Do you always have the same thoughts and feelings? Let's talk about OCD (Obsessive-Compulsive Disorder)!

Do you sometimes have the same thoughts over and over again? Or do you constantly check whether you have done something or not? For example, things like turning off the gas stove or locking the door. These are things that we all have to some extent. But for some people, these thoughts and the actions they take in response to them affect their daily lives to the point where they are unable to function. That's when we need to think a little deeper about this condition. This is what is called `(Obsessive-Compulsive Disorder)` or `(OCD)` in medical science.

What is OCD (Obsessive-Compulsive Disorder)? Simply put...

Simply put, Obsessive-Compulsive Disorder (OCD) is a condition in which you have intrusive thoughts (called obsessions) that are intrusive and repetitive (called compulsions) to relieve the stress and anxiety caused by those thoughts. These repetitive behaviors can interfere with your social interactions and daily functioning.

OCD is usually a lifelong condition (a chronic condition), but symptoms may increase or decrease over time.

We all experience some degree of `obsessions` and `compulsions` at some point in our lives. For example, it is normal to double-check that the stove is turned off, or to check that the door is locked. And we often say things like, "I'm obsessed." But `(OCD)` is much more than that. It can waste hours of a person's day. All normal life activities are disrupted. These `obsessions` are unwanted thoughts that a person with `(OCD)` has that they cannot control. And they do not get any pleasure from doing these `compulsions`.

Are OCD and OCPD two different things?

Many people confuse these two names because they sound very similar. However, `(Obsessive-Compulsive Disorder - OCD)` and `(Obsessive-Compulsive Personality Disorder - OCPD)` are two completely different conditions.

Obsessive-compulsive disorder (OCPD) is a personality disorder characterized by perfectionism, a desire to do everything in a very orderly, rule-based manner, and an attempt to control everything.

People with OCD usually know that their thoughts and actions are abnormal and that they have a problem. They also accept that they need treatment. However, people with OCPD often do not think that there is anything wrong with their behavior or beliefs.

Who is most affected by this OCD condition?

Anyone can develop OCD. The condition usually begins around the age of 19. About 50% of people with OCD develop symptoms in childhood or adolescence.

It is very rare for someone to develop OCD after the age of 40.

How common is OCD?

Obsessive-Compulsive Disorder (OCD) is actually a relatively common condition. It is reported to affect between 1.6% and 2.3% of the general population in the United States. There are quite a few people with this condition in Sri Lanka as well.

What are the symptoms of OCD?

The main symptoms of OCD are the obsessions (unwanted thoughts) and compulsions (actions that you do in response to them), which we discussed earlier. These symptoms can interfere with your normal functioning. For example, these symptoms may make you unable to get to work on time. Or you may take longer than usual to get ready for bed at night.

You may realize that these symptoms are a problem, but you can't stop them. OCD symptoms can flare up, subside, and get worse or better over time.

If you or your child are experiencing symptoms of OCD that are affecting your daily life, it is best to see a doctor for advice.

Obsessions (unwanted, distressing thoughts) that occur in OCD

In OCD, obsessions are intrusive thoughts or mental images that you cannot control and that cause excessive distress or anxiety. Many people with OCD know that these thoughts are irrational and abnormal.

Some common examples of `obsessions` are:

• An extreme fear of touching or getting sick with germs, dirt, or other dirty things. Imagine, you're afraid of touching a wire on a bus, changing money in a shop, or even shaking hands.
• Fear of harming oneself or others. Specifically, thoughts like, "If I'm not careful, will I hurt someone?" "If I don't lock the door, will a thief break in and harm the family?" Sometimes, there may also be a fear of doing something violent that they can't control.
• The formation of unwanted, unpleasant thoughts or mental images related to sex in the mind. These come without one's consent and cause great psychological distress.
• Excessive fear of making a mistake. If you make a mistake, even a small one, you will be in great embarrassment.
• Overthinking about right and wrong (morality). Overthinking everything, asking "Is this right? Is this wrong?"
• Constantly feeling suspicious and disgusted.
• The intense need for everything to be orderly, symmetrical, and flawless. It's hard to believe that even the books on the table and the clothes in the closet are moved even a millimeter.
• Constant need for reassurance from others. Constantly asking, "Did I do this right?" "Did I turn off the stove?"

