Obsessive Compulsive Disorder (OCD) is a clinical condition in which there are various combinations of obsessions and compulsions. It is common for this term to be casually used when a person is excessively preoccupied with cleanliness and order. However, OCD is not limited to just that and is a condition which needs clinical attention. Obsessions are repetitive, intrusive, distress causing thoughts, images or impulses. Generally, a patient understands that these thoughts are excessive and irrational, except in the cases where there is poor insight. Compulsions are acts which could even be mental acts in response to these obsessions.
Contamination obsessions: Patient gets repetitive thoughts that hands or other body parts are dirty and need to clean them. They may also feel the same regarding their personal and household items and surfaces.
Pathological doubts: Repetitive doubts if one has locked the room/house, switched off the stove, has told the right thing or not, whether they have worn dress properly or not, etc
Symmetry obsessions: Need to keep things in order, arrange things in order.
Aggressive obsessions: Repetitive thoughts or images of harm to self or others. They may feel like either them or their loved ones will meet with an accident or any other untoward events may happen. Patients may also have impulses of harming others like throwing stones, stabbing, hitting, etc.
Sexual obsessions: Repetitive thoughts or images of sexual content. It may be more distressing sometimes because these may include family members or friends or God.
Religious/blasphemous obsessions: Repetitive thoughts or images or impulses of scolding or insulting God.
Hoarding obsessions: Not able to discard items since the patient feels that they will be of use or are of emotional significance. There may also be excessive collection of objects. There can also be digital hoarding.
Somatic obsessions: Concern with illness or disease, concern with certain body parts.
Miscellaneous obsessions: Need to know or remember, colours with special significance, lucky and unlucky numbers, superstitious fears, fear of losing things or saying things, etc.
Cleaning or washing compulsions: Patients will repetitively washing their hands or other household items like utensils, repetitively cleaning surfaces. Usually in response to contamination obsessions. Can also happen as a part of just right phenomena where patients need to wash until they feel just right.
Checking compulsions: Repetitive checking and confirming that they have locked the door, switched off the stove, reassurance seeking, readjusting dress, etc. Nature of these compulsions depends on the nature of pathological doubts.
Arranging compulsions: Usually in response to symmetry obsessions.
Repeating rituals: Repetitive performance of certain acts which could be repeated reading, writing and rewriting, praying, touching, etc. There may be particular number of times they need to do this, like for example, odd or even number of times, avoiding certain numbers, preferring certain numbers. This number might vary in each instance. Sometimes, there is no specific number and they need to repeat till they feel satisfied.
Mental compulsions: Praying, counting, replacing bad thought with good thought, replacing images, doing the compulsions in mind.
Proxy compulsions: The patient may sometimes make their family members or friends to do compulsions for them.
Avoidance behaviour: It is common for patients to avoid certain tasks and situations to prevent the distress caused while in these situations.
There are many classes of medicines that are useful in the treatment of OCD. They mainly belong to a class called serotonin reuptake inhibitors. If there is partial response, augmenting agents are used to achieve further response. These belong to different classes like atypical antipsychotics, NMDA antagonists, antiemetics.
Psychotherapeutic approaches are very useful in the management of OCD. Cognitive Behaviour Therapy is the most effective treatment strategy. In OCD, exposure and response prevention is the mainstay of psychotherapy.
Brain stimulation methods like deep transcranial magnetic stimulation, transcranial direct current stimulation is also available for the treatment of OCD.
Psychosurgeries, mainly deep brain stimulation are rarely considered for carefully selected treatment refractory cases.
It is common for these individuals to have comorbid conditions like depression, anxiety, suicidality, psychosis, substance use, ADHD, personality disorders. These conditions need to be diagnosed and treated for the overall management of these individuals.