What Causes Obsessive Compulsive Disorder?

Obsessive Compulsive Disorder (OCD) is a mental disorder that prompts a person to repeat certain actions or think certain thoughts on a loop. While the person may be well aware of the behavior, they can’t stop themselves from repeating the action – much like Shakespeare’s Lady Macbeth who is obsessed with washing the blood off her hands! Daily life takes a severe hit as the OCD behavior engulfs their time and energy.

Symptoms Of OCD

OCDs manifest as obsessions with a certain thought, image, or impulse, or compulsions to perform a certain action. People with OCD may be found washing hands continuously, arranging and rearranging things “perfectly,” or repeatedly thinking thoughts that are otherwise considered taboo. Cleaning up continuously because of a fear of germs, counting obsessively, or checking and rechecking things (say, whether a light has been switched off or a window is shut) are also common OCD behaviors. People wth OCDs may also have tic disorders, causing them to blink, jerk, shrug, grunt, or clear their throats repeatedly.

Contrary to what internet memes would have us believe, straightening something askew, say a rug or a painting, feeling discomfited by an odd-colored tile, or even double checking a door is not OCD. That’s just human nature. People with OCDs have a far more serious problem on their hands – they cannot distract themselves from a particular task however hard they try. Repeatedly thinking or doing the same things gives them a sense of balance and order. If they’re stopped from doing so for very long, they may become restless and anxious and can even have a panic attack. They try and avoid scenarios that can set off a specific behavior, while some even resort to alcohol or drugs to cope.

The symptoms tend to ebb and flow, often reducing over time; disappearing for a while before making a reappearance; or even worsening.

What Causes OCD?

Like many other mental disorders, the causes of OCD are still understood clearly. Some damage in the brain circuitry is suspected to be a cause, but this is still a gray area. Some other factors that precipitate the development of OCDs have, however, been established. For example, genes are known to play a major role in OCDs. In people diagnosed with OCD, an immediate family member often exhibits the same symptoms as well.

Interestingly, even in people not related to each other in any way, mutation of a certain gene that regulates serotonin levels is shown to cause OCDs. Serotonin is a hormone that serves many functions such as mood, behavior and appetite regulation in the body. More specifically, it plays a role in suppressing obsessive behavior in healthy adults.

In one study of pediatric and adolescent subjects, OCDs were found to develop very rapidly after a severe streptococcal infection. These infections, known as PANDAS, encompass a variety of neurological disorders that develop right after a person, especially a child, suffers from an infection caused by bacteria of the Streptococcus family.

Children who have suffered some form of childhood trauma and abuse seem to be at greater risk of developing OCD later in life. Even in people who have been successfully treated for OCD, an extremely stressful situation can cause a relapse.

Treatment For OCDs

Psychotherapy, medication, or a mix of both is usually recommended for treating OCDs. But in most cases of OCDs, therapy, especially Cognitive Behavioral Therapy (CBT), is the first line of treatment. One specific type of CBT called Exposure Response Prevention has been proven to be effective in both children and adults. In this method, under controlled supervision, the patient is exposed to personal triggers, following which they are slowly conditioned to holding off on an action they would otherwise perform in such a situation. For example, take the case of a person who fears contamination and washes themselves every time they’ve been touched even lightly. Here, the therapist may start off by having them touched initially by someone with a gloved hand until the patient is comfortable enough not to react to it. With practice, this approach could condition the brain not to overreact to touch and eventually stop the repeated ritual (washing oneself in this case).

Drugs that work on the brain, particularly on the serotonin receptors, have been used effectively to treat OCD. These medicines work by suppressing the serotonin pathway that prompts patients to practice their ritual-like behavior.

Studies on natural alternatives are also gaining ground. Inositol, a compound that belongs to the sugar family, has been found to be effective in treating depression and OCDs. This is a fairly natural approach and doesn’t involve the suppression of brain function as in the case of traditional medication. Another study on milk thistle found that it was as effective as traditional drugs in treating OCDs. Meditation and mindfulness practices can also improve OCD symptoms to a large extent. Steady support from family and friends can work as a natural de-stressor for people with OCD.

About a third of people with OCDs also have some form of clinical depression. In such cases, therapy for OCDs alone may be insufficient. Deep brain stimulation (DBS), involving electrical stimulation of specific parts of the brain, is emerging as a potential procedure here as well as in OCD which is treatment resistant. In one study, DBS was found to resolve symptoms of both depression and OCD within six months’ time. Further clinical trials will help to firm up the role of this technique.

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