Obsessive-compulsive and related disorders (OCRDs)

Hearing disorder, obsessive-compulsive disorder (OCD), trichotillomania (hair-pulling disorder), body dysmorphic disorder, and exoriation (skin-picking) disorder are obsessive-compulsive and associated disorders (OCRDs). Past research suggests that between OCD and the remaining conditions there is a substantial similarity. As such, these diseases are classified into one group. The categories of OCRDs have common symptoms, similar course and development, age of onset, family history, co-occurrence, and treatment responses and coping strategies related to them. The classification of the disorders together assists in the improvement of treatment outcomes in the health care organizations. Further, clinicians get a chance to identify specific disorders that could be overlooked easily. The OCRDs have several treatment options, which can be individualized to achieve the desired success. The combination of the different treatments depends on several factors that include preferences and characteristics of a person, as well as the living environment and social support system. Introduction
The Obsessive-compulsive disorder is made of two parts, which are different, compulsions and obsessions. The compulsions refer to the things, which a person engages in doing as a way of lessening the anxiety feelings (Seedat & Stein, 2002). For example, when a person develops the obsession of being sick, such an individual could engage in excessive washing of the hands. These compulsions consume a lot of time and they have a significant impact on the way of life of a person. The obsessions relate to the unwanted ideas, thoughts, or urges, which are distressing (Thomsen, 2013). These appear as strange and they could not be prevalent as things that an individual is thinking of doing. Further, it is impossible to control obsessions and they result into different anxiety levels.
The related disorders to the obsessive-compulsive include body dysmorphic, hoarding, trichotillomania, excoriation, and substance obsessive-compulsive. The body dysmorphic disorder results into one or more flaws or defects in the appearance of a person, as well as regular aim on fixing the problem (Stanley, Björgvinsson & Frueh, 2010). A young person could constantly engage in the comparison of their appearance to others and engage in spending a lot of time grooming or looking in the mirror. Some may file to identify the defect and developing thoughts that it is a minor flaw.
The hoarding disorder relates to the serious problems where a person parts with or gets rid of possessions related to actual value. An individual becomes upset with the idealization of discarding the possessions (Seedat & Stein, 2002). Trichotillomania, which is also regarded as the hair-pulling disorder refers to the pull out of hair, which result in the loss of hair in spite of trials or attempts to stop or decrease the condition. The excoriation disorder refers to the skin picking that lead to skin lesions despite the regular trials to stop or decrease the condition.
There three categories of the causes of the OCRDs: biological, socio-cultural, and psychological. The biological causes comprise of several factors, which include the neural abnormalities and genetic vulnerabilities (Stanley, Björgvinsson & Frueh, 2010). The socio-cultural cause relate to things associated with behavioral standards, cultural norms, and observation of others. The psychological vulnerabilities emerge from past life experiences that include trauma and dysfunctional beliefs, which develop over time.
The OCD that develops in childhood is common in boys as compared to girls. However, the onset at later times is higher in females than males. The triggering of the disease is associated with environmental, cognitive, behavioral, neurological, and genetic factors. OCD runs in families. As such, the condition could be regarded as a familial disorder (Seedat & Stein, 2002). There is a possibility of the disease to span from one generation to another where there are close relatives. Furthermore, the symptoms of the obsessive-compulsive disorder are moderately heritable. Nevertheless, there is no single gene, which has been labeled as the main cause of OCD.
Group A streptococcal infections that result in dysfunction and inflammation of the basal ganglia lead to the development of obsessive-compulsive disorder among the children (Stanley, Björgvinsson & Frueh, 2010). Other bacteria, which lead to the development of the flu virus and Lyme disease, also trigger the onset of OCD among children.
There are also behavioral causes of OCD. The theory of behavior indicates that individuals with OCD tend to associate specific situations or objects with fear. Thus, these people avoid things or engage in performing rituals as a way to reducing fear. The avoidance and fear or ritual cycle starts during the time of intense stress (Wang, Woo & Bahk, 2014). The situation is common when a relationship comes to its end or when a new job is being started. Once there is a connection between the fear feeling and object, OCD individuals begin to avoid the generated fear or object intends of engaging in confrontation or toleration of the same in society.
