What is OCD? Common myths, symptoms, causes, resources and the most effective treatment options available in 2023 for long-term recovery


Obsessive compulsive disorder (OCD) is a mental health disorder characterized by recurrent and persistent thoughts, impulses, or images which create concern and distress about a feared scenario (obsessions). This compels the individual to engage in repetitive behaviours (compulsions) in order to cope with a neutralise the anxiety and distress. [1]

This psychiatric disorder affects around 2% of the population and if left untreated can be debilitating, causing significant distress and interfering with an individual’s daily functioning and overall quality of life. Examples of themes involved with OCD include magical thinking, religion, morality, fear of harm, perfectionism and contamination.

Common myths about OCD

Due to the nature of OCD being a doubting disorder, sufferers are often left second-guessing themselves about whether this disorder is serious or debilitating. They may ask themselves, “what if this isn’t a real, mental health condition?” or “what if this is just a quirk?”

Important: OCD is not a quirk – it’s a real and serious mental health disorder. Please seek advice immediately from a mental health professional if you experience any of the symptoms listed below.

To help dispel these myths we’ve created this evidence-based, cited and referenced article, that highlight’s the underlying pathophysiology and neural basis of OCD.

Symptoms of OCD

The following are common symptoms of OCD:

1. Obsessive thoughts:

  • Fear of contamination or germs
  • Excessive concern with order or symmetry
  • Unwanted violent, sexual or aggressive thoughts
  • Persistent doubts or fears that something bad will happen
  • Unwanted intrusive blasphemous, religious or superstitious thoughts

2. Compulsive behaviors:

  • Excessive hand washing or cleaning
  • Checking (e.g., door locks, appliances)
  • Arranging and rearranging objects
  • Counting
  • Repeating actions or words

3. General symptoms and baseline differences of OCD

  • Higher baseline anxiety, stress and cortisol when compared to people that don’t have OCD [2]
  • Intense feelings of anxiety and distress in response to triggers
  • Fatigue and being drained of energy
  • Headaches
  • Feeling strongly compelled to engage in neutralising and coping behaviours
  • Excessive doubting and being unable to accept uncertainty 
  • Excessive perceived shame, guilt and disgust [3] [4]
  • Intense feelings of chronic guilt in response to triggers, false memories and real-life events.

Causes of OCD 

The exact cause of OCD is unknown, but it is thought to be influenced by a combination of genetic, environmental, and brain chemistry factors. Research suggests that OCD is likely to have a complex genetic basis, with multiple genes interacting with environmental factors to increase an individual’s risk of developing the disorder. The following are some potential risk factors for the development of OCD:

1. Genetics:

  • Family history of OCD
  • Inheritance of certain genetic markers

2. Environmental factors:

  • Stressful life events
  • Trauma or abuse

3. Brain differences:

  • Hyperactivity in the brain circuits that regulate the threat and danger response
  • Hyperconnectivity of the ventromedial prefrontal cortex (VMPFC) with surrounding regions of the brain. The VMPFC is the area of the prefrontal cortex involved in processing fear, risk, decision-making, memory, self-perception, moral judgement, empathic processing and social cognition. [5]
  • Abnormalities in the levels of certain neurotransmitters (e.g. low serotonin levels)
  • Abnormalities and differences in grey matter volume of specific brain structures (medial frontal gyrus, medial orbitofrontal cortex and anterior cerebellum). [6]
PET scan showing OCD brain vs normal control

Diagnosis of OCD

Obsessive-compulsive disorder (OCD) is typically diagnosed by a psychiatrist or by other mental health professionals, such as psychologists, or licensed clinical social workers, based on a thorough assessment of an individual’s symptoms, thoughts, behaviors, and functional impairment. The diagnostic criteria for OCD are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be diagnosed with OCD, an individual must experience obsessions and/or compulsions that are severe enough to cause significant distress and impairment in daily functioning.

The following are some common methods that mental health professionals may use to diagnose OCD:

  • Interviews with the individual to assess symptoms, thoughts, behaviors, and functional impairment
  • Use of standardized assessments and rating scales to measure the severity of OCD symptoms

Treatment options for OCD sufferers 

Combining different treatments seems to be the best approach to achieving the best results for OCD sufferers. It is important for individuals with OCD to work with a healthcare provider and mental health therapist to determine the most appropriate treatment plan.

Treatment options and recovery strategies include:

  • Selective serotonin reuptake inhibitors (SSRIs) – the first-line medication treatment for OCD. Examples of SSRIs include fluoxetine, sertraline, and paroxetine.
  • Cognitive behavioural therapy (CBT) – changing distorted, rigid and irrational beliefs and helping the individual to make peace with worst-case scenarios through unconditional acceptance
  • Exposure and response prevention (ERP) – gradually exposing the individual to the fear-invoking stimulus
  • Cognitive diffusion and acceptance and commitment therapy – learning to observe and make room for thoughts and emotions whilst moving towards your life goals
  • Mindfulness and meditation can also help to observe thoughts
  • Trans Magnetic Stimulation (TMS) – works by stimulating areas of the brain that are associated with OCD

Treatment and recovery strategies for morality-related obsessions

Morality-related obsessions can trigger excessive amounts of anxiety and guilt. To learn about how to dampen these negative emotions in the long term, please read this helpful guide about moral scrupulosity OCD.

Key Takeaway for OCD recovery

Recovery requires the sufferer to cut out compulsions and gradually expose themselves to the feared stimulus, which results in less distress and anxiety in the future. Creating a flexible belief system and learning to make peace with worst-case scenarios as well as learning about unconditional life acceptance is key to OCD recovery.

References

1: Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://pubmed.ncbi.nlm.nih.gov/23995026/

2: Perceived stress in obsessive-compulsive disorder. Frontiers in Psychiatry Journal.https://www.frontiersin.org/articles/10.3389/fpsyt.2013.00021/full

3: The association between OCD and Shame: A systematic review and meta-analysis. British Journal of Clinical Psychology. https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjc.12392

4: Obsessive-compulsive disorder and propensity to guilt feelings and to disgust. Clinical Neuropsychiatry. https://www.researchgate.net/publication/272676260_Obsessive-compulsive_disorder_and_propensity_to_guilt_feelings_and_to_disgust

5: Ventromedial Prefrontal Cortex. Fundamentals of Cognitive Neuroscience. https://www.sciencedirect.com/topics/neuroscience/ventromedial-prefrontal-cortex

6: Mapping Structural Brain Alterations in Obsessive-Compulsive Disorder. Archives Of General Psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482027

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