Obsessive-Compulsive Disorder: Symptoms, Causes, and Demographics

Introduction to OCD

Obsessive-Compulsive Disorder (OCD) is a neurobehavioral disorder in which the patient feels a strong need to control their environment (Yaryura and Neziroglu, 1997). In the process of trying to gain this control, patients experience forceful, repetitive, and generally unwanted thoughts, and participate in mental and/or motor activities that they have difficulty resisting (Yaryura and Neziroglu, 1997). This paper begins by discussing what symptoms are linked to OCD, what the possible causes may be, and how OCD is treated. It then goes on to discuss what can be inferred from the culture, race, gender, and age range of OCD patients.

Symptoms of Obsessive-Compulsive Disorder

The basic symptoms that patients with Obsessive-Compulsive Disorder tend to experience are obsessions, compulsions, doubting, hyper-vigilance, and the feeling that they need to control the world around them. Of these, obsessions and compulsions are the most common and prevalent. Obsessions occur when a patient experiences intrusive thoughts that they cannot stop and that interfere with their normal thought patterns. The obsessive thoughts experienced can take many forms, but some of the most common deal with contamination, religion, sex, and morbidity. Many patients also experience doubt alongside their obsessive thoughts—they believe, yet do not fully believe, in their obsessions.

When a patient experiences a compulsion, they feel a strong ideational or motor pressure that is against their will. This pressure is only relieved if the patient completes the act or thought process. An ideational compulsion occurs when a patient feels pressured to complete an act in their own mind. Motor compulsions, on the other hand, occur when the patient feels pressured to physically complete a task. Motor compulsions can be further subdivided into aggressive, physiological, bodily movement, and ceremonial types. Compulsions may be performed repetitively, may or may not serve a clear purpose, or may be carried out in order to avoid some feared disastrous event. If the patient does not follow through with the act, they may develop anxiety that does not subside until it is carried out. There are also secondary symptoms associated with OCD, including sexual anxiety disturbances, anger, depression, and phobias (Yaryura and Neziroglu, 1997).

Possible Causes of OCD

There are two main schools of thought regarding the possible causes of Obsessive-Compulsive Disorder. OCD is generally believed to stem from either a psychological problem or an abnormality in the brain. Those who view OCD as a psychological disorder believe it is caused when patients feel personally responsible for the obsessive thoughts they experience. In order to alleviate this sense of responsibility, patients act on their compulsions.

Those who believe OCD is caused by a brain abnormality, on the other hand, argue that the thoughts and actions of OCD patients reflect a problem in an essential neural pathway. This pathway is a loop involving the orbital-frontal cortex (OFC), the head of the caudate nucleus, and the thalamus. The OFC registers when something is not as it should be; the thalamus directs signals from one brain region to another where they can be interpreted; and the caudate nucleus sits between these two structures, regulating the signals sent between them. Normally, the caudate nucleus suppresses "worry" signals sent from the OFC to the thalamus, preventing the thalamus from becoming overactive. In patients with OCD, however, it is believed that the caudate nucleus is unable to suppress these signals. As a result, the thalamus becomes overactive and sends strong signals back to the OFC, which responds by intensifying compulsive behavior and anxiety.

An imbalance in the neurotransmitter serotonin may also play a role. Neurotransmitters travel from one cell to another across fluid-filled gaps called synapses. Serotonin is believed to regulate a wide range of functions, from anxiety to sleep. When released from a cell, serotonin enters another cell through receptors in the cell membrane. In patients with OCD, it is believed that some receptors may block serotonin from entering cells, leading to a deficiency of the neurotransmitter in important parts of the brain ("Causes of OCD," n.d.).

Cultural and Racial Factors in OCD

Society's attitudes toward mental illness in general are often shaped by religious and superstitious beliefs, moral codes, cultural knowledge, and economic factors—all of which vary from culture to culture (Yaryura and Neziroglu, 1997). An OCD patient's symptoms can often take on features of their own culture (Pallanti, 2008). Not only does religion influence how a disorder is perceived, but in the case of OCD, religious practice may also help develop obsessive-compulsive patterns in some patients (Yaryura and Neziroglu, 1997). This is because the obsessive and ritualistic behaviors associated with religious belief and practice can easily become incorporated into a patient's OCD behaviors (Yaryura and Neziroglu, 1997).

Despite this, the epidemiology of OCD is fairly consistent across different countries and cultures, and it has been shown that cultural variation has very little influence on lifetime prevalence rates of OCD (Pallanti, 2008). The disorder appears to be more deeply rooted in neurobiology than in any particular cultural context (Pallanti, 2008). Racial and ethnic differences similarly do not appear to have a significant impact on the prevalence of OCD (Greenberg, 2011).

Conclusion

Obsessive-Compulsive Disorder is a complex disorder that still requires further research in order to better help patients who live with it every day. What is currently understood is the following: patients diagnosed with OCD generally display symptoms such as compulsions, obsessions, doubting, hyper-vigilance, and an overwhelming need to control their environment. The precise cause of OCD remains uncertain, though two main theories exist—one framing it as a psychological disorder and the other attributing it to brain abnormalities. OCD is treated through CBT, pharmacotherapies, and/or SSRIs.

Obsessive-Compulsive Disorder is a far-reaching mental disorder that can occur across any culture, race, gender, or age group. However, the beliefs and practices within a given culture may shape the specific obsessions and compulsions observed in OCD patients from that culture. OCD affects both males and females, though there are notable differences between the two: males are more likely to experience a childhood onset of the disorder, while females show a higher prevalence rate after puberty. OCD also occurs across all age groups, but there are meaningful differences between children and adults with OCD. Children differ from adult patients in symptom presentation, patterns of comorbidity, sex distribution, degree of insight, and etiopathogenesis.

Works Cited

BBC Science. "Causes of OCD." Retrieved November 15, 2011 from www.bbc.co.uk/science/humanbody/mind/articles/disorders/causesofocd.shtml.

Dickel, Diane E., et al. (2006, July). "Association testing of the positional and functional candidate gene SLC1A1/EAAC1 in early-onset obsessive-compulsive disorder." Archives of General Psychiatry. 63:778–785.

Greenberg, William M. (2011, August 25). Medscape Reference. "Obsessive-Compulsive Disorder: Race preference in OCD." Retrieved November 27, 2011 from www.emedicine.medscape.com/article/1934139-overview#aw2aab6b2b5.

Kalra, Simran K. and Susan E. Swedo. (2009, April 1). "Children with obsessive-compulsive disorder: are they just little adults?" The Journal of Clinical Investigation. 119(4):737–746.

Pallanti, Stefano. (2008, February 1). "Transcultural observations of obsessive-compulsive disorder." The American Journal of Psychiatry. 165(2):169–170.

Yaryura, Jose A. and Fugen A. Neziroglu. Obsessive-Compulsive Disorder Spectrum: Pathogenesis, Diagnosis, and Treatment. American Psychiatric Press Inc.: 1997.