Obsessive-compulsive disorder (or OCD) has gained a great deal of interest among mental health experts, scientists, and the general public. Though the maladaptive disorder has yet to be fully understood, several its defining symptoms have been identified and included in its basic definition. So, what constitutes OCD symptoms, and why has this mental health disorder received so much attention? Read on to find out.
Though the root cause of OCD is currently being disputed (more on that in a moment), OCD symptoms are generally agreed upon as falling under obsessive thoughts or compulsive actions. Individuals facing OCD often deal with an intrusive, relentless focus on a particularly troubling topic, such as the constant need to sterilize their body or surroundings, or persistently worrying that a loved one will come to harm.
In an effort to calm themselves and divert their attention from the unpleasant theme of their obsession, many of those with OCD will develop their own ritualistic behavior. At first, repeating such an action (for example, pressing on a door handle five times in a row) acts as an effective distraction from their OCD-related thoughts. Over time, though, these rituals become part of their OCD, activating even more adverse feelings, as the individual feels compelled to repeat their actions in order to achieve a sense of (even temporary) relief.
2.3% of adults and 1%-2.3% of children and adolescents within the US contend with OCD. While it can develop at any age, OCD symptoms typically appear between age ten and early adulthood. Unfortunately, since many instances of OCD are initially misdiagnosed, it can take several years until individuals are properly treated. As a result, the average age to receive OCD treatment is between 14-17.
OCD symptoms are divided into the following categories:
Obsessive-compulsive disorder was first considered to be its own, distinct disorder around the mid-1800s. At the time, and up until fairly recently, OCD was emphatically believed to be an anxiety-based condition, rooted in an adverse overreaction to a perceived threat.
An anxiety hypothesis does make sense here: together with depression, anxiety is considered the cornerstone of the world of mental health disorders. The two mental health families make up the majority of the mental health disorders recognized by the American Psychiatric Association’s diagnostic guide, the DSM. And symptoms of anxiety or depression are prevalent in many other mental health disorders, as well.
Moreover, OCD itself is known for causing clinical levels of unpleasantness surrounding a certain topic, which oftentimes can be connected to a source of anxiety: cleanliness, for example, can easily be associated with a fear of infection; worrying about a fatal accident can be linked to catastrophizing. Seen from this perspective, OCD can be understood as the result of overwhelming anxiety.
This, at least, was the APA’s line of thinking until 2013, when it published the current edition of its diagnostic manual, the DSM-V. Until then, the APA had listed OCD as a part of the anxiety family. But the DSM-V changed that, separating OCD into its own family, including a number of other, OCD-related disorders within the same grouping.
So, what changed? Well, firstly, OCD (and OCD-related disorders) seem to share their own comorbidities with each other, but not with other anxiety-related disorders. Secondly, OCD seems to respond particularly well to treatments such as selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) compared to anxiety disorders. Thirdly, while OCD has been found to be related to disruptions in the individual’s self-regulating abilities, anxiety has been linked more to emotional processing.
This is where an OCD distress hypothesis comes in. While an anxiety-based explanation would describe OCD as a state of acute fear due to a perceived threat, a distress-based one would view OCD as a state of pervasive uneasiness and disquiet, due to a nagging, unrelenting thought.
The idea of OCD stemming from distress goes against the dichotomous anxiety/depression prism through which mental health is currently seen. But a growing number of researchers and clinicians are siding with a distress perspective, considering it to be a superior explanation of OCD symptoms: obsessing over whether one remembered to lock the door to their house can be understood as a feeling of disquiet from the possibility of contracting an illness. A case can also be made for interpreting this situation as an anxiety-ridden response to the fear of discovering an intruder.
As with other theoretical constructs, the actual cause for OCD remains unproven. But as our understanding of OCD symptoms becomes clearer, so does our perception of this condition as a whole—along with our understanding of how to best alleviate these symptoms.
OCD medications mainly revolve around the release and activations of chemical compounds produced by the brain called neurotransmitters, which relay messages between different neurons. Out of the different OCD medications currently available, selective serotonin reuptake inhibitors (SSRIs) are considered a first-line treatment for this condition. SSRIs focus on prolonging the activation period of the mood-elevating neurotransmitter serotonin. High levels of serotonin have been proven to not only alleviate the frequency and severity of symptoms of OCD, but also of depression.
While SSRIs have been FDA-approved due to their safety and efficacy, they are not without side effects. Among the more common ones are sexual dysfunction, nausea, and weight gain, causing some patients to continue the treatment.
Through psychotherapy, patients can achieve a greater understanding of their life, and personal perspective, while finding new, more beneficial ways to manage their own challenges. Among the different forms of psychotherapy, cognitive-behavioral therapy (CBT) is the only first-line treatment FDA-approved to offer significant OCD symptom relief.
CBT takes a targeted approach to mental health, focusing on the relevant condition’s symptomatology, rather than on the patient’s overarching life story. With OCD, CBT helps patients describe the thoughts, feelings, actions, and physical sensations they associate with their condition, as a way for them to gain a greater awareness of their OCD. Gradually, they are exposed to triggering stimuli as they learn to withstand the significant unease and anxiety they experience as a result. Instead of automatically carrying out OCD-related rituals that add to their frustration, under the guidance of their therapist, patients learn how to respond in more beneficial ways to these stimuli that can help alleviate their symptoms.
Transcranial magnetic stimulation (or TMS) utilizes a series of electromagnetic pulses to regulate the neural activity of brain structures associated with the appearance of OCD symptoms. Due to its safety and efficacy, TMS has been FDA-cleared to treat OCD, as well as other conditions.
Due to its non-invasive nature, TMS is able to alleviate symptoms of OCD without necessitating anesthesia or a lengthy recovery period. TMS also does not usually cause any severe or long-lasting side effects, allowing patients to fit treatment sessions into their daily schedules.
Among the different TMS options presently available, Deep Transcranial Magnetic Stimulation (or Deep TMS) is the only non-invasive medical device to be FDA-cleared with clinically proven data to treat OCD.