Compulsions (repetitive actions) that occur in OCD

In OCD, these 'compulsions' are repetitive actions that you feel compelled to do to relieve the pressure and fear caused by the previously mentioned 'obsessions', or to get some relief from it.

People with OCD do not want to do these compulsions, and they do not enjoy doing them. But they feel that if they do not do these things, the fear and stress caused by those distressing thoughts will increase. But the relief from these compulsions is temporary. After a while, the obsessions come back to mind, and they are tempted to do the compulsions again. It is like a cycle.

These `compulsions` waste a lot of time and interfere with the important things you value. These actions don't necessarily have to be related to your `obsession`.

Some examples are:

• Arranging everything in a very specific way. For example, you have to arrange the things and books on your desk in the same order and in the same way. If you move it a little, you have to start over again.
• Repeated bathing, cleaning, hand washing. Some people wash their hands ten to fifteen times a day, rubbing and rubbing for minutes.
• Hoarding is the act of collecting or accumulating things that have no personal or financial value. Things like old newspapers and empty bottles are piled up and cannot be disposed of.
• Checking things repeatedly. Checking to see if the doors are locked, the lights are turned off, the gas stove is turned off. Some people leave the house, walk a short distance, and then come back and check.
• Always trying to make sure that no one gets hurt because of their actions.
• Constantly seeking reassurance from others.
• Rituals related to numbers. For example, doing something a certain number of times (like doing it three times, doing it seven times), or liking or avoiding certain numbers.
• Saying certain words or prayers while doing unrelated work.

Compulsions can also include avoiding situations that trigger obsessions. For example, refusing to shake hands with others or touching things that many people touch, such as doorknobs.

What causes OCD?

Researchers still don't know exactly what causes OCD, but they think several factors contribute to it:

• Genetics: Studies have shown that if someone in the family (parents, siblings) has OCD, others are at greater risk of developing the condition. Also, if someone in the family has had OCD in childhood or adolescence, the risk is even greater.
• Brain changes: Imaging studies have shown that people with OCD have changes in the frontal cortex and related subcortical structures. OCD is also associated with neurological conditions that affect similar areas of the brain, such as Parkinson's disease, Tourette's syndrome, and epilepsy.
• PANDAS syndrome: PANDAS is an acronym for "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections." It describes a group of conditions that can affect some children who have had streptococcal bacterial infections, such as strep throat or scarlet fever. OCD is one of these conditions.
• Childhood trauma: Some studies show a link between traumatic experiences such as childhood abuse and neglect and the development of OCD.

How is OCD diagnosed?

There is no specific test to diagnose OCD. A doctor will diagnose the condition after asking you about your symptoms, medical history, and mental health history. Doctors use criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) to diagnose OCD.

Those criteria include:

• Having `obsessions` (unwanted thoughts) or `compulsions` (actions taken in response to them), or both.
• These `obsessions` or `compulsions` take up more than an hour a day.
• These obsessions or compulsions cause severe distress or interfere with social, occupational, or other important activities in life.
• These symptoms are not caused by drugs, alcohol, other medications, or another physical condition.
• These symptoms cannot be explained by another mental illness (e.g., generalized anxiety disorder, eating disorder, body image disorder).

What are the treatments for OCD?

The most commonly used treatment plan for OCD includes psychotherapy (talk therapy) and medication.

If these treatments do not relieve your OCD symptoms and your symptoms are severe, your doctor may recommend a treatment called Transcranial Magnetic Stimulation (TMS).

Psychotherapy for OCD

Psychotherapy is a variety of treatment methods that help you identify and change your unhealthy feelings, thoughts, and behaviors. You work with a mental health professional , such as a psychologist.

