One of the most disabling conditions affecting humans is obsessive-compulsive disorder (OCD). The condition entails troublesome meddling thoughts, which present feelings of discomfiture. Patients adversely affected by the condition experience compulsions, which help in reducing the anxiety and distress that accompany the intrusive thoughts. Although the compulsions are often personal and private, patients sometimes involve others. The purpose of the rituals is to make up for the ego-dystonic feelings associated with obsessional thoughts, which can have a debilitating effect in function. Herein, this paper will explore the pathophysiology, symptoms, diagnosis, and medications of OCD.
OCD can affect anyone and present in different forms. One such form is checking, whereby individuals have a compulsion to check the safety or locking of several items including switches, locks, ovens or alarm systems (Pittenger, Kelmendi, Bloch, Krystal, & Coric, 2015). Additionally, such individuals have a feeling of having a medical condition such as schizophrenia. Contamination and symmetry are additional forms of OCD. For contamination, patients have a fear of dirt or have an obsession to clean. Symmetry and order, on the other hand, involve the need to line up objects in a specific way; either by size or color.
At present, OCD remains a mystery; medical professionals do not yet comprehend the causes of OCD. The condition develops in individuals without a known cause. Stress can, however, worsen the symptoms of the condition. Further, the condition occurs more often in women than in men, with symptoms appearing after adolescence or during young adulthood (Pittenger et al., 2015). Despite the condition’s pathophysiology remaining a mystery, some of the risk factors for the condition include depression, trauma, a parent or member of the family with OCD, a history of physical or sexual abuse during childhood, and a difference (physical) in parts of the brain.
Different forms of OCD present symptoms of obsession and compulsion towards certain objects and activities, as well as the development of certain behaviors. Obsessions involve the display and intrusion by certain repeated thoughts, impulses, or mental images accompanied by anxiety (Pittenger et al., 2015). Obsessive symptoms can include: hostile thoughts towards self and others; needing to arrange objects in perfect order or symmetrically, which may also include arranging colors sequentially; excessive fear of germs or contamination; and unreasonable thoughts on harm, religion, or sex.
Compulsions involve repetitive actions accompanied by the urges in response to the obsessive thoughts. The compulsive behaviors, in this case, can include: excessive cleaning or hand-cleaning; repetitive ordering and arrangement of gadgets is a specific way; frequent checking up on objects such as locks to ascertain whether they are locked; as well as compulsive counting (Pittenger et al., 2015). While the thoughts and actions of safety and checking locks are normal to everyone, what makes it different for OCD patients is the fact that they are helpless in controlling such thoughts, even with the recognition that such thoughts are excessive and unnecessary (Pittenger et al., 2015). Additionally, although patients may experience a brief relief from the anxiety associated with the thoughts, they derive no pleasure in performing the compulsions. Moreover, the patients spend at least an hour a day on the thoughts and experience substantial problems in their daily lives occasioned by their thoughts or behaviors.
The diagnosis of the condition requires thorough observation and possible tests. Doctors traditionally perform a physical examination of the patient, as well as blood tests, to rule out the possibility of other infections/conditions that may cause the symptom. The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association requires that patients become overwhelmed for more than an hour a day by the obsession or compulsion to ascertain diagnosis with the disorder (Pittenger et al., 2015). Additionally, if the obsession or compulsion causes daily distress, such reactions qualify as an OCD diagnosis.
Given the debilitating nature of the condition, several treatment methods have proven effective in managing/ridding patients of the condition. Particularly, behavioral treatment has proven effective through exposure and response prevention (ERP) and cognitive-behavioral therapy (CBT) (Pittenger et al., 2015). The treatment involves exposing patients to anxiety-inducing stimuli while preventing them from engaging the compulsions. Pharmacotherapy, on the other hand, involves the use of antidepressants for patients. A combination of the two forms of treatment, that is, ERP/CBT and pharmacotherapy is, however, more effective than the use of each treatment method separately.
Obsessive-compulsive disorder (OCD) is a disorder with debilitating effects on the patients. It presents in different forms including checking, contamination, and symmetry. There is no known cause of the disorder, although a history with the disorder, trauma, and abuse can be risk factors. Its symptoms include; repetitive actions, frequent checking of locks, and excessive cleaning with an awareness of such actions but with little control over them. In diagnosing the disorder, tests are run and observation is done. Treatment includes ERP/CBT and pharmacotherapy, although a combination of both is more effective.
