OCD is an obsessive compulsive disorder. Not so rare because it concerns 3% of the population. How do you know if you have OCD? Is it a mental illness? What are the causes and how can they be treated?
TOC is theacronym for obsessive compulsive disorderwhich are behaviors or repetitive obsessionscompulsive and irrational. 2 to 3% of the population would be concerned in France, reports theINSERM. This makes it the 4th most common psychiatric illness after phobias, addictions and depressive disorders. What are the examples of OCD? Is it a mental illness ? How do you know if you have OCD? What signs? What test to diagnose it? How to treat it? Seeing a psychiatrist? A psychologist ? With medication?
Definition: What is Obsessive Compulsive Disorder (OCD)?
Obsessive compulsive disorder – or OCD – is characterized by repetitive behaviors and obsessive thoughts. “It is the association of mental ruminations which we cannot get rid of – and which often seem absurd to the person who suffers from them – and repetitive and irrational behaviors“, explains Dr. Dominique Servant. Concretely, the person who suffers from OCD is invaded by obsessions or recurring thoughts which are often centered on order, cleanliness, alignment, symmetry, or rituals of tidying up or checking (checking that the door is closed, check that each object is in its place…).
What causes OCD?
Like many mental disorders, OCD results from the interaction of several biological, environmental and social factors. Recent advances in brain imaging and the development of animal models have provided insight into the mechanisms underlying OCD. It has been shown that different brain circuits are disrupted in this disease, can we read on the Inserm website. Two biological avenues are now put forward by specialists:
► Dysfunction of neurotransmitter systems. “It has been shown that patients suffering from OCD have areas of the brain deficient in neurotransmitters, in particular serotonin“, specifies Dr. Chapelle.
► One functional disturbance of the brain at the level basal gangliainvolved in behavior and habits, or even in the anterior cingulate cortex and the orbito-frontal cortexwhich have a role in emotions and reasoning.
Is OCD a mental illness?
Yes, OCD is a mental illness or mental disorder. it’s about the 4th psychiatric disease in Franceafter phobias, addictions and depressive disorders, reports INSERM.
What are the symptoms of OCD?
The patient who suffers from OCD is aware of the silly or inappropriate character of his obsessive thoughts.
OCD differs from anxiety disorder in that obsessive thoughts and rituals are neither consistent, nor useful for the person. “In general, the patient who suffers from OCD is aware of the silly or inappropriate character of his obsessive thoughts. Which is all the more a source of anguish and uneasinessexplains Dr. Dominique Servant. Compulsions trigger to relieve this obsession-related anxiety. For example: the idea that we did not close the door will be relieved by the fact of checking that we had indeed closed it well“. Obsessions often revolve around the fear of contamination; the need for symmetry and accuracy or even repeated doubts and manifest themselves in verification compulsions (check several times that the light is off, that the door is closed); washing or counting rituals. We speak of TOC, when these disorders last at least an hour a day and have a significant negative impact on the patient’s social life.
Examples of TOC: the list to better understand
It is commonly accepted to classify OCD according to obsession:
► The phobic obsessions : the most frequent obsession is the fear of being soiled or infected by germs. The corresponding ritual is excessive cleaning and washing.
► Obsessions with error : it is the permanent and obsessive fear of having forgotten to do something and/or of having done it badly. The compulsion is expressed by systematic and excessive checking (closing the door, the window, the gas, etc.).
► obsessions of impulsivity : the people affected are afraid of committing a malicious or even criminal act in an unintentional way. “The person tells himself, for example, that if he thinks of a misfortune, it will happen. To “ward off” the spell, a ritual of thoughts or magic phrases can soothe this anxiety.“, explains Frédéric Chapelle, psychiatrist and president of the French Association for Behavioral and Cognitive Therapy.
► Collecting obsessions : here, the person will try to pile up and accumulate objects without particular value but above all, without the pleasure specific to the collector.
What are the profiles at risk of having OCD?
“There is often a vulnerabilitysays the psychiatrist. People who have anxiety traits like hyperemotivity, perfectionism, worrying, hypercontrol, or introversion may be more prone to developing OCD“. Women are as affected as men, but early disorders seem to be more common in boys than in girls. Symptoms most often appear in childhood or early adulthood: about a quarter of cases OCD are revealed before the age of 14, 65% before the age of 25 and only 15% after the age of 35.
When to worry about OCD?
You have to be concerned when the disorders begin to affect the person’s life severely. “When the disorders become bothersome in school or work, it may be worth going further and seeing a doctor”confirms Dr. Dominique Servant.
Who to consult in case of OCD? A psychiatrist ? A psychologist ?
As a first step, it is useful to talk about it with a general practitioner (your general practitioner for example) who will then refer the patient to a psychiatrist or psychologist. In some very rare cases, small brain tumors can be masked by OCD, so it is essential to see if there are no other associated symptoms.
Which test to diagnose OCD?
The diagnosis of OCD consists of a clinical examination carried out by a psychologist, a general practitioner or a psychiatrist. This examination is based on well-defined international criteria, depending on the Yale-Brown obsession-compulsion scale (Y‑BOCS) or the Children’s Yale Brown Obsessive Compulsive Scale (CY-BOCS) for children. These scales take into account the daily duration of the obsessions and compulsions, the embarrassment and anxiety associated with these symptoms, the patient’s willingness and ability to resist the obsessions and compulsions. An evaluation of the symptoms of depression and anxiety is often proposed in addition, as well as a global psychiatric evaluation which makes it possible to detect other possibly associated psychiatric disorders.
OCD is chronic and usually does not heal on its own. The two first-line treatments are generally:
- the cognitive behavioral therapy (CBT). “The cognitive behavioral therapies who teach patients to reduce rituals by exposing themselves and to distance themselves from obsessions are very effective to treat OCD“, concludes Dr. Servant.
- and or the use of serotonin reuptake inhibitors (SRIs) such as escitalopram, fluoxetine, sertraline… in the most intense forms
What are the drugs to fight OCD?
“The earlier the treatment, the greater the chances of a favorable response to treatment., says the psychiatrist. Generally, antidepressants are the main drugs used and they would be effective in most cases. This does not mean that the OCD is “cured” but at least that the symptoms have decreased in intensity. Two types of antidepressants are used: certain serotonin uptake inhibitors (the deficiency in serotonergic concentration in nerve transmission would be one of the causes of OCD) and an imipramine antidepressant. “The dosage of drugs can be particularly high but it is for the benefit of the patient above all, specifies Frédéric Chapelle. Nor should the patient expect to recover in 15 days, as is the case with antibiotics. There, the treatment must be followed scrupulously for at least 2 months. In general, the benefit/risk ratio is established to find out which treatment is best suited to the patient.“
Are TOCs part of the DSM-5?
Yes the DSM-5 (DSM 5; APA et al., 2015) defines the criteria for obsessive-compulsive disorder.
What is the difference between a TOC and a TIC?
An ICT is repetitive and uncontrollable movement of the body resulting from the contraction of one or more muscle groups. For example, eye blinking, rolling of the shoulders, jerking of the body. Unlike OCD, tics are not associated with an obsessive idea or compulsions.
Thanks to Dr Dominique Servant, psychiatrist, head of the Stress and Anxiety Unit at Lille University Hospital and author of Freeing yourself from anxiety and phobias in 100 questions and Frédéric Chapelle, psychiatrist and president of the French Association of behavioral and cognitive therapy