Obsessive Compulsive disorder (OCD) is a disorder belonging to the anxiety group of disorders and is characterized by obsessions and compulsions. Obsessions are repeated, recurrent thoughts and ideas that are intrusive and inappropriate. Compulsions are repeated acts that are performed by the patients in response to an obsession or according to rigid laid down rules. The main aim of compulsion is to relive the anxiety caused by the obsession.
Seen commonly between the ages of 20-25 years. The mean age is 19 years for male and 22 years for females.
Males are more commonly affected than males.
It runs in families and 40% of first degree relatives suffer from the disorder.
Seen increasingly as comorbidity with other anxiety disorders.
An association has been found between OCD and motor tics and tic disorders like GILLE de la Tourette’s syndrome.
ETIOLOGY or CAUSES
Biological- there is a dysregulation of the neuronal pathways in the brain involving the serotonergic, dopaminergic and the cholinergic pathways. The basal ganglia, cingulated cortex and the caudate nucleus are the implicated structures implicated as per neuro-imaging studies.
Psychosexual Development- Freud is stated that OCD occurs as a result of a fixation at the anal stage of psychosexual development. There is a regression to the anal stage and prevention of the conflicts of the oedipal stage from resurfacing.
Premorbid Personality- obsessive compulsive or obsessoid personalities characterized by punctuality, regularity, cleanliness, obedience, religiosity and a tendency to insist on deadliness. They demand a particular type of behavior form others and are restless, always worrying about the future. They are engaged in unnecessary naturals, wishing to appease to all gods and follow a chain pattern of activity but may go backward and forward in their activity at times. They are very stubborn and refusing to listen and yield at all times.
The Superego- the patient with OCD has a tyrannical superego that dominates all activities and the patient suffers when he is not allowed to carry out his compulsive activity.
Stressful Events- anxiety is very marked in these cases and any stressful event can precipitate the OCD.
Mental mechanisms and Defenses used- there is marked anxiety as a result of a stressor that increases and undergoes isolation. An effort is used reduce this anxiety and cause an undoing of what has been done. This causes a result formatting result in the carrying out of the compulsive activity. At the same time the attitude of all these actions are ambivalent and magical thinking serves to reduce anxiety but complicates the overall picture.
Streptococci Hypothesis- Sydenham”s chorea seen in rheumatic heart disease has symptoms of OCD seen with it. This has resulted in the causative organisms for rheumatic fever being implicated as a cause of OCD.