Neurological causes include the imbalances of glutamate or serotonin that results in having different brain development resulting in OCD among individuals (Stanley, Björgvinsson & Frueh, 2010). There are also environment stressors, which can lead to the development of OCD among individuals. Traumatic brain injury, life, and stressful events trigger the onset of OCD among people.
Obsessive-compulsive disorder is distinguished from other conditions because of the presence of compulsions or obsessions, or both. The compulsions or obsessions cause marked distress, interfere with normal functionality of a person, and are time-consuming. OCD indications can be present in teenagers and children where the disorder begins slowly and eventually worsens with age (Seedat & Stein, 2002). The OCD symptoms tend to be severe or mild. There are individuals who experience only obsessive thoughts and there is no compulsive disorder. Hence, individuals suffering from the OCRDs tend to hide the symptoms because they fear stigma or embarrassment. Family and friends need to notice some of these physical signs.
The obsessions include repetitive images, thoughts, or urges, which an individual finds it complex to control. Such a person has the awareness of the intrusive feelings and thoughts, but is not ready to generate the ideas (Wang, Woo & Bahk, 2014). The thoughts are considered as unwanted, lack sense, and disturbing. There are also the uncomfortable feelings of doubt, disgust, fear, and an individual spends most of the time on the obsessions that interfere with professional, social, and personal activities.
These obsessions include harm, which is the fear being responsible for things that are terribly happening, contamination that include dirt, germs, and body fluids, and religious obsessions that involve the concerns of offending god (Murphy & Flessner, 2015). There are also obsessions for the loss of control, concerns related to perfectionism on the needed number of things and exactness, and unwanted sexual thoughts that include incest and homosexuality.
The compulsions include excessive cleaning and hand washing, checking of the different body parts to establish what could have happened (Seedat & Stein, 2002). There is also repetition of routine activities, which involve getting from the chair, and mental compulsions that involve mentality review of different events. However, these behavioral actions depend on the context of the environment that surrounds an individual.
Diagnosis and tests
The diagnostic criteria for the OCRDs focus on the establishment of the presence of compulsions, obsessions, or both. There is also an examination of the functionality of other areas that include occupational, distress, and social (Stanley, Björgvinsson & Frueh, 2010). The symptoms of the disorder are not linked to the physiological substance effects that include medication or drug abuse or another condition. Further, there is no other better explanation of the disturbance using the mental disorder of a person.
An essential prevention strategy is the focus on relapse prevention. The aim is to engage in cognitive restructuring, goal setting, anxiety management techniques, enhancement of social support, and having self-directed exposure (Murphy & Flessner, 2015). These include ensuring that individuals are not exposed in environments, which result into the development of stimuli that provokes a response.
OCRDs are treated using antidepressants and anxiolytics. These different medication categories have specific impact and effect on the neurotransmitters. The neurotransmitters act as the main chemical messages, which are present in the brain (Wang, Woo & Bahk, 2014). Hence, they are considered to play a significant role in the psychiatric disorders. The antidepressant drugs affect the norepinephrine and serotonin neurotransmitters. In OCRDs, the serotonin acts as the main targeted neurotransmitter.
Selective serotonin reuptake inhibitors (SSRIs) are one of the anti-depressant medication groups, which are used in the treatment of OCRDs. These assist in relieving the ritualistic behaviors and obsessive thoughts through the re-uptake and blocking of serotonin present in the receptor cells of the brain (Thomsen, 2013). The other group is the serotonin norepinephrine reuptake inhibitors (SNRIs), which engage in the blocking of the re-uptake of both norepinephrine and serotonin. The action of blocking results in the increase of the norepinephrine and serotonin levels in the brain. There are other possible medications, which include tricyclics, anxiolytic, and antipsycotics. All these groups of medication help in treating the OCRDs.
Treatment plans: short- and long-term goals
If OCRDs are not treated, they develop into chronic conditions characterized of specific episodes where there is a chance for improvement of the symptoms (Murphy & Flessner, 2015). There are low remission rates, which is approximately 20 percent when treatment is not provided to the patient. Nevertheless, the treatment depends on the possibility of the conditions to affect the ability of a person to function. The first-line treatments include cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRI), and combination of CBT and SSRI.
