiences and stressors that have had a traumatic impact, such as abuse, bullying, the unexpected death of loved ones, grief, etc.) and also in situations that represent a change for the individual, especially if they involve an increase in their perceived responsibility (starting new studies, a new job, becoming independent from their family of origin, beginning a romantic relationship, etc.). Those who associate the onset of their OCD with environmental stressors tend to be somewhat older and have less of a family history of OCD than those with a more "spontaneous" onset.
Can OCD be cured?
Currently, we have very effective treatments, both psychological and pharmacological, for treating OCD, which allow us to reduce the symptoms and even make them disappear completely, and make it easier for affected people not to have so many limitations and for their quality of life to improve considerably.
This favorable prognosis is especially clear in childhood-onset forms of OCD. More than half of children diagnosed with OCD in childhood will not exhibit obsessive symptoms in adulthood. These childhood forms of OCD, with their particularly good prognosis, are often accompanied by other neurodevelopmental disorders such as tics or attention deficit hyperactivity disorder (ADHD).
When a person has been performing rituals continuously for many years, they can develop distorted ideas, such as believing that nothing bad happens to their loved ones because of it.
A key aspect of maximizing the chances of a successful response to treatment for OCD is to start it as soon as possible; hence the importance of early diagnosis . This is often not easy, because people tend to hide their symptoms out of shame, because they believe they should be able to control them on their own, or even because they are unaware that their symptoms constitute a disorder. Some studies describe that, in many cases, between five and ten years pass from the onset of obsessions and rituals until an OCD diagnosis is made.
Carmen Jiménez
Performing rituals continuously for many years leads to the development of distorted beliefs that worsen the disorder. The person may believe, for example, that nothing bad has happened to their loved ones because they carried out their rituals, or that they haven't contracted an illness because they washed their hands repeatedly, when in reality, in both cases, nothing terrible has occurred because the obsessions represent imagined threats rather than real ones.
For this reason, it is important to begin cognitive-behavioral therapy as soon as possible when OCD appears. This therapy helps the person to interrupt the rituals (what we know as exposure and response prevention), thus avoiding the false confirmations of obsessive fears. It also helps to identify and modify the distorted beliefs that often accompany OCD. These include thought-action fusion (the belief that simply thinking about something increases the likelihood of it happening), overestimation of risk and intolerance of uncertainty (if I am not certain of safety, it means there is danger), and perfectionism (there is only one perfect and desirable way to do things).
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