A lot of social stigmata still revolves around the topic of mental health. It is scarcely talked about and the people have become victims to their own thoughts. We are obsessed with our physical well-being but psychological wellness is often overlooked. It worries me as a medical student, as I see depressive and suicidal patients in wards, kept in intensive care. They have previously attempted to end their life. There are several moderate disorders too, which could have been cleared off by professional therapy or just basic understanding of mental illnesses but utter ignorance leads to their catastrophic consequences.

The Mental Health Programme of World Health Organization launched in early 1960s became actively engaged in improving the mental health and the diagnosis and classification of mental disorders. Several conventions were held, and schools of psychiatry were founded in various parts of the world. In 1970s, this programme was internationally expanded, many collaborative studies were undertaken and there was active participation from numerous universities and research institutions. The Copenhagen conference of 1982 was a major milestone, it paved the way for the extensive study in psychiatry and the overall classification of the subject.

In August 1982, the adoption of the National Mental Health Programme was major win in the history of Indian psychiatry. This very ambitious programme was formulated in a time period where there were less than a thousand psychiatrists in the nation. It was a triumph of need for mental health care in a developing country like India. Even after finally finding light at the end of the tunnel, the fight to make mental health care more accessible continues to go on.

One of the commonest of all disorders is Obsessive Compulsive Disorder or popularly abbreviated as OCD. Obsessive-compulsive disorder (OCD) is a prolonged disorder in which a person experiences uncontrollable and recurring thoughts, sensations or obsessions, is engaged in repetitive behaviors or compulsions, or both of them. It is very vast, has various levels and intensities. These obsessions are rather long-lasting and unwanted thoughts that keeping coming back or the urges or the images that are intrusive and cause distress or anxiety in a person. It obstructs their daily tasks and their well-being on whole.

These obsessive thoughts are ideas, images or impulses that enter the individual’s mind again and again in a stereotyped form and continue to hurdle their routine. They are almost invariably distressing because they are violent or obscene, or simply because they are perceived as senseless or useless, and the sufferer often tries, unsuccessfully, to resist them. The inability to resist them may even inflict guilt on the person.

They are, however, recognized as the individual’s own thoughts, even though they are involuntary and often repugnant. Compulsive acts or rituals are stereotyped behaviors that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks. They may even be harmful to the person in someway. Usually, though not invariably, this behavior is recognized by the individual as pointless or ineffectual and repeated attempts are made to resist it; in very long-standing cases, resistance may be negligible. This disorder is likely chronic.

The cause of these obsessive behaviours are considered to be genetic or hereditary. It may result from any chemical, structural or functional abnormality of the brain. These compulsions are a result of learned behaviour and often become chronic, once the person associates them to relief from anxiety.

The exact cause of OCD Is still unknown but there are several factors that are believed to have a major contribution to the development of this disorder. They are stated as following:

Genetics and Hereditary Causes

When a family member or close relative suffers the pangs of OCD, it significantly increases one’s chances of developing the condition in future. This is because certain variations in the genetic make-up make a person more susceptible to the disorder. The family aggregation and twin studies have shown this. However, it’s not a mandatory phenomenon, not everyone with a genetic predisposition is going to develop the condition

Brain abnormalities

Studies suggest that people with OCD may have differences in the, chemical nature, structure and function of certain regions in the brain, particularly those involved in habit formation, decision-making, and regulation of emotional quotient.

Neurotransmitters

Neurotransmitters are often referred to as the body’s chemical messengers of the nervous system of the body. They are the molecules used by the nervous system to transmit messages between the neurons, or from neurons to the muscles. Imbalance in chemicals of the nervous system like serotonin and glutamate which play a major role in mood and behavior, may be involved in obsessive compulsive disorder

Extrinsic factors

Stressful life events, traumatic course of events in the childhood, and certain infections may trigger OCD in individuals with a genetic predisposition of the condition.

Obsessive Compulsive Personality Disorder or OCPD is a different condition. In this the person develops an obsession or preoccupation with perfectionism, extreme organization and has a controlling nature. The people with OCD often understand their obsessions and compulsions are senseless and they seek professional help but the people with OCPD are deeply engrained and they fail to understand their condition. Ther find their behavior absolutely normal.

SYMPTOMS

The primary symptoms of OCD include compulsions and obsessions that are unwanted and interfere with the daily activities of the individual. Often the person understands that this behaviour is problematic but they fail to resist themselves from committing it. The symptoms may exaggerate or lessen over time, sometimes even be harmful to the person.

People with OCD may have obsessions, compulsions, or both. Obsessions are repeated thoughts, urges, or mental images that are intrusive, unwanted, and make most people anxious. Common obsessions include:

• Fear of pathogenic microbes or contamination
• Fear of forgetting, losing, or misplacing something
• Fear of losing control over one’s behavior
• Aggressive or intrusive thoughts toward others or oneself
• Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm
• Strong desire to arrange things in a symmetrical or perfect order

Compulsions are repetitive behaviors that an individual performs in response to their obsessive thoughts. Common compulsions include:

• Excessive cleaning or handwashing
• Ordering or arranging items in a particular, precise way
• Repeatedly checking things, such as that the door is locked or the stove is off
• Compulsive counting
• Praying or repeating words silently or in low sound

Not all repeated thoughts are obsessions, and not all rituals or habits are compulsions. However, people with OCD generally:

• Can’t resist the urge to act upon their obsessions or compulsions, even when they know they’re excessive.
• Spend more than 1 hour a day on their obsessions or compulsions.
• Don’t get pleasure from their compulsions but may feel like they provide a temporary relief from their anxiety.
• Experience significant problems in daily life due to these thoughts or behaviors. 

