Introduction

Imagine your life dictated by repetitive behavior. To feel the need to turn on and off a light before going in to a room or wash your hands so much they bleed because of dryness. Obsessive-compulsive disorder (OCD) is characterized by unreasonable thoughts and fears. This term can be subdivided by two concepts; the core concept of fear and how it influences behavior. Fear, in the normal sense, is a vital response to danger but with people suffering OCD fear becomes common. By not achieving a behavior people who suffer from OCD build a sense of dread of an inevitable consequence that is outside their reach; and, to avoid such consequence they tend to do repetitive behaviors that are also known as compulsions. Some common themes of OCD may be an irrational fear of getting contaminated by germs and a compulsion that alleviates that fear would be to constantly wash hands. This often leads to repetitive and ritualistic behavior in order to find relief in their self-inflicted stressful situation.

This blog will look at the behavioral effects of said disease how it affects sleeping patterns and the big five personality traits. OCD will also look at the treatments to deceive besides cognitive behavioral therapy there is also from a collage of methods like drug therapy with the selective serotonin reuptake inhibitors or SSRI. Since it has been proven by many studies the most effective behavioral treatment for OCD is exposure and response prevention. This blog will also deal with surgical approaches to treating OCD and social observations that people with OCD have to struggle with like the following:

Causes of the disorder: cortico–striato–thalamo–cortical circuit, genes that affect serotonergic, dopaminergic and glutaminergic system, environmental factors

 In a study that evaluated two rodent models of OCD, a disruption of the dopaminergic system, more specifically a decrease in the dopamine signaling mediated by dopamine neurons reflected and supported the theory that OCD affects dopaminergic systems. In this experiment, investigators repeated injection of dopamine D2 agonist quinpirole and injection of the tricyclic antidepressant agent clomipramine in combination with a behavioral paradigm designed to

produce compulsive lever pressing. The results were then compared with their relative impact on the state of activity of the mesolimbic dopaminergic system in the ventral tegmental area. The clomipramine model did not caused an increase in compulsive level pressing. In contrast, quinpirole treated animals did in fact showed significant increases in compulsive level pressing. Therefore, it was concluded that VTA dopamine activity correlated with the behavioral responses in these models and confirmed other experiments that concluded that the disorder impacted the dopaminergic system.

Obsessive compulsive disorder is a multifactorial condition that, as demonstrated in twin studies, it’s related to polygenetic and environmental factors. It has been observed in neuroimaging studies with patients that have the condition that the cortico-striato-thalamo- cortical circuit or corticostriatal system plays a role in OCD. This circuit is part of one of the feedback loops between the basal ganglia and the motor cortex/ premotor cortex. In OCD, genes affecting the dopaminergic, serotonergic and glutaminergic systems as well as the interaction within them have been identified as causes of the disorder. Also, external circumstances like prenatal events, psychological and neurological trauma may modify the expression of risk genes and, hence, trigger the manifestation of obsessive–compulsive behaviors. Since the late 1980s, a rapid growth in the number of imaging studies of individuals with OCD and improve­ments in imaging technology and methods have led to considerable advancement in the understanding of the neural indicators of OCD pathophysiology. As said earlier, the corticostriatal system has been the prevailing model regarding the neural and pathophysiological foundations of OCD. It has been explained that the corticostriatal system performs an excitatory and inhibitory pathway. In healthy individuals, the excitatory pathway is modulated by the inhibitory function and based on convergent findings from animal and human research, the prevailing model postulates that a lower threshold for activation of this system results in excessive activity in the excitatory pathway over the inhibitory one. This leads to hyperactivation of the orbitofrontal–subcortical pathway. As a result, exaggerated concerns about danger, hygiene or harm may result in persistent conscious attention to the per­ceived threat (obsessions) and, subsequently, to compulsions aimed at neutralizing the perceived threat. The temporary relief that results from performing compul­sions leads to reinforcement and repetitive or ritualistic behavior when obsessions reappear.

Finally, it’s important to mention that some functional imaging stud­ies have found distinct neural correlates of specific OCD symptom dimensions. In other words, variations in neuronal systems may be partially different depending of the kind of symptom that the person has like washing, hoarding and checking.  

Types of OCD

OCD is a heterogeneous disorder with a number of subtypes of obsessive-compulsive problems, the most common subtype involving:

 Thoughts behaviors: Intrusive thoughts that is undirected and unproductive. This particular type dwells on a time consuming question like “what is the meaning of life?” Another type of thought could have sexual, disturbing and horrific undertones. It’s also noted that this type is repetitive and not voluntarily produced though they are least likely to act on the thought. The compulsion is avoidance of the trigger in order to prevent them from happening.

Checking: involves the compulsion to prevent damage. This tends to help make the person will “make sure” that certain disasters can be avoided like constantly checking house alarms or even the fear of losing important documents.

Contamination: The compulsion is the fear to clean or wash; this includes a fear to use public restrooms to the fear of contact; such as, touching other people. The ritual that accompanies the compulsion is in order to “feel” clean rather than to “be” clean.

 Hoarding: The inability to discard useless or worn out items. This particular type of OCD is the least responsive to treatment.

 It has been classified as an insider disorder by the American psychiatric Association diagnostic and statistical manual of mental disorders or DSM4. Inside the variety of anxiety disorders there are many forms such as panic attacks phobias and social anxiety.

Symptoms in a Nutshell

To better understand the stated symptomatology, Samantha Pena explains her daily life while struggling with OCD.

