OCD (obsessive compulsive disorder) – medical revision notes
In this article we will describe 10 revision medical notes about OCD (obsessive compulsive disorder).
Key Points
- Obsessive compulsive disorder (OCD) is a mental health condition. It causes a person to have obsessive thoughts and carry out compulsive activity.
- It is characterised by recurrent, persistent, unwanted, and intrusive thoughts, urges, or images (obsessions) and/or by repetitive behaviors or repetitive mental acts that patients feel driven to do (compulsions, rituals) to try to lessen or prevent the anxiety the obsessions cause
- Diagnosis is based on history
- Treatment consists of psychotherapy, pharmacologic therapy (e.g. selective serotonin reuptake inhibitors (SSRIs) or clomipramine), or both.
1. Definition
- Obsessive-Compulsive Disorder (OCD) is a mental health condition where a person experiences obsessive thoughts and engages in compulsive behaviours
- These thoughts are intrusive, unwanted, and cause significant anxiety, while the compulsions are repetitive actions that individuals feel they must carry out to reduce their distress or prevent something bad from happening.
2. Epidemiology
OCD isn’t as rare as some might think. It affects about 2% of the population. Although it can develop at any age, it typically begins in childhood, adolescence, or early adulthood.
- In males, symptoms often appear before the age of 10
- In females, OCD more commonly emerges during adolescence
- Women are also more likely to experience OCD during the peripartum and postpartum periods.
Interestingly, women are about 1.5 times more likely than men to develop OCD.
Comorbid conditions
Up to 90% of individuals with OCD also have another mental health condition, such as anxiety, depression, or substance use disorders.
3. Risk factors
Certain factors can increase the likelihood of developing OCD, including:
- Genetics: A family history of OCD or other mental health conditions
- Pregnancy and postpartum period: OCD can worsen or first appear during these times, with common obsessions centred around the baby’s safety or hygiene.
4. Causes
The exact cause of OCD is unclear, but it likely involves a combination of:
- Genetic factors
- Neurological abnormalities: Certain areas of the brain, such as the orbitofrontal cortex and basal ganglia, may function abnormally in people with OCD
- Environmental influences
5. Symptoms
People with OCD experience obsessions (disturbing thoughts) and compulsions (repetitive actions).
Common obsessions include:
- Fear of contamination
- Unwanted sexual or aggressive thoughts
- A need for order or symmetry
Common compulsions (often called rituals) include:
- Washing: Frequent handwashing or showering
- Checking: Repeatedly ensuring the door is locked or the oven is off
- Counting: Repeating actions a specific number of times
- Arranging: Organising items in a precise order
OCD is often referred to as the “doubting disorder” because sufferers frequently doubt whether they’ve completed a task properly, leading to compulsive checking.
6. Diagnosis
Diagnosis is clinical based on the history, using a mental state examination (MSE). The DSM-5 criteria are often used to guide diagnosis.
Differential diagnosis
- Generalised anxiety isorder (GAD)
- Specific phobias
- Major depressive disorder
- Body dysmorphic disorder
- Trichotillomania (hair-pulling disorder)
- Eating disorders.
7. Treatment
OCD is treatable, and the mainstays of treatment are:
- Psychotherapy: The most effective is Cognitive Behavioural Therapy (CBT), specifically Exposure and Response Prevention (ERP).
- Medications: Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine are commonly used, or clomipramine, a tricyclic antidepressant, can be prescribed.
Self-help
If you think you may have OCD, don’t hesitate to seek help. You can refer yourself to NHS Talking Therapies (IAPT) or book an appointment with your GP.
8. Complications
OCD can significantly impact your day-to-day life, affecting work, relationships, and overall quality of life. Stigma around OCD also persists, making it harder for some individuals to seek help. Raising public awareness is essential in reducing stigma and encouraging support.
9. Prognosis
- Relapse is common, with long-term remission seen in fewer than 40% of adults.
- Even after treatment, 40-60% of patients continue to experience residual symptoms.
- Poor prognosis is associated with:
- Delayed diagnosis or treatment
- More severe symptoms
- Comorbid psychiatric conditions
- Male gender
10. Prevention
Currently, there are no proven strategies to prevent OCD. However, early recognition and treatment are crucial in managing the condition and improving quality of life.
Summary
We have described 10 medical revision notes about OCD (obsessive compulsive disorder). We hope it has been helpful.
Other resources
OCD (NHS England)
OCD (NHS Scotland)
Reviews: Hezel, 2019 and Brock, 2023
