• What is an obsessive compulsive disorder?
• Some types of obsessions and compulsions
• How is it diagnosed?
• What are the causes of obsessive compulsive disorder?
• What are treatment options?
• Recommendations for the patient’s relatives
What is an obsessive compulsive disorder?
Obsessions are repeated thoughts that arise outside the person’s control and cause distress to the person. The person tries to ease the distress by repetitive actions which are called compulsions. More often the sufferer is aware that these thoughts and the accompanying behaviour is unreasonable. They complain of not being able to stop themselves.
In obsessive compulsive disorder the constant repetition of the obsession and the compulsions interferes greatly with the person’s everyday life, prevents him or her from carrying out daily tasks and leads to a deterioration of their everyday functions. These actions which the person engages in, in order to rid themselves of the anxiety produced by the thoughts, and the situations which the person tries to avoid in order to escape these thoughts, introduce limitations to many of their daily activities. They are unable to get passed these limitations. These behaviour patterns are called rituals. For example, a patient who has an obsession relating to dirt and constantly washes his hands, may not want to touch some items in fear of getting his hands dirty. As a result of this, the person tries to avoid certain activities throughout the day and carries out the planned work in a specific manner. The disease often appears in the age group 20-40 and follows a fluctuating course. Complaints may worsen during certain periods, whilst during other periods they may improve to some extent.
It is very important to differentiate between obsessive compulsive disorder and a fastidious perfectionist personality. Perfectionists may show great care in many matters but do not have the disruptive repeated compulsions we see in obsessive compulsive disorder.
Some types of obsession and compulsion
• The most common type of obsession and compulsion is that related to dirt. These persons are worried that they may be infested with substances from the environment, for instance dirt, blood, sputum, bacteria. In order to prevent this they avoid touching certain items. They may wash their hands for hours, bathe, or repeatedly clean the house. As a result they find themselves unable to carry out many of their everyday tasks. They tend to keep away from social activities.
• A patient who is overcome by a feeling that something bad is about to happen to one of his relatives, will for example, although there is no logic to it, repeat a certain word a specific number of times, or may feel the need to carry out the complete opposite action of his previous action.
• Due to his apprehension that something will go wrong or a fire will break out, the patient may feel the need to repeatedly check the gas knobs of the cooker.
• The person may have the distressing feeling that he will somehow lose his mind and harm himself or his loved ones, and he may therefore hide all the knives and scissors in his house, or may feel the compulsion to leave the room when he gets these feelings, or repeat certain actions a specific number of times.
• The person may have a compulsion to read the number plates of cars that pass by whilst he is walking, or he may try to avoid stepping on the joints of the paving stones in the belief that if he fails in this, something bad will happen to someone he knows.
• The person may have an obsession with order, where he arranges the items on the table have in symmetrical order.
How is the disorder diagnosed?
Obsessive compulsive disorder should be diagnosed by a psychiatrist. The aim of the diagnostic phase is to make sure that the symptoms are not caused by another physical illness. This is particularly important in cases where the onset of the disease is at a late age. As obsessions and compulsions can also temporarily appear in other psychiatric disorders (for instance in depression) it is important that the correct diagnosis is made. A detailed psychological and physical examination, various blood tests, imaging and, if necessary, consultations with doctors from other branches may be required.
What are the causes of obsessive compulsive disorder?
There is no single known cause for the disorder. It is thought that a combination of various factors triggers it out. It has been confirmed that the disorder, whose hereditary aspect is well known, is characterized by functional changes that take place in certain parts of the brain. Therefore the disorder known as obsessive compulsive disorder is regarded as a kind of brain disease. Family problems or stress do not cause the disorder but can exacerbate an already existing one.
What are treatment options?
The treatment of obsessive compulsive disorder initially involves treatment with drugs. Using drugs in combination with a cognitive-behavioural therapy increases the chances of success.
Alongside appropriate anti-obsessive drugs, various other psychiatric drugs can be used in the treatment if considered necessary. Duration of treatment is longer than that of many other psychiatric disorders.
What we need to know about anti-obsessive antidepressants:
• These drugs should only be used under the supervision of a doctor.
• It takes 2-4 weeks before the patient experiences the full effect of the medication. They have no immediate beneficial effect. In fact, in the early stages some complaints may be exacerbated by the medication.
• Your doctor should decide whether the drug is sufficient for the patient’s needs, whether or not to change it, or if additional medication is required in order to strengthen the effect.
• After a certain level of improvement is achieved, you should continue with the treatment for at least 6-9 months. The decision to stop the medication at the end of the treatment should be discussed with your doctor and you should act in accordance with his recommendation.
• Contrary to what is commonly believed, antidepressants do not act by tranquillizing the patient. Your ability to think and decide will not be affected during the use of antidepressants.
• Antidepressants do not cause drug dependency.
• Side effects associated with antidepressants are usually mild and short-term. They usually occur during the first week. The patient may experience nausea, vomiting, headaches or a feeling of confusion. Longer term side effects may be a lack of sexual drive, difficulties in erection and ejaculation. Weight gain is only associated with a certain group of this medication and does not reach extreme levels. Do not refrain from sharing such side effects with your doctor, he will welcome it. If any unexpected side effects occur during treatment you must contact your doctor immediately.
In obsessive compulsive disorder, cognitive-behavioural therapy has been found to be effective. During therapy the patient is encouraged to increasingly face the situation or objects of his obsession. During this process effort is spent to reduce the usual compulsive actions and/or exchange these with alternative actions.
Recommendations to relatives of patients
• Patients with obsessive compulsive disorder often involve their families in their daily rituals. For example, a patient who has an obsession about hygiene may demand that anyone who enters the house, adheres with his rules (like undressing and bathing as soon as they come in, or not touching the patient’s belongings etc). Such limitations can distress the family and lead to family conflicts. Sometimes patients are aware of their disorder but do not consider treatment because they think they would not benefit from it as their condition is long-standing. In such a situation family members have an important role to play. They should not forget that this is a disorder, and should encourage the patient to receive treatment.
• The disorder has nothing to do with a hardened personality. On the contrary, most patients have a tender nature, but because of their obsessions they force other family members to adhere with their specific rules.
• It is not possible to achieve an improvement in the symptoms by discussing them with the patients, as they are already aware that their thoughts and behaviour are irrational. Trying to discuss these with the patient will only increase their stress. Instead it is more helpful to tell the patient that you understand them and will stand by them and give your support.