Obsessive Compulsive Disorder

ObsessiveCompulsive Disorder


ObsessiveCompulsive Disorder

Fearis considered as part and parcel of life, but it may result in thedevelopment of anxiety when it becomes excess. Fear can be attributedto different factors, including the lack of finances, careerchallenges, and trauma (Bellantuono, Bissi, Cesario, &amp Nussso,2014). Excess fear subjects people to the risk of suffering fromanxiety disorders. In this paper, obsessive compulsive disorder willbe discussed. The paper will focus on different aspects of thedisorder, including the symptom picture, prevalence rates andcultural variables, age of onset, etiology, current treatment,course, prognosis, and differential diagnosis.


Peoplecannot be considered to be suffering from OCD just because they feelobsessed to engage in certain compulsive behaviors. It should bedemonstrated that the thoughts as well as behaviors have the capacityto cause tremendous distress that interferes with the daily life,consume a lot of time, and affect the relationships of an individualadversely (Sacco, 2013). The most common types of symptoms that areused to diagnose OCD are classified into obsessive thoughts andcompulsive behaviors.

Someof the key obsessive thoughts that are associated with OCD includethe fear that one will be contaminated by dirt, intrusive as well asviolent ideas in one’s mind, and being afraid that the affectedpeople might lose things that they love (Bellantuono etal.,2014). In addition, it is quite common to see people with OCDbehaving in superstitious ways, observing order and asymmetry,focusing on morals excessively, and being afraid of losing controlover their own lives.

Someof the common compulsive behaviors that are seen in adolescentssuffering from OCD include the excess desire to double check(including appliances and locks), repeatedly confirming on lovedones, with the objective of ensuring that they are safe, and spendingtoo much time cleaning and washing (Bellantuono etal.,2014). Other compulsive behaviors may include the engagement inrituals that are attributed to fears associated with religion anddoing some senseless things (such as counting) in order to minimizeanxiety. The desire to collect and hoard items that have no value isalso common among people with OCD than the general population.


Differentscholars have provided dissimilar prevalence rates for OCD, but theirestimates are within an agreeable range. According to Uguz &ampAyhan (2011) the global prevalence of OCD ranges from 0.8 % to 3.2 %. However, there are some populations that are affecteddisproportionately due to their life experiences and healthconditions. For example, a study conducted by Uguz &amp Ayhan (2011)indicated that the population of people suffering from schizophreniahas a higher prevalence rate of about 16 %. The same study indicatedthat adolescents suffering from chronic schizophrenia have aprevalence rate of about 13 %. In addition, of expectant women are ata higher risk of developing OCD compared to the general population.

Accordingthe findings of a study conducted by Uguz &amp Ayhan (2011)expectant mothers had a prevalence of 1.6 %, while other women had arate of 0.6-1.2 %. In the U.S., about 2.3 % of the citizens sufferfrom OCD, which is approximately 0.3-1 % of the total pediatricpopulation (Uguz &amp Ayhan, 2011). Gender is a key factor thatcannot be ignored when discussing the issue of OCD prevalence.According to McLean, Asnaani, Litz &amp Hofmann (2011) theprevalence rate tend to be higher in female subjects (3.1 %) comparedto their male counterparts with 2.0 %. The data show that being borna woman increases the risk of contracting OCD at one point in one’slife. Therefore, the prevalence of OCD varies with life experiences,age, gender, and health condition.


TheOCD is found in all countries in the world, but there are somenations (such as Japan, the US. and Oceania) where it is moreprevalent. The issue of whether culture can influence the prevalenceas well as the way OCD manifests in different countries has beencontroversial. However, research has shown that the occurrence of OCDis influenced by similarities or differences in neurobiology and notthe culture (Pallanti, Grassi, Cantisani &amp Pelllegrini, 2011).Consequently, OCD patients in different countries (such as Japan andthe U.S.) show similar signs, irrespective of the culturaldifferences. In addition, studies have shown that the minoritygroups (including the AfricanAmerican, Native American, Hispanic, and Asian American)have a prevalence rate of OCD that is similar to the generalpopulation. For example, Williams, Domanico, Leblanc &amp Turkheimer(2012) compared the OCD prevalence between the White and BlackAmericans and found that it was about 1.6 % to 1.6 %. However, theWhites are more likely to seek for medical care than the minoritygroups.

