Obsessions are defined as recurrent, persistent ideas, images or impulses. Compulsions are an attempt to reduce the anxiety caused by the obsession. Compulsive behaviour may be physical or mental acts that are repetitive and purposeful, and performed in response to an obsession. Individuals with OCD may have co-morbid depression.
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Signs and Symptoms
Common obsessions include:
- Irrational fears of contamination from dirt or germs
- Fear of hurting someone
- Distressing sexual or religious thoughts
- Desire to hoard or a need for symmetry and exactness
Common compulsions include:
- Cleaning and washing
- Mental ruminations
Obsessive compulsive symptoms are also found in patients with other psychiatric and neurological disorders, such as Tourette’s syndrome, Autistic Spectrum Disorder, epilepsy, head trauma and front ear lobe lesions.
A combination of medication and behavioural therapy has been found to be effective in significantly reducing the symptoms of OCD.
Medication may be prescribed before or during behaviour therapy if there is indication of severe depression. Drug treatment after behaviour therapy may be prescribed if the therapy has been only moderately effective despite good cooperation. The use of antidepressants has proven to be effective in the treatment of OCD.
- Cognitive Behavioural Therapy (CBT)
The mainstay of psychological treatment is CBT, where the individual is deliberately exposed to obsessional cues, and then prevented from engaging in the associated repetitive behaviour. With repeated and prolonged exposure to triggers, habituation eventually takes place. Exposure tasks are arranged hierarchically, with treatment commencing with the least anxiety-provoking situation and progressing rapidly through the hierarchy. Ruminations are more difficult to treat. Aversion conditioning such as thought-stopping may be helpful. In addition, it is also useful to teach the individual ways of coping with the anxiety, anger and stress. He will be encouraged to set other targets in life so as to develop a healthier lifestyle.
The combination of CBT and medication increases treatment efficacy. It is important to involve the family in the management of individuals with OCD. Family members are often ignorant about the disorder and may be drawn into the patient’s rituals.
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