OBSESSIVE-COMPULSIVE DISORDER (OCD)

Obsessions are persistent, recurring ideas accompanied by a subjective feeling of compulsion which the patient tries to resist but cannot get rid of.

Compulsions are irresistible urges to carry out irrational activities.The patient knows about the irrationality of these obsessions and compulsions, but cannot prevent them. When he tries, the emotional tension mounts and he becomes miserable and exhausted.These obsessions and compulsions restrict the social activities and interpersonal relationships of the patient.

Epidemiology:
About 1 % of the patients attending a psychiatry clinic may have this disorder. The peak age of onset is around early adulthood, and both males and females are equally affected.

Aetiology and Psychopathology:
Though some genetic or constitutional factors may be involved in production of an obsessive type of personality, environmental factors are of primary importance in the causation of the symptoms. It often has a sudden onset (e.g. after stressful ‘loss’ event).
According to psychoanalysis school, patients with obsessive compulsive disorder have a disturbed development commonly around the anal phase of psychosexual development. Anxiety associated with sexuality is displaced to neutral ideas or acts.
Neuroimaging studies have demonstrated a decrease in caudate nucleus volume and abnormalities in frontal lobe white matter. The caudate nucleus seems particularly involved in the acquisition and maintenance of habit and skill learning.

Clinical Manifestations:
Patients with obsessive compulsive disorder usually have a particular type of personality which is characterized by ritualistic, rigid, perfectionist and meticulous tendencies. Patients often conceal their symptoms, usually because they are embarrassed by the content of their thoughts or the nature of their actions. Specific questions regarding recurrent thoughts and behaviors are to be asked, particularly if physical clues such as chafed and reddened hands or patchy hair loss (from repetitive hair pulling) are present. Tics are sometimes associated with OCD.
In all cases, obsessive-compulsive behaviors take up more than 1 hour per day & are undertaken to relieve the anxiety triggered by the core fear.

There are four major symptom patterns.
▪Most common one is an obsession of contamination followed by washing.
▪Second most common is obsession of doubt followed by a compulsion of checking.
▪Third form is one with merely intrusive obsessive thoughts without a compulsion. Such obsessions are usually repetitious thoughts of some sexual or aggressive act that is reprehensible to the patient.
▪Fourthly, there is obsessional slowness in which the obsession and compulsion seem to be united into slow carrying out of daily activities. Such patients can take hours in bathing, eating, shaving etc.

Most of the patients show features of depression because of the inconvenience and embarrassment caused by the symptoms. The patient realizes that the above symptoms are irrational, but cannot prevent them.