Obsessive Compulsive Disorder

Obsessive Compulsive Disorder

1. Definition: Obsessive Compulsive Disorder (OCD) is a mental health disorder characterized by recurring, intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that the individual feels compelled to perform. It is a type of anxiety disorder.

2. Causes / Etiology: The exact cause of OCD is still not known but it is believed to be due to a combination of genetic, environmental, and neurobiological factors. Some studies suggest that imbalanced neurotransmitters like serotonin may play a role in OCD. Stressful life events, trauma, and family history can also contribute to the development of OCD.

3. Types or Classification:

• Washing Compulsion (Mysophobia): Excessive cleaning and washing due to fear of germs or contamination.
• Checking Compulsion (Perfectionism): Repeatedly checking things like locks, appliances, or one's own work due to fear of mistakes or harm.
• Ordering Compulsion (Symmetry): Needing things to be in a specific order or arrangement.
• Counting Compulsion (Arithmomania): Repeating certain actions or words a specific number of times.
• Harming Compulsion (Harm OCD): Fear of causing harm to oneself or others.
• Sexual Compulsion (Sexual OCD): Unwanted, intrusive thoughts or urges related to sex.

4. Pathology:

• Step 1 → Stress or traumatic events trigger the brain's amygdala to send a distress signal to the prefrontal cortex.
• Step 2 → The prefrontal cortex tries to rationalize the threat, but fails to do so, leading to feelings of anxiety.
• Step 3 → The brain's basal ganglia, responsible for movement and habit formation, gets involved, leading to the development of repetitive behaviors.
• Step 4 → The brain's reward system releases dopamine, reinforcing the behavior and making it harder to stop.

5. Clinical Features:

• General features:
  • Recurring, intrusive thoughts (obsessions)
  • Repetitive behaviors (compulsions)
  • Anxiety and distress
  • Avoidance behaviors
• Specific features:
  • Washing and cleaning compulsions
  • Checking and rechecking compulsions
  • Ordering and symmetry compulsions
  • Counting and repeating compulsions
  • Harming and sexual compulsions

6. Complications:

• Acute complications:
  • Anxiety attacks
  • Panic attacks
  • Suicidal thoughts and behaviors
• Chronic complications:
  • Social isolation
  • Marital problems
  • Employment difficulties
  • Co-morbid psychiatric conditions (e.g., depression, anxiety disorders)

7. Diagnosis / Investigations:

• Routine tests:
  • Physical examination
  • Complete blood count (CBC)
  • Blood chemistry profile
  • Electroencephalogram (EEG)
• Special tests:
  • Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
  • Beck Depression Inventory (BDI)
  • Hamilton Rating Scale for Depression (HAM-D)

8. Management:

• General management:
  • Cognitive-behavioral therapy (CBT)
  • Exposure and response prevention (ERP)
  • Relaxation techniques
  • Stress management
• Modern treatment:
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Anti-anxiety medications
  • Neurostimulation techniques (e.g., transcranial magnetic stimulation, TMS)

9. Homeopathic Therapeutics:

• Aconitum napellus: For sudden onset of OCD symptoms, with anxiety and fear of the unknown.

  • Characteristics: Anxiety, fear, and restlessness
  • Indications: Sudden onset of OCD symptoms
  • Potency: 6c to 30c

• Natrum muriaticum: For OCD symptoms related to emotional trauma and grief.

  • Characteristics: Sadness, grief, and emotional trauma
  • Indications: OCD symptoms related to emotional trauma
  • Potency: 6c to 30c

• Arnica montana: For OCD symptoms related to physical trauma and anxiety.

  • Characteristics: Anxiety, fear, and physical trauma
  • Indications: OCD symptoms related to physical trauma
  • Potency: 6c to 30c

• Borax: For OCD symptoms related to obsessive thoughts and compulsive behaviors.

  • Characteristics: Obsessive thoughts and compulsive behaviors
  • Indications: OCD symptoms related to obsessive thoughts
  • Potency: 6c to 30c

• Hydrocotyle asiatica: For OCD symptoms related to anxiety and restlessness.

  • Characteristics: Anxiety, restlessness, and irritability
  • Indications: OCD symptoms related to anxiety
  • Potency: 6c to 30c