There are several types of psychotherapy. The most effective and commonly used methods for OCD are:

• Cognitive Behavioral Therapy (CBT): In CBT, a therapist helps you examine and understand your thoughts and feelings. Over a few sessions, CBT can help you change your negative thoughts, stop your unhealthy habits, and introduce healthier ways to cope with your situation. Imagine that you have a false belief in your mind, such as "If I touch the door, I will get sick," and you wonder if it's true and if it has a scientific basis.
• Exposure and Response Prevention (ERP): This is also part of CBT. In this, the therapist gradually exposes you to the feared situation or thought, but does not allow you to do the compulsion (repetitive action) you are doing in response. For example, you may be asked to touch something that you think is dirty, and then you stop doing it when you try to wash your hands. When you are in this state of fear, and nothing bad happens, you realize that your fearful thoughts are just thoughts, and that they are not really real. This is a difficult, but very effective treatment for OCD.
• Acceptance and Commitment Therapy (ACT): ACT helps you to accept that your obsessive thoughts are just thoughts, and to reduce their power. An ACT therapist can help you live a meaningful life despite your OCD symptoms. That is, instead of fighting these thoughts, you can accept that they will come and go and focus on the things in your life that are important to you.

Mindfulness-enhancing meditation and relaxation techniques can also help manage symptoms.

Medication for OCD

Medications called Serotonin Reuptake Inhibitors (SRIs), Selective Serotonin Reuptake Inhibitors (SSRIs), and tricyclic antidepressants can help treat OCD. They work by balancing the activity of the neurotransmitter serotonin in the brain.

Doctors most often prescribe SSRIs for OCD. These are usually given in higher doses than those used for anxiety or depression. Some of the SSRIs approved by the U.S. Food and Drug Administration (FDA) include:

• `(Fluoxetine)`
• `(Fluvoxamine)`
• `(Paroxetine)`
• `(Sertraline)`

It can take between 8 and 12 weeks for these medications to start working. So don't stop taking them suddenly because they aren't working. You should continue taking them as directed by your doctor.

What is the prognosis of OCD?

The outlook for OCD can vary from person to person. OCD is often a lifelong condition, with periods of remission.

However, people with OCD who receive proper treatment can experience a significant improvement in their quality of life, including improved social relationships, schoolwork, and job performance.

If you don't get treatment, this cycle of obsessions and compulsions becomes difficult to break and treat, because over time, structural changes occur in your brain. Therefore, it is very important to seek medical advice as soon as possible if you or your child start to experience symptoms.

Can I prevent OCD?

Unfortunately, there is no way to prevent OCD. However, early diagnosis and treatment can help reduce symptoms and reduce the impact it has on your life.

If I have OCD, how can I take care of myself?

In addition to seeking medical treatment for OCD, self-care can also help you manage your symptoms. For example:

• Get good sleep. Sleep at least 7-8 hours a day.
• Exercise regularly. Do something like walking, running, or swimming.
• Eat a healthy diet. Eat more vegetables, fruits, and clean foods.
• Spend time with loved ones who support you and understand your OCD.
• Practice relaxation techniques. Things like meditation, yoga, massage, and visualization.
• Join support groups for people with OCD. These can be online or in person. Talking to people who have been through the same things as you can be very empowering.

When should I see my doctor about OCD?

If you or your child has been diagnosed with Obsessive-Compulsive Disorder, you will need to see your doctor and/or mental health professional regularly to make sure your treatment is working properly.

If you are taking medication for OCD and you are experiencing any unpleasant side effects, talk to your doctor about it.

The most important thing to remember is this: Obsessive-Compulsive Disorder (OCD) is a mental illness. Like any other mental illness, seeking help as soon as you notice symptoms can help reduce the disruption to your life. Doctors and mental health professionals can provide treatment plans to help you manage your obsessions and compulsions.

The most important things you need to know (Take-Home Message)

• Obsessive-compulsive disorder (OCD) is a mental condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) to relieve the distress caused by them.
• This is not something we usually say, "I think too much about the other person," but something more serious and affects everyday life.
• `(OCD)` and `(OCPD)` are two different things.
• Although the exact causes are unknown, genes, brain changes, certain infections, and childhood experiences may play a role.
• Psychotherapy (especially `CBT` and `ERP`) and medication are the main treatments.
• Early detection and treatment can improve quality of life.
• If you or someone you know has these symptoms, don't be ashamed or afraid to seek medical advice. You are not alone, and getting help is a sign of strength.

` OCD, Obsessive-Compulsive Disorder, Mental Health, Intrusive Thoughts, Repetitive Actions, Anxiety, Treatment