Obsessive Compulsive Spectrum Disorders

Obsessive compulsive spectrum disorders (OCSD), commonly referred to as OCD, are serious and often debilitating disorders that are characterized by recurring thoughts (obsessions) and repetitive behaviors (compulsions).

Most people experience intrusive thoughts from time to time and may be momentarily concerned, but they are able to put these thoughts aside and carry on. Individuals may also have looping thoughts or everyday routines that don’t interfere with work, school, or home life. In fact, they may provide structure or a framework that helps keep you focused on what you need to accomplish on any given day. Consider how your morning routine helps you get ready for work faster and how your bedtime routine better prepares you for a good night’s sleep.

It’s when persistent thoughts and time-consuming rituals become distressing and cause trouble in your daily personal and professional activities that they are signs of OCD.

WHO GETS OCSD?

In the U.S., about 1 in 40 adults and 1 in 200 children are affected by OCD. Although the onset of OCD can occur at any age, it is typically diagnosed by age 19. According to statistics, men and women are equally likely to have the condition, but boys tend to be diagnosed at a younger age than girls.

OBSESSIONS AND COMPULSIONS

Obsessions are recurring thoughts, impulses, or mental images that are intrusive, usually senseless, sometimes frightening, and often repulsive. Obsessions often involve repetitive thoughts and fears about:

• Germs or contamination
• Forbidden sexuality
• Harm or violence
• Losing control
• Religion
• A need for symmetry or perfectionism

These unwanted thoughts can trigger distressing feelings of anxiety or disgust. People with OCD often make a great effort to suppress or resist these mental images, but the more a person tries to control them, the more powerful they become.

Compulsions are behaviors that are performed persistently and repetitively without leading to an actual reward or pleasure. Often, compulsions are an attempt to make obsessions go away and to reduce the anxiety caused by the obsessions. There is an urgent insistent sense of “I have to do it” inside.

Compulsions are often performed according to certain rules in a very strict or rigid manner and can result in elaborate rituals. The most common compulsions include:

• Rituals
• Excessive washing and cleaning (such as hand-washing or household cleaning)
• Counting (including wanting to end on a “good” or “safe” number)
• Checking (such as checking the door is locked or the stove is turned off)
• Repeating (such as a name, phrase, or prayer)
• Touching (especially in a particular sequence)
• Arranging objects (ordering items in a precise or symmetrical way)

Many people with OCD recognize that their obsessive thoughts are senseless and that their compulsions are outside normal behavior, but they can’t control them. Other individuals with the condition don’t see that there’s anything abnormal about their thoughts or behaviors. For example, with children, it is more likely to be a parent or teacher that notices the distressing symptoms.

OTHER OCSD CONDITIONS

Obsessive Compulsive Spectrum Disorders (OCSD) comprise several conditions that have obsessive compulsive qualities. In addition to OCD, some of these other conditions include:

• Trichotillomania (hair pulling)
• Dermatillomania (skin picking)
• Onychophagia (nail biting)
• Tourette’s Syndrome (tic disorder)
• Kleptomania (compulsive stealing)
• Compulsive shopping
• Hoarding disorder
• Body Dysmorphic Disorder (unreasonably feeling a part of the body is excessively ugly)
• Hypochondriasis (excessive preoccupation with or worry about having a serious illness)
• Oppositional Defiant Disorder (persistent arguing)

The course of OCSD is quite varied. Symptoms may come and go, ease over time, or get worse. If the symptoms become severe, OCSD can keep a person from working or carrying out normal responsibilities at home.

CAUSES OF OCSD

Although the exact cause of OCSD is not fully understood, studies have shown that a combination of biological and environmental factors may be involved.

Research shows that OCSD tends to run in families, suggesting that genes likely play a role in the development of the disorder. However, genetics appear to be only partly responsible for causing the disorder.

Environmental stressors may trigger OCSD in people with a predisposition for the condition or cause a worsening of symptoms. These include:

• Abuse
• Early childhood trauma or neglect
• Changes in living situation
• Illness
• Work- or school-related changes or problems
• Relationship concerns
• Death of a loved one

Additionally, a growing body of research suggests a link between certain types of infections and the acute onset or worsening of certain OCSD conditions. For example, PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) refers specifically to children whose symptoms of OCD and/or tic disorders either develop suddenly or dramatically worsen after having a strep infection. Another term, PANS (Pediatric Acute-onset Neuropsychiatric Syndrome), refers to all incidences of sudden onset of certain OCSD conditions.

WHAT BRAIN SPECT IMAGING SHOWS ABOUT OCSD

Brain abnormalities have also been found in people with OCSD. Brain SPECT studies have shown increased blood flow specifically in two regions of the brain—the basal ganglia and anterior cingulate gyrus.

• Basal ganglia: This region helps set the body’s anxiety level and is involved in forming habits. When there is too much activity in the basal ganglia, it is associated with increased anxiety and heightened fear.
• Anterior cingulate gyrus (ACG): This area is involved in allowing people to shift attention from subject to subject. When the ACG is overactive, people tend to get “stuck” on the same thought or behavior.

WHY MISDIAGNOSIS AND IMPROPER TREATMENT IS COMMON

Many mental health conditions can be misdiagnosed, but OCD is one of the most likely to be mistaken for other conditions because it involves so many overlapping symptoms. In fact, a 2015 study among primary care physicians found that half of OCD cases were misdiagnosed. OCD can be misdiagnosed as ADD/ADHD, anxiety, bipolar disorder, autism, PTSD, or even schizophrenia.

Getting an accurate diagnosis is critical since the treatments for these conditions differ dramatically. And the wrong treatment plan can make a person with OCD worse. For example, giving stimulant medication, which is commonly used to treat ADD/ADHD, can exacerbate some OCD symptoms.

In addition, like many other conditions, OCD is not just a single and simple disorder. In terms of treatment, one size does NOT fit all. Giving everybody the same OCD treatment may help some people but can make others worse. It is imperative to find out what is causing the obsessive compulsive symptoms you are experiencing and treat the underlying cause, rather than just trying to use a band-aid to mask the symptoms.

HOW AMEN CLINICS CAN HELP DIAGNOSE AND TREAT OCSD

At Amen Clinics, we take a unique brain-body approach to evaluation to make an accurate diagnosis of OCSD conditions. We use brain SPECT imaging as part of a comprehensive assessment to diagnose and treat our patients. We also assess other factors—biological, psychological, social, and spiritual—that can contribute to OCD symptoms. Based on all of this information, we are able to personalize treatment using the least toxic, most effective solutions a better outcome.