A neuropsychological disorder that everyone has heard of. We explain its characteristics.
Obsessive-Compulsive Disorder (OCD) is a type of disorder classified within obsessive-compulsive disorders in the DSM-5 (Diagnostic Manual of Mental Disorders).
Within the category of obsessive-compulsive disorders we find others, such as body dysmorphic disorder, trichotillomania or hoarding disorder. In this article, however, we will focus on OCD; We will know its symptoms, the causes that originate it and the indicated treatments so that the patient can experience fewer symptoms and have a normal life.
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Obsessive-Compulsive Disorder: what is it?
This chapter or category of disorders is newly created in the latest edition of the manual, although Obsessive-Compulsive Disorder already existed as such. In the previous edition, OCD was considered an anxiety disorder.
Symptoms
The main symptoms of Obsessive-Compulsive Disorder are two: obsessions and compulsions (although in the DSM-5 only one of the two is needed to diagnose OCD). Let’s look at these symptoms and others that are present in clinical cases.
1. Obsessions
The obsessions of Obsessive-Compulsive Disorder are recurrent and persistent images, thoughts, ideas or impulses that the person experiences as something intrusive and inappropriate. You cannot control them, and they generate a high degree of anxiety or discomfort since, no matter how hard you try, you cannot divert your attention to other thoughts. They usually refer to feeling ‘invaded’ by these recurrent thoughts, without the possibility of being able to disconnect from them.
The obsessions are not habitual excessive worries of daily life (as would occur, for example, in Generalized Anxiety Disorder). Examples of obsessions typical of OCD are: thinking that someone is going to die (if we don’t do the compulsion), thinking that hands are never clean enough, worrying that the gas or the door of the house has not been properly closed when leaving , etc.
In addition, the person with OCD recognizes that these obsessions are the product of their mind, and are not imposed as in thought insertion (although this criterion is eliminated in the DSM-5).
The person who has obsessions typical of Obsessive-Compulsive Disorder tries to suppress or ignore them, or tries to neutralize them through some action, ritual or other thoughts (compulsions).
2. Compulsions
Compulsions, on the other hand, are the well-known “rituals”; these are repetitive behaviors or actions (for example, ordering, checking, washing your hands in the face of an obsession with dirt, checking if the light has been left on, etc.) or mental actions (for example, repeating words silently, counting, praying , etc.). The person feels that he has to carry out such compulsions to neutralize the previous obsessions, or else feels that he has to do them according to rigid application rules that he “creates” himself.
The compulsions, for the patient, have the objective of preventing or reducing the discomfort associated with the obsession, or of preventing a feared situation (for example, touching the ground three times in a row to avoid the death of a loved one, or checking if has left the lights on at home when leaving for work, although he knows for a fact that he has turned them off conscientiously).
Such behaviors or actions are not realistically connected to what the person is trying to eliminate, neutralize or prevent, or are excessive.
3. Associated discomfort or interference
Another symptom of Obsessive-Compulsive Disorder, and at the same time a diagnostic criterion, is the discomfort caused by the disorder, or the loss of time caused by obsessions and/or compulsions, which is more than one hour a day.
If no such discomfort or loss of time occurs, there is significant interference in the person’s daily routine (or may occur alongside the above).
Causes
Different types of models have been proposed to explain the causes of Obsessive-Compulsive Disorder.
1. Biological models
They speak of a hereditary contribution in the development of Obsessive-Compulsive Disorder. They posit a relationship between motor symptoms and the basal ganglia (which are smaller in patients with OCD). They also allude to the frontal lobe (there is an increase in metabolism in OCD), and relate it to cognitive symptoms.
2. Behavioral and cognitive psychological models
Here are the learning models , which allude to classical conditioning.
2.1. Mowrer’s two-factor model
Mowrer’s bifactorial model explains that the escape or avoidance responses that occur in Obsessive-Compulsive Disorder (compulsions) are negatively reinforced by reducing anxiety (instrumental conditioning).
On the other hand, passive avoidance (for example avoiding situations where one can get dirty) corresponds to an avoidance learning paradigm. For its part, active avoidance (for example compulsive behaviors) is part of an escape learning paradigm.
2.2. Salkovsky’s model
Another well-known psychological model that attempts to explain Obsessive-Compulsive Disorder is the Salkovskis model, which differentiates two concepts: NAPs (Negative Automatic Thoughts) and obsessions. PANs are consistent with the patient’s beliefs, plausible, and cause discomfort. The second (the obsessions) are unacceptable to the patient, implausible and irrational.
How do these two elements act in Obsessive-Compulsive Disorder? Obsessions activate PANs. The PANs, by creating discomfort and a negative affective state, lead the person to carry out the neutralizing behavior, thanks to which the discomfort is temporarily reduced.
Treatment
The psychological treatment of choice for Obsessive-Compulsive Disorder is exposure with response prevention (ERP) ; Through it, the person is exposed to having the obsessions without applying any compulsion to neutralize the anxiety. The goal is to get used to this discomfort and that it ends up disappearing without the need for the person to perform any ritual or compulsion.
Pharmacotherapy is also considered a well-established treatment (same as EPR), and SSRI antidepressant drugs (Selective Serotonin Reuptake Inhibitors) are used.
Cognitive therapy is also used, although it has not been shown to be as effective as the previous treatments. Through it, specific cognitive interventions are used, such as the downward arrow technique to eliminate the belief that “if I think this, it will happen” (very typical of Obsessive-Compulsive Disorder). The patient’s overestimation of the importance of her thoughts is also worked on a lot.
Bibliographic references
- American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Pan American.
- Belloch, A.; Sandin, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
- Perez, M.; Fernandez, JR; Fernandez, C. AND FRIEND, I. (2010). Guide to effective psychological treatments I and II:. Madrid: Pyramid.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.