According to the National Institute of Mental Health, the 12-month prevalence rate for obsessive-compulsive disorder (OCD) in the United States stands at 1%(National Institute of Mental Health, n.d). While this figure seems small, it means that millions of Americans suffer from this condition. The sufferers of the condition are unable to use their environment to make wise decisions (Makin, 2017). An unhealthy and extreme urge to engage in certain activities is the main symptom that characterizes this disorder. The National Institute of Mental Health estimates that as many as 56% of cases of OCD may be regarded as severe (National Institute of Mental Health, n.d). The prevalence rate and the severity of OCD underscore the importance of robust treatment and further research to better understand this condition.
Pathological features
There is some debate in the scientific community regarding whether OCD is a pathological condition. Some scholars such as Jesse Cougle and Han-Joo Lee are of the view that the pathological features that have historically been associated with OCD are simply normative (Cougle & Lee, 2014). However, some insist that these features are indeed pathological. An examination of the brains of OCD sufferers reveals some abnormalities. It is understood that lesions form in the dorsolateral prefrontal cortex (DLPC) of OCD patients. One of the key functions that the DLPC performs is allowing individuals to respond to changes in the environment (Gaikwad, 2014). The DLPC also facilitates the functioning of the working memory. The lesions that form on the DLPC could be to blame for the compulsions that OCD sufferers experience. In addition to the DLPC, scientists believe that the basal ganglia, striatum, amygdala, brainstem, thalamus and anterior cingulate cortex (ACC) also suffer impairment thereby resulting in the development of OCD. In addition to the parts of the brain listed, OCD is also understood to impair neural function. It has been observed that patients with OCD have impaired neural inhibition and this has been blamed for the obsessive symptoms that they display (Gaikwad, 2014). Given that OCD affects the performance of body organs, it can be regarded as a pathological condition.
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Clinical diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (DSM) identifies the symptoms that an individual must display to be diagnosed with OCD. Experiencing obsessions and compulsions that are recurrent and persistent is among these symptoms (APA, 2013). The obsessions and compulsions include thoughts, urges and such behaviors as hand-washing, checking, praying, counting and ordering among others The DSM also stipulates that the obsessions and compulsions must be time consuming and that there should be no other condition or substance to which these compulsions and obsessions may be attributed (APA, 2013). Most OCD sufferers report these symptoms. However, there are some symptoms that only a portion of the sufferers experience. These include anxiety and panic attacks.
Biopsychological theories
A number of theories have been developed in an effort to understand the development of OCD. Functional neuroanatomy is among the biological models that help to explain the pathology of OCD. According to this theory, neurons that connect such parts of the brain as the orbital frontal cortex and the cingulate gyrus suffer impairment (“Understanding Obsessive-Compulsive”, n.d). The impairment hinders proper emotional response and has been blamed for the development of anxiety. This impairment is also responsible for the compulsive and obsessive symptoms that the patients display. Another biological theory holds that serotonergic neurotransmission develops abnormalities (“Understanding Obsessive-Compulsive”, n.d). Thanks to these abnormalities, the reuptake of serotonin and norepinephrine is impaired. Norepinephrine and serotonin help to inhibit the symptoms of OCD. Another biological theory has linked the pathology of OCD to genetics. It is believed that individuals may inherit OCD (“Understanding Obsessive-Compulsive”, n.d). A number of psychological theories have also been developed. These theories explore the role that the mind plays in the pathology of OCD. Behavioral theory is among these. Essentially, the theory posits that the compulsions and obsessions that patients display are responses that they adopt in an effort to combat fear (Fava et al., 2014).
Nervous system structures, neurotransmitters, receptors and pathways implicated
The investigations that the scientific community have allowed for parts that OCD affect to be identified. Some of the receptors that have been implicated include the presynaptic receptors and the postsynaptic receptors (Fava et al., 2014). Serotonin 2A receptors have also been implicated (Simpson et al., 2011). The brain has numerous neurotransmitters. However, scientists have only been able to link the serotonin neurotransmitters to OCD (John, 2017). Links have also been established between dopamine pathways and OCD. Three particular pathways have been implicated. They are basal ganglia, caudate nucleus-putamen and substantia nigra (John, 2017). OCD has also been shown to affect the nervous system. It impairs the functioning of neurotransmitters and receptors which are needed for the relaying of information.
