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What is OCD?

Dr Hassoulas describes the symptoms and causes of OCD
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Obsessive Compulsive Disorder or as it’s more commonly known, OCD, is a debilitating anxiety disorder that is characterised by the World Health Organization as being within the ten most debilitating conditions. So the portrayal that we tend to see in the media and social media, in movies of OCD, doesn’t tend to be the most accurate when it when we consider the kind of distress that patients with OCD experience. And it’s estimated that anywhere between 2 and 3% of the world population have been diagnosed with OCD. Symptoms generally appear earlier on in life, either during our teenage years or early twenties. It can happen later on in life as well, though.
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And there are a number of different subtypes of OCD that are important to consider. So we tend to think of OCD as sort of a condition, but we know that there are certain different types of OCD. For instance, there is a checking type of OCD, contamination related OCD, Order symmetry, and also pure obsessional. So I’m going to share something about myself. When I was a teenager, I was diagnosed with OCD. And specifically, even though this doesn’t form part of a formal diagnosis, the pure O type.
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So by pure, we don’t just mean obsessions in the absence of compulsions, but what we tend to find here is that the kind of behaviours that the patient may engage in to sort of alleviate the distress that they’re experiencing from those really, really nasty thoughts Are internalised behaviours. So you don’t always see the kind of checking or washing behaviour, it can be hidden. And that’s something really important to consider because those are the types of signs that can be easily missed. So when it comes to considering the key symptoms as per our diagnostic manuals again, the ICD 11 and the DSM 5, we have firstly the obsessions. Now, the obsessions are those very, very nasty thoughts.
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They’re intrusive in nature, they’re aversive, they’re unpleasant, and they’re persistent. And these are not just thoughts. They can also take the form of being very unpleasant images or even ideas that cause distress. And what’s key with OCD is that individuals who experience these unpleasant thoughts tend to place a lot of importance on these thoughts. And this is what’s the key differences between people with OCD and those without. So we all tend to have nasty thoughts but people with OCD tend to find it more challenging to dismiss those nasty thoughts or to push them to the side. They place a lot more importance and emphasis on them. And then we have the second component here, which is that of the compulsions.
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So the compulsions are those ritualistic, repetitive behaviours or mental acts that are performed that provide some temporary relief from the very aversive nature of the obsession of that thought or idea that pops into the individual’s mind. Now, the compulsive behaviour initially provides relief from the distress, and that’s why it’s strengthened over time. It serves a purpose in the short term, but that behaviour becomes more ingrained. And as such, what we tend to find is that this makes the condition and the situation worse for the patients. So obsessions and compulsions tend to occur together in all instances, regardless of the subtype of OCD that we’re looking at.
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And what’s key in terms of the diagnostic criteria is that these symptoms, the obsessions and the compulsions must be present and persistent for a period of at least two consecutive weeks. So what are the causes? So we know that there are certain genetic issues and biological models that account for OCD in certain people. And the research is actually growing. We know that that potentially there is a genetic component, but to what degree is yet to be discovered. We know that there are certain circuits in the brain that are influenced by the the condition itself. And these circuits have an impact on our thought processes.
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So, for instance, placing that importance on a negative thought and also the performing of compulsive behaviours. So certain brain circuits are implicated in OCD and that’s why there are certain medications that act on these circuits or neurotransmitters specifically involved in those parts of the brain that alleviate some of the distress experienced by the symptoms. And there are certain evolutionary accounts that are important to consider as well. So when it comes to the evolution of our species and other species on the planet, we see that there are some OCD like behaviours in other animals. So birds may compulsively pick their feathers until they’ve almost picked all of their feathers apart. Horses may lick themselves compulsively until they bleed.
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So there is potentially an evolutionary basis here, which we don’t know too much about. But there are also environmental causes that are key to consider when it comes to OCD. And these are any kind of adverse experiences again, either adverse early life experiences. Trauma. Trauma can also be a powerful cause when it comes to OCD and many other psychiatric conditions, as well as learned behaviour. So the behaviour that we learn from our loved ones, those older individuals we model our behaviour on when it comes to any adversity that we may face, how do we respond to that adversity? So again, it’s probably a mixture here of biological and environmental, genes and environments, that influence our predisposition to OCD.
