Held Hostage by 'What if': Inside the OCD Brain

Understanding the Symptoms

Most people have heard someone in their life say "I'm just so OCD" when talking about their organizational habits, and while this may be true, it vastly minimizes the experience of those with Obsessive Compulsive Disorder (OCD). Characterized by recurrence of uncontrollable obsessions that the sufferer attempts to mitigate by engaging in time-consuming compulsive behaviors, the everyday life of those experiencing OCD is often severely impacted. OCD often encompasses both obsessions and compulsions, but it is possible to only possess one or the other. Obsessions are unwanted, intrusive thoughts that keep coming back and cause distress or anxiety. Obsessions often fall into themes or categories such as fear of contamination, fear of being a pedophile, upsetting thoughts or doubts about ones partner, fear of harming oneself or others, etc. OCD often latches onto taboo topics, which can lead the person experiencing it struggle with guilt and shame, allowing them to continue to engage in the OCD cycle. Compulsions take place as a way to alleviate the anxiety that these thoughts cause. Examples of compulsions include excessive handwashing, seeking excessive reassurance from partners, rituals related to numbers or counting, or avoiding situations or locations that trigger obsessions.

What Causes OCD

There is no known exact cause of OCD, but it is suspected that brain abnormalities, genetics, and environmental factors all play a role. OCD was actually one of the first psychiatric disorders to show abnormal brain activity in specific brain areas when a PET scan was conducted. Two notable brain regions involved in the OCD loop are the orbitofrontal cortex (OFC) and the caudate nucleus. These structures project to one another, creating a positive feedback loop that is overactive in individuals with OCD, with level of brain hyperactivity correlating with symptom severity. OCD symptoms are also associated with dysregulation of the neurotransmitters GABA and Glutamate. This information has led scientists to believe that early intervention could help prevent long term brain damage from neurotoxicity from the dysregulation of these neurotransmitters.

OCD Treatment

But how do we manage symptoms of OCD? OCD is managed with two main forms of treatment: psychotherapy and medication, with a mix of both often being the most effective. Cognitive behavioral therapy (CBT), considered the 'gold star' of mental health treatment, can be used to treat OCD, but achieves greater success if we use a form of CBT known as exposure response therapy (ERP). ERP involves repeated exposure to the feared object or situation where the individual eventually learns to not engage in compulsive rituals. Medication is also a commonly used treatment for management of symptoms, with the most common drug being selective serotonin reuptake inhibitors (SSRIs). Now if you remember, the key neurotransmitters involved in OCD are GABA and glutamate, so you may be wondering why SSRIs are used as treatment. This is because SSRIs do not only affect serotonergic systems, but also impact something known as downstream effects by acting as a neuromodulator of GABA and glutamate. This means that by serotonin remaining in the brain for longer, it can balance the regulation of GABA and glutamate, allowing for greater stability in the neurotransmitters present in the brain, preventing chemical imbalances associated with negative symptoms.

Do I have OCD?

Double checking and experiencing doubt happens to everyone; so how do you recognize if your symptoms are OCD?

The DSM-5 defines obsessions as:

1. Recurrent and persistent thoughts or urges that are defined as intrusive and unwanted and in most people, cause anxiety or distress

2. Attempts to ignore thoughts or urges are neutralized by performing a compulsion

Compulsions are defined as:

1. Repetitive behaviors or mental acts that one feels driven to perform according to set rules

2. The repetitive behaviors are aimed to reduce anxiety or prevent some feared event or situation- although they are not connected and are clearly excessive.

The presence of these symptoms can be defined as OCD if:

1. Obsessions take up more than one hour per day and cause significant distress

2. The symptoms are not attributed to physiological affects of a drug or another mental condition

3. The symptoms are not better explained by another mental disorder

Although the symptoms can feel isolating, it's important to remember that intrusive thoughts are not a reflection of character, as they often latch onto a person's greatest fears. People with OCD can live completely full and healthy lives and you are not alone.

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