Ageof Onset and Gender Features

Theage of the onset of OCD symptoms differs from one person to another.On average, it is estimated that all cases of OCD are discoveredbefore the age of 25 years, but most of the patients start showinginitial signs during childhood and adolescence (McLean etal.,2011). In most cases, the onset of the key symptoms of OCD occurs intwo phases. The First phase takes place at the age of between 8-12years (Williams etal.,2012). This phase coincides with a period during which pressure fromacademic work and the desire to perform in all activities increases.The period is also characterized by the onset of biological as wellas physiological changes. The second phase begins during adolescence.During this time adolescents go through a serious developmentaltransition that subjects them to the risk of suffering frompsychological disorders. The onset of the symptoms is also affectedby gender differences. Studies have shown that the initial symptomsappear at an average age of 9.6 years in boys and 12 years in girls,in spite of the fact that women have a higher prevalence rate thanmen (McLean etal.,2011).

Althoughthe explanation for genetic differences in the onset as well as theprevalence of OCD is not clear, studies have shown that these trendscan be attributed to a combination of psychosocial and geneticfactors. For example, boys and girls have different hormonal andsex-linked genetic characteristics (Mathis, Funaro, Alvarenga,Torres, Moraes &amp Hounie, 2011). These factors may be used toexplain why the onset of the symptoms is different.


Thehuman brain has many neurotransmitters that play the role of carryingmessages to various parts of the body. The brain of an individualsuffering from OCD conveys messages in a different way due to theinflux of dopamine and the shortage of serotonin (Bellantuono etal.,2014). The delicate association between changes in the levels of thetwo types of neurotransmitters elevates the level of anxiety thatleads to the occurrence of OCD.

Dopamine,which is a common type of transmitter, plays the role of helping anindividual feel motivated, experience compulsion, and appreciate therewards. Pleasurable experiences result in an elevated level ofdopamine. From this perspective, OCD can be seen as a perpetuation ofseason that is associated with a reward that tries to minimize theanxiety that is generated by obsessive thoughts (Bellantuono etal.,2014). The affected person develops a perception that the anxietygenerated by these thoughts can only be stopped by pleasure that isbrought about by the completion of compulsion. Three dopaminepathways (including the basal ganglia, substantia nigra, and caudatenucleus-putamen) contribute towards the increase in the level of thistransmitter since they are over-stimulated.

Althoughdopamine plays a critical role in the occurrence of OCD, most of thesymptoms that are considered when diagnosing the disorder are broughtabout by a decrease in the level of serotonin. For an instant, theoccurrence of obsessive thoughts is associated with changes in thelevels of serotonin (Williams etal.,2012).

Thesignificant role that a change in the levels of two neurotransmittersplays in the development of OCD suggests that the disorder isbiological in nature. In addition, stress and trauma take part in theprecipitation of the onset of the disorder, but they are notconsidered as its key causes (Bellantuono etal.,2014). They only trigger and speed up its development in persons whoare already predisposed.

TheOCD is a multi-factorial type of disorder, given that its occurrenceis triggered by the environmental and genetic factors. Changes in thelevels of different transmitters that determine the occurrence ofobsession and compulsion can be influenced by genetic defects(Bellantuono etal.,2014). The association between genetic defects and the risk ofsuffering from OCD is confirmed by studies showing that it runs infamilies, which is an indication of the fact that the disorder ishereditary.

Thefact that OCD is linked to genetic predisposition suggests that it isa lifelong condition. However, medication and psychotherapy play acritical role in helping the affected people manage the conditionmore effectively. The onset of the symptoms occurs when children arestruggling to become industrious or inferior as per the Erikson’sdevelopment model (Sacco, 2013). Being obsessed and the adoption ofcompulsive behaviors result in the development of the sense ofinferiority.


Biologicalchanges and pressure from academic work are some of the key factorsthat trigger the onset of OCD symptoms (Williams etal.,2012). Therefore, there it is possible that some symptoms willdisappear by the time the affected persons reach the age of 70 years.In addition, patients who go through treatment will not exhibit thesame symptoms.


OCDcan be treated through medication and psychotherapy. The health careproviders select one type of talk-therapy depending on the severityof the OCD that the client is suffering from. However, most of thetherapists apply the cognitive behavioral therapy (CBT). The CBTapproach facilitates collaboration between the therapist and theclient where they join hands to break the underlying problem intoseparate segments, including the actions, feelings, and thoughts(Johnsen, 2015). The objective of the therapists who use the CBTapproach is to help the clients discover the negative thoughts thathave subjected them to the risk of acquiring obsessive as well ascompulsive behaviors. The therapists focus on assisting the clientsface their fears and permit the obsessive thoughts take place withoutbeing neutralized with compulsive behaviors. They start with anexposure to situations that cause least anxiety to clients beforeintroducing the difficult thoughts. The CBT approach is supported bylearning theory. The theory holds that behavior can be learned andunlearned.