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What’s also important to consider is that children may present with OCD like behaviours following a certain viral infection. So this is referred to as PANDAS, paediatric autoimmune neurological disease, associated with streptococcus, which is a specific kind of infection that we’re looking at. And what we tend to find in these children is that following exposure to the pathogen they may develop certain OCD like behaviours, which is interesting, not necessarily OCD in itself. But that’s not to say that we don’t see early onset of OCD separate to PANDAS. So that is something that we may see as well.
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So overall, what we do tend to find is that, again, as with the other psychiatric conditions that we’re touching on, OCD tends to be multifactorial in nature, it’s biology and environments that can predispose one to the condition. Now, in terms of diagnosis, if you suspect that a loved one is experiencing any of the key signs and symptoms that we’ve touched on, make an appointment with their GP. So usually the patient may be hesitant, but it’s important to have a chat with the GP about your concerns and if you suspect OCD, the GP will then be able to take it from there and ask any specific questions.
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They may even be able to refer the patient for talking therapies such as cognitive behaviour therapy and in cases where they suspect that they’re looking at maybe more of a moderate to severe picture of OCD, they can refer to a psychiatrist. And the psychiatrist will once again perform a an initial assessment, further assessments to ascertain what it is exactly that they’re looking at here and how it’s impacting on the individual’s well-being. And they’ll also do a risk assessment. So again, assessing the risk if a patient is experiencing any thoughts of harming themself or others. And that’s part of the process, again, in relation to keeping the patient safe.
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What’s also important to consider is the degree of severity here because that influences treatment. So where we’re looking at mild to moderate cases of OCD, usually talking therapy. So cognitive behavioural therapy and a specific type of cognitive behavioural therapy referred to as exposure response prevention tends to be quite effective. So ERP involves exposing the patients to those very feared thoughts or those images, but doing so in a kind of hierarchical way. So if you think of a ladder, they’ll start off on the first rung of the ladder, which is perhaps of those most feared, the least feared, and work their way up to the top rung, which is the most feared of those images or thoughts or ideas.
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And what’s key in that exposure is also to prevent response or that compulsive behaviour that is associated with having that nasty thought. So ERP can be quite challenging at first for the patient, but it has proven to be quite effective. Now where we’re looking at more moderate to severe presentations of OCD. We tend to find that combination therapy, once again, the use of certain medications such as SSRI, which are those antidepressants involved in serotonin, alongside talking therapy, for instance, CBT and ERP tend to be very effective.
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So whilst there is no cure for OCD, we do tend to find that two thirds of patients will show a decrease in the severity of the symptoms and the distress that their symptoms present. And once again, as with all of these conditions, social interactions, exercise, physical as well as cognitive exercise, all very important in terms of keeping the the condition at bay. Now, when it comes to further supporting information, once again, your GP is the best person to consult in the first instance.
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But if you want to do a bit of more reading around the subject and consider OCD and the different types of OCD, OCD UK is a great charity who provide not only this information that you may be interested in, but they also provide support and advice. Obviously a UK based charity. As are OCD Action UK, so the second largest charity in the UK for OCD. And again, they have a direct support line if you’d like to talk to someone directly. But for more information from the NHS, the NHS have a website or a page rather, dedicated specifically to OCD that provides more information as well as the support services that are available through our National Health Service.

This video is presented by Dr Athanasios Hassoulas. Dr Hassoulas describes the symptoms and causes of OCD.

He then goes on to explain how this mental health problem is diagnosed and treated. At the end of the video, Dr Hassoulas recommends resources for further information and support. The approach to identifying and treating depression in this video is based on mainstream (Western, or secular) understandings of mental health.

You will find a link to the slides used in Dr Hassoulas’ presentation below, you can download and keep these for reference.

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