TRIGGERING FACTORS AND COMMON SYMPTOMS OF OCD (CHAPTER 2)

Before delving into discussing what are the common symptoms and triggering factors of OCD, let’s have a look at the diagram below in order to better identify how OCD can persistently manifest in people who suffer from it.

As you can see from the above diagram, obsessions often take the repetitive form, persistent ideas, thoughts, images, or impulses that are experienced as distressing. Generally, people attempt to resist thinking of the obsession and get rid of the thoughts. However, as people strive to resist, the intrusion persists. Compulsions, on the other hand, are repeated patterns of behaviours or actions used to reduce anxiety and prevent an outcome following a strong urge or pressure to do so (they are sometimes known as neutralising). This is because people with OCD, in general, often feel deceived into believing that compulsive behaviours can affect or "fix" the issues. Although they are rarely related to outcomes and have no impact, however, the risk of merely not performing them is too great. In short, OCD is a mental health adversity in which intrusive thoughts are misrepresented as warning signals and such misrepresentation can cause anxiety to a person who may try to avoid or neutralise them by engaging themselves in their obsessive behaviours.

TRIGGERING FACTORS OF OCD

Obviously, there are a number of different ideas which may all have some contribution to make in understanding the problems of OCD. Despite considerable research into the possible causes of OCD, however, no clear answer has emerged. As with most psychiatric conditions, different factors may be involved. Whatever it is, the most we can say at present is that OCD appears to be caused by a combination of psychological and biological factors.

1. Genetic Factors

Sadly, OCD often seems to run in families. In fact, almost half of all cases show a familial pattern. Research studies on families of people with OCD, as well as data from national health registries indicate that first-, second-, and third-degree relatives of people with OCD possess a greater chance of developing the illness compared to someone with no family history of the disorder. Additionally, when a medical disorder runs in families, it can be due either to genes that are passed on (hereditary) or to shared environment (taught by one family member to another). In the case of people with OCD, for instance, it is believed that genetic factors play a key role in the tendency to cultivate obsessions and compulsions. The evidence for this belief derives from twin studies, which show that if one twin has OCD, the other twin is far more likely to develop the disorder if they are 100% identical twins than if they are fraternal twins who share about 50 per cent of genetics.

2. Behavioural Theory

The behavioural theory suggests that people with OCD associate themselves certain objects or situations with fear, and learn to avoid the things that they are afraid of to perform rituals which may help reduce the fear. This pattern of fear and avoidance or ritual, in fact, may begin when people are under periods of high emotional stress, such as starting a new job or ending a relationship. At such times, we are more vulnerable to fear and anxiety.

Often, when things are regarded as "neutral", people may begin to bring on their feelings of fear. For example, a person who has always been able to use public toilets may, when they are under stress, make a connection between the toilet seat and a fear of catching an illness. Needless to say, once a connection between an object and the feeling of fear becomes established, people with OCD avoid the things they fear, rather than confronting or tolerating the fear.

So, that is one example to illustrate the behavioural theory. Another example could be of a person who fears catching an illness from public toilets will avoid using them. When forced to use a public toilet, he or she will perform elaborate cleaning rituals, such as cleaning the toilet seat, cleaning the door handles or following a detailed washing procedure. Because these actions temporarily reduce the level of fear, something that the person is afraid of will never be challenged and dealt with, and the behaviour is ultimately reinforced. In any case, the association of their so-called "fear" may spread to other objects, such as public sinks and showers.

3. Biochemical Factors

In the biochemical factors, the theories assume that there is some chemical imbalance or other irregularity in the brain of OCD sufferers that is associated with their disorder. Research in this area is relatively new and still has a long way to go before anything certain can be concluded. However, there is a more consistent body of evidence which has identified a particular brain chemical called Serotonin, which may be related to OCD problems.

There is also evidence which argues that there could be an abnormality in the transmission of information via some serotonin neuronal pathways. The precise nature of this problem is unclear. However, some patients with OCD respond to medication that increases the Serotonin available within the brain. There are many people with obsessional problems identify a relationship between their mood and their obsessions. Feeling stressed, low or exhausted can often be associated with a worsening of symptoms. For example, women often find their OCD problems are worse just before menstruation and they may report an increased difficulty at resisting their compulsive behaviours.

Meanwhile, some research proposes that there is a direct association between swings in mood and the development of obsessions. This theory suggests that whenever our mood changes dramatically, we become more susceptible to developing obsessional problems. Perhaps, a good example of this is the behaviour of some students at examination time. The usual response to exams is a change in mood towards becoming more anxious. This is similar to the situation in which we can develop unusual behaviours, such as becoming more particular about our routines or the things that we eat, or we desire to have a lucky charm with us during the examination, etc. Although these behaviours in most of us do not amount to clinical problems, however, they do suggest that mood may have an essential part to play in developing and maintaining OCD which is closely linked to the brain functioning.

4. Cognitive Theory

The cognitive theory focuses on how people with ocd misinterpret their thoughts. Most people have intrusive or uninvited thoughts similar to those reported by people with OCD. For example, parents under stress from caring for an infant may have an intrusive thought of harming the infant. While most people would be able to shrug off such a disturbing thought, individuals who are prone to developing OCD might exaggerate the importance of their thoughts and respond as if they represent an actual threat.

Moreover, people who come to fear their own thoughts usually attempt to neutralize feelings that arise from their thoughts. One way they do this is by avoiding situations that might spark such thoughts. In the cognitive theory, it is suggested that as long as people interpret intrusive thoughts as catastrophic, and as long as they continue to believe that such thinking holds the truth, they will continue to feel distressed and practise avoidance or ritual behaviours. What’s more, people who attach exaggerated danger to their thoughts are very much inclined to do so because of the false beliefs learned earlier in their life. At this point, researchers perceive the following beliefs may appear to be important in the development and maintenance of such obsessions as "exaggerated responsibility" or the belief that one is responsible for preventing misfortune or harm to others.

COMMON SYMPTOMS OF OCD

People with OCD often experience feelings of intense shame about their need to carry out these compulsions. These feelings of shame, in fact, can exacerbate the problem further. Shame and the consequent secrecy associated with OCD, often times, lead to a delay in diagnosis and treatment. Besides, it can also result in social disability (e.g. children failing to attend school or adults becoming housebound). That being said, a person may have OCD if he or she:

1. Has recurrent, persistent and unwanted thoughts, impulses or images (obsessions) that cause distress, as these are not just excessive worries about daily life.

2. Performs repetitive, often seemingly purposeful, ritualistic behaviours (compulsions) in order to reduce distress or neutralise the thoughts.

Additionally, obsessions whether they are thoughts, ideas or images and compulsions share the following features:

a. Repetitive and unpleasant with at least one obsession or compulsion recognised as excessive or unreasonable.

b. Persisting symptoms for at least one hour a day or significantly interfering with normal functioning.

c. Although the person tries to resist them, however, at least one obsession or compulsion is not resisted.

d. The obsessions or compulsions cause distress or interfere with the person’s day-to-day functioning (e.g. work, social life, school, and so forth).

e. The person considers that the obsessions and compulsions do not occur exclusively within an episode of depression.