OCD symptoms may begin anytime but usually start between late childhood and young adulthood. Most people with OCD are diagnosed as young adults.

The symptoms of OCD may start slowly and can go away for a while or worsen as time passes. During times of stress, the symptoms often get worse. A person’s obsessions and compulsions also may change over time.

Differentiating between obsessive – compulsive disorder and a depressive disorder may be difficult because these two types of symptoms frequently occur together. In an acute episode of disorder, precedence should be given to the symptoms that developed first; when both types are present but neither predominates, it is usually best to regard the depression as primary.

In chronic disorders the symptoms that most frequently persist in the absence of the other should be given priority.

Occasional panic attacks or mild phobic symptoms are no bar to the diagnosis. However, obsessional symptoms developing in the presence of schizophrenia, Tourette’s syndrome, or organic mental disorder should be regarded as part of these conditions. Although obsessional thoughts and compulsive acts commonly coexist, it is useful to be able to specify one set of symptoms as predominant in some individuals, since they may respond to different treatments.

Obsessive-compulsive disorder (OCD) is classified in two major diagnostic manuals used by mental health professionals worldwide:

1. Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

• Published by the American Psychiatric Association (APA).
• Classifies OCD under its own category: Obsessive-Compulsive and Related Disorders (OCRD).
• This category also includes conditions like:
  1. Body Dysmorphic Disorder (BDD)
  2. Hoarding Disorder
  3. Trichotillomania (hair pulling disorder)
  4. Excoriation (skin picking) disorder

2. International Classification of Diseases (ICD-11):

• Published by the World Health Organization (WHO).
• Currently lists OCD in a subcategory under the broader category of Neurotic, stress-related and somatoform disorders.
• This categorization is undergoing revision, and the upcoming ICD-11 (expected in 2022) proposes a separate category for Obsessive-compulsive and related disorders (OCRD), similar to the DSM-5.

It's Important to note that these classifications are used for diagnostic purposes and may not reflect the underlying causes of OCD.

OCD can be treated with evidence-based treatment methods. They are mainly of two types:

1. Therapy
2. Medication

These can significantly reduce the intensity of the symptoms and ease the person.

1. Therapy:

Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP): This method is regarded as the gold standard for OCD treatment. It has the strongest scientific evidence for its effectiveness in the condition.

Cognitive Behavioral Therapy: Helps the individuals to identify and challenge senseless thought patterns and beliefs that are resulting in their obsessions and compulsions.

Exposure and Response Prevention: In this, the individual is slowly exposed to the triggers of their obsessions and prevents them from getting engaged in their compulsions. By allowing them to experience the associated anxiety and learn to tolerate the discomfort, this therapy slowly helps them to get out of the vicious cycle of their compulsive behaviors. This therapy is used to break the cycle of their obsession.

2. Medication:

Selective Serotonin Reuptake Inhibitors (SSRIs): These are the first-line medication for OCD and work by increasing the levels of serotonin in the brain, a neurotransmitter believed to play a role in OCD symptoms.

Other medications: In some cases, other medications like clomipramine (a tricyclic antidepressant) or antipsychotics may be used in combination with SSRIs, especially for individuals with severe OCD symptoms or those who haven’t responded adequately to SSRIs alone.

Additionally, other potential treatment methods, still under research or with limited evidence, include:

1. Mindfulness-based interventions: These practices can help individuals become more aware of their thoughts and feelings without judgment, potentially reducing anxiety and improving emotional regulation.
2. Deep Brain Stimulation (DBS): This is a surgical procedure involving implanting electrodes in specific brain regions to modulate electrical activity. It’s considered a last resort for severe, treatment-resistant OCD cases.
3. Transcranial Magnetic Stimulation (TMS): This non-invasive technique uses magnetic pulses to stimulate specific areas in the brain. While research on its effectiveness for OCD is ongoing, it shows promise as a potential treatment option.

It’s crucial to remember that for every individual the treatment differs according to the severity, the causes, symptoms, onset, progression and the duration of the clinical manifestations.

The best treatment approach for obsessive-compulsive disorder is individualized and determined by a qualified mental health professional based on the severity and specific type of symptoms manifesting, as well as personal preferences of the person and overall health and other psychological conditions.

No single treatment works for everyone, and sometimes a combination of approaches may be necessary.

Early intervention and healthcare treatment can significantly tackle the symptoms and quality of life for individuals with OCD.

Lastly, there are a few points that must be remembered:

1. Seeking help is very important, and reaching out to people who may be of substantial help is very crucial.
2. There are several organizations that are extending help without any monetary donations. No one is alone in this so suffering alone may end someone in a catastrophic course of events.
3. The ongoing research in this field may be focused upon and supported so that we may create a more congenial atmosphere for our upcoming generations
4. Talking about mental health can revert distressed lives to normal status, improve relationships, increase the productivity of people and overall add up to the economical growth of the Nation.

So, let's together make this world a better place to live. 

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