We’re now going to talk
about the anxiety disorder
known as obsessive
Let’s start with a case example.
Jane is a 30-year-old woman who
fears contracting a disease.
She scrubs her hands in order to stay
clean about a dozen times a day.
There’s chaffing on her hands
and they sometimes bleed from
excessive rubbing and scrubbing.
Jane has intrusive thoughts about becoming
contaminated with an incurable illness.
To counter these thoughts,
she counts down from 10
and switches on and off
light switches in her home.
Jane is very distressed by her thoughts and
she rarely leaves home because of them.
Fortunately, her job
lets her work from home,
but there are weeks where she
won’t interface with other people
and in fact doesn’t
go outside at all.
Let’s define obsessions.
They are recurrent, intrusive
thoughts or images
that typically cause
anxiety or distress.
And how about compulsions?
They are defined as repetitive
mental or behavioral acts
that the individual
feels driven to perform
often in an effort to neutralize
the obsessive thoughts.
So when we consider
the case of Jane,
what signs of obsessions or compulsions
did you see in her from the case example?
You probably saw a few things.
So she has obsessional thoughts,
fears of contracting disease,
compulsions like scrubbing here hands,
counting and switching on and off lights.
The lifetime prevalence of OCD is
2-3% in the general population.
Females are affected
more than males.
Note that more males are affected with
OCD, however, in childhood than women.
In fact, males will specifically
have an onset of age
before 10 years old
when they acquire OCD.
The main age of onset, however,
for most people with the disorder
including women are the mid-20s.
And 25% of cases will occur
before 14 years old.
There’s a strong link between suicidal
thoughts and behaviors and OCD,
very important to note because in the
psychiatry exam and in clinical practice,
you want to pay close attention
to suicide risk all the time.
There’s also a strong link
between mental illness
with in close relative especially
those diagnosed with OCD.
So let’s think of this
example a little bit more.
Let’s say you’ve actually
started treating Jane
and you’ve come to learn that she often she
restricts here food intake to 10 bites
at meals in an effort to stop her intrusive
thoughts about having a disease.
She often feels fatigued without energy
and has trouble getting out of bed
and she reports to you that
she has a very low mood.
What other psychiatric disorders is Jane at
risk for having as a comorbidity to OCD?
Well, here’s some of the
differential diagnoses for OCD.
Personality disorders, obsessive
compulsive personality, anxiety disorders.
This could include panic, social anxiety,
generalized anxiety disorder
and specific phobias.
Schizophrenia, mood disorders including
depression and bipolar disorder,
also somatoform disorders.
Things like body dysmorphic
disorder, eating disorders
and impulsivity disorders,
which include tic disorder,
Note that OCD increases the likelihood
of other mental illnesses in general.
Up to 29% of individuals
have been found to have a
history of a tic disorder.
So what are the different
factors that lead to OCD?
Let’s go through them one by one.
There are genetics.
So is there a correlation between
genetic factors and OCD?
We tend to think there’s both familial
and sporadic types of a link.
Twin and family studies show a
correlation to a genetic contribution.
And how about the environment?
What bacteria affects
the development of OCD?
The answer is group A streptococcus.
And what parts of a woman’s cycle
affects the development of OCD?
The premenstrual and postpartum periods.
Does trauma affect the development of OCD?
Actually, exposure to
traumatic events or stress
can exacerbate OCD or lead
to its manifestation.
And which medical trauma affects
the development of OCD?
Well, that would be
things like an ischemic stroke
or traumatic brain injury.
Neurobiological factors are also important.
Do you know which circuit
in the brain is linked
to the neuroanatomical
abnormalities seen in OCD?
Well, structural imaging shows a link
to neuroanatomical abnormalities
in the cortico-striato-thalamo-cortical
circuits, the CSTC circuits.
PET Scanning and functional MRIs
have found abnormal activity
in different nodes of
the CSTC circuits.
Here’s a question for you,
do individuals experience obsessions
as voluntary and pleasurable?
The answer is no, they do not.
In fact, it’s extremely
distressing to a patient with OCD
and it really interferes with
their day to day functioning.