Possible causes
Various factors have been linked to the development of OCD. It is understood that when an imbalance in the neurotransmitters occurs, OCD sets in. Genetics have also been linked to OCD. Scientists have observed that some patients inherit the condition from their parents and that they may pass it on to their children (Nichols, 2017). Twin studies have allowed the scientific community to establish the link between genetics and OCD. Autoimmune factors have also received blame for causing OCD. The scientific community believes that streptococcal infections in Group A which are responsible for causing dysfunction in the basal ganglia set the stage for OCD (Nichols, 2017). Behavioral factors have also been identified as among the possible causes of OCD. Patients with the condition link certain situations or items with fear. They then adopt compulsive and obsessive behaviors in a bid to deal with the fear (Nichols, 2017). Cognitive, neurological and environmental forces are other possible causes of OCD. The cognitive theory of OCD posits that patients with OCD interpret their thoughts incorrectly and this firmly establishes the condition (Nichols, 2017). The neurological theories suggest that impairment of various parts of the brain is responsible for the development of OCD. Brain injuries that individuals suffer are among the environmental factors that have been linked to the condition (Nichols, 2017). As is clear from the discussion this far, a number of etiological theories help to shed light on the causes of OCD. These theories range from psychological, biological and neurological explanations. The biological and neurological theories concern the impairment of various brain parts and functions. These theories hold that these impairments hinder proper brain function and this results in the development of OCD. On the other hand, the psychological theories examine the minds and behaviors of those with OCD.
No discussion of the possible causes of OCD would be complete without a look at the risk factors. Genetics is among the risk factors. Individuals whose first-relatives have the condition face a higher risk of developing the condition (“Obsessive Compulsive Disorder”, 2016). The structure and functioning of the brain is yet another risk factor. Thanks to imaging studies, it is understood that abnormalities in the brain is a risk factor for OCD. The environment is yet another risk factor. Physical or sexual abuse is understood to expose individuals to a greater risk of developing OCD (“Obsessive Compulsive Disorder”, 2016). A history of streptococcal infection is another environmental risk factor.
Epidemiology
To understand OCD fully, one needs to examine the demographic profile of US adults with this condition. The lifetime prevalence rate for the condition is 2.3% while the 12-month rate stands at 1.2% (Ruscio et al., 2010). It has also been noted that those with OCD usually have other mental disorders such as post-traumatic stress disorder (PTSD). Scholars have also observed that OCD is more prevalent among females (Ruscio et al., 2010). Age also appears to define how this condition develops. More cases of the condition are reported among younger individuals. The disease also appears to be more prevalent among females who are not married.
Clinical presentation and natural history
There are a number of physical symptoms that OCD patients exhibit. Obsessions and compulsions are the main clinical symptoms (Penzel, 2017). These include persistent thoughts, urges and behaviors that result in anxiety and erode the quality of the life of the patient. Scholars have attempted to understand the natural history of OCD. Their efforts have allowed for the course of this condition to be understood. Goodwin et al. are among the scholars whose work is regarded as an authority on the natural history of OCD. According to Goodwin and his team, OCD develops in three phases. In the first phase, the condition is “unrelenting and chronic” (Rasmussen & Eisen, n.d). The second phase involves complete remission. In the third phase, the condition becomes “episodic with incomplete remission that permits normal social functioning” (Rasmussen & Eisen, n.d).
Potential complications
Left untreated, OCD may result in a number of complications. Other mental health conditions are some of the complications that may result. These disorders include social phobias and anxiety (Pietrangelo, 2015). To ensure that these disorders do not set in, individuals suffering from OCD should seek treatment urgently.
Current treatment options
Pharmacologic and non-pharmacologic approaches for treating OCD have been developed. Cognitive-behavior therapy is the main non-pharmacological treatment option that is used. Two types of this treatment are available: cognitive therapy and exposure response prevention (ERP). When ERP is used, the patient is exposed to the fears that are responsible for the compulsive and obsessive behaviors (“Treatments for OCD”, n.d). The rationale for this treatment is that patients resort to obsessive and compulsive behaviors as a coping mechanism for handling fear. On the other hand, cognitive therapy aims to allow the patient to understand that the functioning of the brain has been impaired (“Treatments for OCD”, n.d). This treatment is based on the understanding that OCD impairs cognitive function. Patients may also be provided with medication. Serotonin reuptake inhibitors are among the drugs that the patients are given (Jenike, n.d). This medication works on the principle that OCD interferes with serotonin reuptake.
Future directions for research and clinical management
The scientific and medical communities have made remarkable progress in enlightening the world regarding OCD. However, there is need for these communities to dedicate even more effort. Some of the issues that they need to focus on as part of research in the future include effective treatment techniques and effects of comorbid factors (Lack, 2012). There is also need for more research on the exact causes of OCD because there is no clear understanding of how this condition develops. More effort is also needed in the management of the clinical symptoms of OCD. Scholars and medical practitioners should work together to develop approaches for addressing the symptoms that patients present with.
In conclusion, OCD is one of the most prevalent mental conditions. This condition affects millions and poses a serious challenge to mental health practitioners. Obsessions and compulsions are the key symptoms that patients present with. This condition has bene linked to genetics, environmental factors and abnormalities in the brain. A number of treatment approaches have been developed to restore the quality of life of patients. Despite the progress that has been made, more effort is needed to enhance the fight against OCD.
References
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