Post-traumatic Stress Disorder
One of the disorders that have attracted extensive medical research in the recent past is post-traumatic stress disorder (PTSD). The disorder mostly presents among individuals that have undergone traumatizing events such as wars and natural disasters. Classified as an anxiety disorder, PTSD has prompted research due to the rising number of wars in the world, natural disasters, and cases of domestic violence. Its classification as an anxiety disorder presents the need for deeper research considering that the associated disorders are among the most common in psychiatric illnesses. Given the disorder’s prevalence, it is important to understand the pathophysiology, symptoms, diagnosis, and medications.
PTSD is a disorder that affects a majority of people across the board. Notably, like OCD, its pathophysiology remains unclear (Vieweg et al., 2005). The unclear nature of the pathophysiology, however, continues to attract more research into the disorder. Early research into the disorder highlighted a difference between the hippocampus of patients and that of normal people. From the research, PTSD patients tend to have a decreased volume of the hippocampus compared to individuals not affected by the disorder. Even with the unclear cause, genetics is suspected to contribute to an individual’s susceptibility to the disorder (Vieweg et al., 2005). Genetics, in this case, contribute to the susceptibility due to the interacting environmental factors. Mental health problems, absence of a strong and reliable support system, nature of job, such as first responders and military personnel, and experiences with long and intense trauma are also risk factors to the disorder.
While individuals without a history of trauma react in particular way to extreme conditions, for instance, war or natural disasters such as hurricanes, those with PTSD show particular symptoms. Patients with PTSD show heightened cognitive, behavioral, and affected responses to any reminders of traumatic experiences (Vieweg et al., 2005). Given the heightened arousals to such stimuli, the patients are likely to attempt to avoid any experiences that may remind them of the trauma. Avoiding such experiences, therefore, highlights the symptoms of the disorder including disinterest in routine activities, emotional numbing, and sometimes detachment from others (Vieweg et al., 2005). Suicidal behavior, unregulated anger, and self-destructive behavior can also show symptoms of PTSD, especially among patients who underwent traumatic experiences, for instance, physical and sexual abuse, when they were young.
Like other mental disorders, a PTSD diagnosis must meet all the DSM criteria for the disorder. The criteria encompass: a personal experience with trauma; witnessing of the trauma occur to another person; learning of the trauma experienced by a person known to the patient such as family member or friend; or repeated exposure to the traumatic event as is the case of first responders (Vieweg et al., 2005). Moreover, the patient must experience recurrent and intrusive, often involuntary, distressing memories of the event, recurrent dreams related to the traumatic event, physiological reactions to both internal and external cues to the traumatic event, and long-lasting psychological distress on exposure to such an event or occurrences that symbolize or resemble the traumatic event (Vieweg et al., 2005).Along with these criteria, diagnosis occurs at least a month after the occurrence of the traumatic experience, wherein a doctor performs physical tests to rule out the possibility of a physical illness as the cause of the symptoms. In the absence of any physical illness, a psychiatrist uses assessment tools using the aforementioned criteria to evaluate the presence of PTSD as well as other psychiatric conditions.
Most mental disorders require a combination of regimens for their treatment or management. Psychotherapy is possible and available for patients with PTSD. Psychotherapy aims to help patients cope with the emotional and physical symptoms associated with the disorder, as well as help in improving their daily functioning (Vieweg et al., 2005). Besides psychotherapy, medications are available for the patients. Antidepressants such as isocarboxazid, serotonin reuptake inhibitors (luxov), and mood stabilizers have proven effective in the management of the feelings of anxiety associated with exposure to traumatic event symbolizers (Vieweg et al., 2005). However, a combination of psychotherapy and medication is more effective than the singular solutions on their own.
Post-traumatic stress disorder is a disabling disorder resulting from experiencing traumatic events. PTSD affects both adults and children. It is often characterized by heightened cognitive, behavioral, and affected responses to any reminders of the traumatic experiences. While the exact cause of the disorder remains unknown, traumatic events and exposure to traumatic events are among the risk factors. Psychotherapy and medication are possible solutions for its management; however, a combination of the two offers better results.
Pittenger, C., Kelmendi, B., Bloch, M., Krystal, J. H., & Coric, V. (2015). Clinical treatment of obsessive-compulsive disorder. Psychiatry, 2(11), 34–43.
Vieweg, W., V., Julius, D., A., Fernandez, A., Beatty-Brooks, M…Pandurangi, A., K. (2005). Posttraumatic stress disorder: Clinical features, pathophysiology, and treatment. The American Journal of Medicine, 119, 383-390.