Obsessive-Compulsive Disorder

INTRODUCTION

Obsessive-Compulsive Disorder commonly referred to as OCD, is defined according to the Obsessive Compulsive Foundation (2007), as the neurological disorder characterized by recurrent unwelcome thoughts known as obsessions and repetitive behaviors known as compulsions that its sufferers feel the need to perform.

Though OCD sufferers are usually over meticulous, and feel some stress while performing their “rituals”, people should not be quick to judge an individual that is overly zealous about the appearance of things. A person has to have obsessions, compulsions or a combination of both to be classified as a sufferer of OCD (DSM-IV-TR, 2000).

OCD affects 2.2 million American adults (Kessler et al, 617); it is the 4th most common neuropsychiatric illness in the United States, 1 in 40 adults and 1 in 200 children suffer from OCD at some point in their lives (OCF, 2007). Judging from these numbers, one can infer that this is a serious disorder, whose signs and symptoms affect the lives of its sufferers and those around them. Fortunately, research has been conducted to show probable cause, identify the signs and symptoms, and prove treatments that can be used in treating or reducing the signs and symptoms. This paper will elucidate on the cause, signs and symptoms, treatment, and future directions in combating the disorder known as OCD.

CAUSES OF OBSESSIVE-COMPULSIVE DISORDER

There are two different factors that are considered to be the cause of OCD, with each having its own proponent: there is the minority supported psychological factor and the majority supported biological factor.

The psychological factor was explained by Sigmund Freud (1950), and he called it “touching phobia”. He said:

After it has started, in early childhood, the patient shows a strong desire to touch, the aim of which is of a far more specialized kind that one would have been inclined to expect. This desire is promptly met with an external prohibition against carrying out that particular kind of touching. The prohibition is accepted, since it finds support from powerful internal forces, and proves stronger than the instinct which is seeking to express itself in touching. In consequence; however, of the child’s primitive physical constitution, the prohibition does not succeed in abolishing the instinct. Its only result is to repress the instinct (the desire to touch) and banish it into the unconscious. Both the prohibition and instinct persist: the instinct because it has only been repressed and not abolished, and the prohibition because, if it ceased, the instinct would force its way through into consciousness and into actual operation. A situation is created which remains undealt with- a psychical fixation- and everything else follows from the continuing conflict between the prohibition and the instinct. (p. 29)

Because it has been alleged that Freud frequently consumed opium, and because of the controversy of his beliefs, it would not be out of character if this may be the reason why most psychologists do not believe this theory, because the validity may have been compromised.

The biological factor comprises of a number of hypotheses and theories that attempt to explain how OCD may be caused. They include: genetics, neurotransmitters, and brain activity and function.

Recently, more specifically August 2007, researchers at the Duke University Medical Center, North Carolina performed experiments in genetically altered mice that lacked the gene SAPAP3, which is highly expressed in the striatum, the area linked to the appropriation of actions and planning. They found out that these mice spent as much as three times the amount of time normal mice spent in grooming themselves to the extent that their fur fell off (“Missing gene”, New Scientist, 2007). They hypothesized that what these mice were experiencing might be OCD, and it was probably caused by the absence of the SAPAP3 gene, and since mice have a neurological system similar to that of humans, more research has to be conducted to see if this gene might be responsible for OCD in humans.

Serotonin, is the neurotransmitter that regulates sleep and memory function; it is also suggested to be responsible for regulating anxiety. It has been hypothesized that OCD sufferers may have damaged or blocked receptor sites, which prevent the binding of serotonin to receptor sites. The hypothesis was made after it was proven that sufferers of OCD respond favorably to SSRIs- selective serotonin reuptake inhibitors- antidepressants that allow the selective uptake of serotonin. It is not yet clear why this is so, because another drug that is sometimes used to treat this disorder, Clomipramine, only elicits specific responses (Heyward, Mataix-Cols, & Fineberg, 2006).

It has been theorized that there is some sort of miscommunication between the orbitofrontal cortex, thalamus, and caudate nucleus, and this is responsible for OCD. The

orbitofrontal cortex is the first of the brain that notices when something is amiss, and it sends a signal to the thalamus. The thalamus receives the signal, and sends another signal for the orbitofrontal cortex to interpret the signal. In between these two organelles is the caudate nucleus, which prevents the same signal from been repeatedly sent between the thalamus and the orbitofrontal cortex. The theory suggests that the caudate nucleus does not function properly in OCD sufferers, hence the signal is repeatedly being sent back and forth between the orbitofrontal cortex and thalamus, and the sufferer starts to get the feeling that something is not right, wants to make it right, but still does not get the sense of accomplishment associated with completing a task.

Using positron emission tomography (PET) scan, it has been proven that OCD sufferers have brain wave activity different from those not suffering from the disease (Tennen, 2005). This implies that OCD might be caused by the failure of the part of the brain that is responsible for translating complex intentions to correctly communicate the chemical message into the necessary fundamental action. For example in Brain Lock (Schwartz, 1997), the author suggests that in OCD sufferers, “I will pick up the cup”, “move arm forward, rotate it 15 degrees”, is not properly communicated, therefore there is a feeling of incompleteness in the sufferer.

In infantile cases, it is thought that OCD is partly caused by streptococcal infections known as Pediatric Autoimmune Neuropsychiatric Disorder (PANDAS). The antibodies of this infection bind to the basal ganglia,

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