Medicationis recommended when the client is suffering from a severe case of OCDor psychotherapy fails to work. The objective of the medicationprocess is to increase the level of serotonin in the patient’sbrain. Consequently, most therapists prescribe selective serotoninreuptake inhibitors. The drug plays the role of increase theserotonin levels (William etal.,2012). However, there are specific drugs that are manufactured forchildren and adolescents. The medication process is supported by thetheory that most of the symptoms considered when diagnosing OCDresult from deficiency of serotonin in the patient’s brain.

Cognitiverestructuring (CR) is the main strategy that should be applied in thetreatment plan. The aim of applying the CR is to assist clientsidentify and acquire the capacity to dispute thoughts that leads tocompulsive behaviors (Bellantuono etal.,2014). This technique will help clients avoid engaging in compulsivebehaviors as a way of satisfying their obsessive thoughts.


Afailure on the part of a therapist to determine the exact disorderthat the client is suffering from affects the effectiveness of thetreatment in a negative way. Misdiagnosis takes place because most ofthe disorders present some similar symptoms. For example, therapistscan easily confuse between OCD and generalized anxiety disorder(GAD). The two disorders (including GAD and OCD) are similar in threeways. First, the occurrence of both disorders involves unwantedthoughts and fears (Bellantuono etal.,2014). Secondly, both OCD and GAD can trigger physiological symptoms,such as heart racing, pounding, unreality chills, throat shakiness,and flushing. Lastly, patients tend to react to their fears byengaging in compulsive behaviors.

Althoughthe two disorders have numerous similarities, therapists candifferentiate them by analyzing the type of behavior and thoughtsexpressed by the client. In most cases, GAD patients suffer fromfears that can be attributed to real-life issues, such asrelationships, finances, education, and health (Williams etal.,2012). Therefore, GAD can be regarded as an extension of the normalfear, but it becomes clearly excessive. This fear results from biasedthinking or contemplation on potential catastrophes. OCD, on theother hand, involve thoughts that tend to go beyond worries aboutday-to-day concerns. These thoughts are usually unrealistic, but theaffected people are able to give them the magical quality in theirmind.

Inaddition, people suffering from OCD and GAD engage in behaviors thatare opposite of each other. People with OCD tend to engage inbehaviors that are repetitive as a way of satisfying their obsession.People suffering from GAD, on the other hand, engage in avoidancebehavior (Bellantuono etal.,2014). Therefore, a qualified therapist can distinguish between GADand OCD by analyzing the cause of obsessive thoughts and the type ofresultant behaviors.


TheOCD is a common type of anxiety disorder. Its occurrence ischaracterized by two factors, including the development of obsessivethoughts and the tendency to adopt compulsive behaviors. The disorderaffects boys and girls, but it is more prevalent in female subjectsthan in male. In addition, the occurrence, development, and theprevalence of OCD are affected by neurobiological factors, whichimply that the culture of citizens of different countries cannotinfluence the type of symptoms that are exhibited. Its occurrence canbe attributed to an imbalance in neurotransmitters, where the levelof serotonin goes below the optimum level while that of dopamineexceeds the required level. Therefore, an effective medicationprogram should seek to restore the optimum levels of theseneurotransmitters. However, the treatment process starts withpsychotherapy while medication is recommended when the alternativemethod fails.


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Mathis,M., Funaro, G., Alvarenga, P., Torres, A., Moraes, I. &amp Hounie,A. (2011). Gender differences in obsessive compulsive disorder: Aliterature review. RevistaBrasileira,de Psiquiatri,33 (4), 390-399.

McLean,P., Asnaani, A., Litz, T. &amp Hofmann, G. (2011). Genderdifferences in anxiety disorder: Prevalence, course of illness,comorbidity and burden of illness. Journalof Psychiatric Research,45 (8), 1027-1035.

Pallanti,S., Grassi, G., Cantisani, A. &amp Pelllegrini, M. (2011). Obsessivecompulsive disorder comorbidity: Clinical assessment and therapeuticimplications. FrontPsychiatry,2, 70-80.

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Williams,M., Domanico, J., Leblanc, N. &amp Turkheimer, E. (2012). Barriersto treatment among African Americans with obsessive computerdisorder. Journalof Anxiety Disorder,26 (4), 555-563.