Social Implications

Aside from the psychopathology of OCD a study searched to explore and understand psychosocial aspects of the disease and to provide positive accounts of the condition and its treatment. This study accounted groups of self-diagnosed OCD and using the interpreted phenomenological analysis or IPA. This test consist of data study that came from a series of nine semi structured interviews carried out with individuals whose OCD diagnosis is not been measured by its severity. The age of the patients also varied in range from 22 to 53 years. The IPA is based on three key philosophical tenets phenomenology (or first person perspective), ideography and hermeneutics (text interpretation) bringing about a test that tests how people make sense of their major life experiences.  In other words to study actually focuses on a more humane division it moves on empathetic accounts questions and analyzes people's life experiences. This entails researchers producing an interpretive critical framework initially guided by the accounts produced from participants. After researchers interviewed each person preliminary things were produced from each transcript, which showed a pattern of super ordinate and subordinate themes. This study showed a more social aspect of the disease, identifying the subordinate theme as "wanting to be normal and to fit in" a social context and the subordinate theme of wanting therapy in order to achieve a better self. Other super-ordinate themes where how this condition has adversely affected their education careers and family and personal relationships leaving them with an overwhelming sense of personal failure. to better understand a person with OCD one has to see this as a type of barrier that worked against their fulfillment in developing meaningful relationships. One also has to understand that these individuals make tensions about their life's progress and compare against age-appropriate lifecycle goals they want to achieve normalcy but the condition's presence leaves them with resulting feelings of disappointment. These researchers also had the chance to accounts how people with OCD treats their condition and dealt with others who did not understand the drive to maintain OCD behaviors. In the end several participants felt that being able to locate the psychological causes of OCD help they make sense of it as an anxiety disorder.

This study also focused on the un-medicated way to treat obsessive-compulsive disorder is a cognitive behavioral therapy (CBT) which seeks to underlie dysfunctional beliefs and provides individual with an alternative explanation of anxiety origins pointing to the dysfunctional beliefs a person could have. In other words makes a person be more aware in order to challenge and replace cognitions in a systematic logical and empathetic way. It was concluded that 30% of the people who engage in CBT will not be helped by it because either they don’t engage in the therapy or they eventually drop out which does not improve their symptoms. A long term follow-up showed that CBT has a 55% success rate, showing that some treatment strategies are underdeveloped.

“How ‘Normal’ is ‘Abnormal’”; Big Five personality traits (extraversion, neuroticism, openness to experience, agreeableness, conscientiousness) and Narcissism

It has been subjected that abnormal personality can be molded as extremes of normal personality. The big five personality traits have been constantly used by psychologists describe the human psyche. These include:

This study also involved other traits such as narcissism and creativity which can be related to the big five. It is known that high end of extraversion and low and agreeableness are related to narcissism. Creativity, which is such an abstract concept, was measured using self-reported creativity and biographical inventory of creative behaviors. Interestingly, both openness and extraversion were related to self-reported creativeness in order to create novel and creative ideas this was turned over inclusiveness. Now there is a considerable body of empirical research the proposed a link between creativity and personality mood disorders leading to a genetic marker that brings creativity and psychotic traits as they come hand in hand. Obsessive-compulsive disorder exhibit neatness, order, cleanliness and perfectionism which contrasts completely with creative mindsets. This study also post narcissism as the other extreme of personality variants, since most narcissists would be characterized by grandiosity they would think of themselves as highly creative individuals. In this study there was a sample of 207 individuals that were recruited, the participants for each between 16 and 54 and came from diverse ethnic backgrounds. In order to attain creativity they use the biographical inventory of creative behaviors(BICB) that correlates self-rated creativity with divergent thinking. A self-rating would also provide a secondary measure creativity. The study concluded to be a positive car relationship between creativity and both openness and extroversion with the two accounting for approximately 26 to 31%. To contrast this data there was a correlation that shows that obsessive-compulsiveness is associated with introversion and neuroticism and it's not especially related to openness. It was also suggested that obsessive-compulsiveness is hard to measure by the big five questionnaire. Although, contrary to their hypothesis, obsessive-compulsiveness was positively related to everyday creative achievement. In other words this evidence suggests that ritualistic behaviors could possibly help promote creative behaviors. But to be more specific, the creative behavior of people with OCD are more likely to be associated with creativity in the areas of science and technology rather than in the arts. People who also suffer from OCD have been shown to have high levels of narcissism that is related to self-perception.

Pharmacotherapy

The primary pharmacotherapy treatment for OCD are serotonin reuptake inhibitors (SSRI's) which helped partially with the condition as it is shown improvements in 40 to 60% of OCD patients. A study showed the potential of cortical morphology based on individual structural covariance or ISC. This showed dysfunctional cortical maturation process as a biomarker that protects the clinical treatment response to SSRI based for current therapy success in patients suffering from OCD.



Brain morphology for OCD patients have reported just think of morphological or functional de-arrangements of multiple brain regions, such as the orbitofrontal cortex, anterior cingulate cortex, insula, inferior parietal lobule, precuneous, superior temporal cortex and lingual cortex which collectively constitute the pathopsychological brain circuit of OCD called the"cortico-striato-thalamo-cortical" loop. This study coordinated variations in brain morphological features including cortical surface area or CSA and thickness. This model seeks to understand how some people responded positively to SSRIs rather than others that didn't respond at all. This study recruited 56 medication for the OCD patients who met the diagnostic and statistical manual of mental disorders the fourth edition (DSM IV). Each of them was given a certified psychiatric scored test which measured obsessive-compulsiveness, depression and anxiety to measure the severity of their symptomatology. Using a whole brain anatomy three-dimensional McIntyre station prepared rapid gradient echo, they measured the structural covariance of cortical thickness at the individual level. Out of the data that was recruited they average and calculated the standard deviation of each result. The group was also subdivided into two portions; the nonresponsive group and the responsive group.