CBT is an effective treatment method, which focuses on assisting patients to change the way they feel, think, and behave. There is inclusion of cognitive therapy and exposure and response prevention (ERP). ERP helps majority of patients to recover effectively. The exposure entails subjecting individuals to objects and situations that trigger anxiety and fear (Wang, Woo & Bahk, 2014). As time passes, the generated anxiety for the obsession cues decrease. The situation is called habituation. The response prevention relates to the ritual behaviors adopted by the OCD patients, which help in the reduction of anxiety. Hence, the treatment focuses on assisting patients on how to learn to resist different compulsions as they are engaged in the performance of the rituals.
Cognitive therapy entails engaging in the identification and re-evaluation of the beliefs of not engaging or engaging in the compulsive behavior (Murphy & Flessner, 2015). Once the individual acknowledges these meanings and thoughts, the therapist motivates the person to participate in evidence examination by looking at what or what does not support the entire obsession, the identification of the cognitive distortions, and the development of alternative response and less threatening intrusive idea, image, or thought.
There are several SSRIs, which could be prescribed to help in managing the OCRDs that include sertraline, clomipramine, escitalopram, fluoxetine, and paroxetine hydrochloride among others (Thomsen, 2013). These SSRIs are used in large doses for OCD as compared to depression. Further, the SSRIs last for at least three months.
Tips to avoid the disaster
The first strategy to overcome OCRDs is to learn how to resist the different rituals of OCD. As such, the patient should formulate strategies for eliminating the rituals and compulsive behaviors, which contribute in the development of the obsessions (Wang, Woo & Bahk, 2014). The person should not avoid fears, but get to much exposed OCD triggers to overcome the problem. The individual should also refocus the attention to other things like listening to music, jogging, exercising, walking, making phone calls or playing video games among others. An individual should also anticipate the OCD urges and engage in them before they develop to have an extra attention.
Further, one should challenge obsessive thoughts. This includes writing down the worries or obsessive thoughts. Continuous writing of the repetitive obsession leads to significant loss of its power. On the same note, an OCD worry period has to be established where there is rescheduling of the compulsions or obsessions (Murphy & Flessner, 2015). Moreover, the patient has to take care of herself or himself. The care includes regular exercises, practice relaxation, having enough sleep, and avoiding nicotine and alcohol. In addition, it is vital for a person to reach out for support. Such involves joining the OCD support group and staying connected with friends and family members.
In conclusion, the obsessive-compulsive disorder (OCD) refers to the mental health condition, which is characterized by intrusive, distressing, repetitive, obsessive thoughts, and compulsive mental or physical acts. As such, the disorder results into several functional impairments and has an impact on occupational and social life.
The heterogeneous disorder may be very challenging to treat. Modification of problematic responses and exposure to the stimuli that is feared is the core strategies for the OCD treatment. However, there is an indication of the use of ritual prevention strategies and exposure processes that include inhibitory learning, which helps in the treatment of the disorder. Hence, the providers of the treatment for the disorder have to ensure that they remain current in relation to the emerging research, which focuses on the guide decisions and exposure therapy for the augmentation treatment.Reference
Murphy, Y. E., & Flessner, C. A. (2015). Family functioning in pediatric obsessive compulsive
and related disorders. British Journal Of Clinical Psychology, 54(4), 414-434. doi:10.1111/bjc.12088
Seedat, S., & Stein, D. J. (2002). Hoarding in obsessive_x0096_compulsive disorder and related disorders: A preliminary report of 15 cases. Psychiatry & Clinical Neurosciences, 56(1), 17-23. doi:10.1046/j.1440-1819.2002.00926.x
Stanley, M., Björgvinsson, T., & Frueh, B. C. (2010). Special issue: Update on the nature and treatment of obsessive-compulsive-related disorders. Bulletin Of The Menninger Clinic, 74(2), 93.
Thomsen, P. (2013). Obsessive-compulsive disorders. European Child & Adolescent Psychiatry, 2223-28. doi: 10.1007/s00787-012-0357-7
Wang, H. R., Woo, Y. S., & Bahk, W. (2014). Potential role of anticonvulsants in the treatment of obsessive-compulsive and related disorders. Psychiatry & Clinical Neurosciences, 68(10), 723-732. doi:10.1111/pcn.12186

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