OCD (Obsessive-Compulsive-Disorder) is a serious psychiatric illness that affects millions of people around the world. The disorder is characterized by the urge to perform repetitive actions or rituals or by having repeating thoughts.
The obsessions experienced by individuals with OCD are outside of the normal range of worries and concerns and tend to be recognized as irrational by the individual.
A person with OCD may try to ignore or suppress the obsessions or neutralize them with some other thought or action.
Compulsions, which can also be present in healthy individuals, become clinically relevant in OCD when they are performed in response to an obsession or have a particular rigidity that significantly affects the individual’s life.
CHMC, German Clinic for Psychiatry and Psychotherapy, offers comprehensive diagnostics and treatment for Obsessive-Compulsive Disorder (OCD) in Dubai. In this article, we shed light on different aspects of OCD with the main focus on its diagnosis and treatment.
Symptoms of Obsessive-Compulsive Disorder
Obsessive-compulsive disorder can appear as a variety of symptoms, such as washing compulsions, checking things countless times (e.g., locks on doors), performing rituals, arranging objects in a certain way, repeating words and phrases, or experiencing reciprocal thoughts often with disturbing content. Other symptoms are counting in a certain way or performing some actions/rituals before being able to move to the normal life routine.
Intrusive Thoughts and Rituals
In many cases, the repetitive actions can evolve into complex rituals, and when patients resist performing them, they can experience severe anxiety. In some patients, OCD only manifests as compulsive thoughts that the individual is unable to resist.
Despite being aware that the compulsive thoughts and actions are irrational, they are so overwhelming that the patient feels powerless to stop them.
The intrusive thoughts and rituals can take up a significant portion of the day and interfere with normal life activities. This can result in a vicious cycle where the untreated OCD only becomes more severe, leading to full debilitation. This is a stark contrast to patients affected by schizophrenia, who are usually not able to recognize that their behaviour and thinking is irrational.
Other OCD Related Themes
OCD symptoms are related to such themes as symmetry, cleanliness, collecting and grouping objects, as well as forbidden thought contents. The symptoms related to symmetry correlate with obsessional ordering, counting, and grouping objects in a certain—perfect and highly symmetric—way. The thought contents related to taboo subjects include intrusive and distressing thoughts of violent, sexual, or blasphemous content. The symptoms grouped around cleanliness correlate with obsessions related to washing hands or excessive bathing up to dozens of times per day, cleaning objects, and fears of contamination. The hoarding compulsion and obsessions appear as obsessive collections of items that often have no value.
Some patients with obsessive-compulsive disorder could experience sexual obsessions with intrusive thoughts or images related to sexuality. Those obsessive thoughts can question a patient’s sexual orientation or create highly disturbing images of sexual relationships with parents, children, family members, or friends. Patients never put sexual compulsions into action, and they are unrelated to the patient’s sexual orientation or preferences. These patients could be extremely scared, doubting themselves regarding whether they might act upon their inappropriate ideas.
Patients with OCD perform tasks, rituals, or follow the intrusive thoughts to escape the unbearable anxiety in case they would try to stop the compulsion.
DSM 5 Diagnostic Criteria for Obsessive-Compulsive Disorder (OCD):
- Obsessions: recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress.
- Compulsions: repetitive behaviours or mental acts that an individual feels driven to perform in response to an obsession or in accordance with rules that must be applied rigidly.
- The obsessions or compulsions are time-consuming (taking up more than an hour a day) or cause significant distress or impairment in social, occupational, or other important areas of functioning.
- The obsessions or compulsions are not due to the physiological effects of a substance or another medical condition.
- The obsessive-compulsive symptoms are not better accounted for by another mental disorder.
In addition to the presence of obsessions and compulsions, the DSM criteria for OCD also include the requirement that the symptoms are not due to the effects of a substance or medical condition and are not better accounted for by another mental disorder.
Diagnosing OCD at CHMC in Dubai
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by persistent and intrusive thoughts, images, or impulses (obsessions) and repetitive behaviours or mental acts (compulsions) that a person feels driven to perform. In Europe, Obsessive-Compulsive Disorders are diagnosed according to the ICD-10 (International Classification of Diseases). Diagnostic criteria from the American Diagnostic Manual, DSM 5 may also be considered. To make a diagnosis of OCD, the below-listed DSM-5 criteria must be met.
The diagnosis process begins with gathering medical history (anamnesis), including questions about symptoms and life history (e.g., stressful crises, other illnesses, medications, etc.). Clinical psychological assessment may also be useful. Physical causes for the disorder (e.g., dementia or stroke) must be ruled out by a physician (e.g., through neurological examination or MRI).
The diagnosis of OCD should be made based on a comprehensive evaluation, including a thorough medical and psychological assessment and by ruling out any other underlying conditions that may be contributing to the symptoms.
Distinguishing OCD from Other Mental Health Disorders
There are other mental illnesses that can resemble OCD, such as:
Generalized Anxiety Disorder (GAD)
Involves excessive worry and fear about various life situations.
Tic Disorders
can also resemble OCD or occur together, especially if the condition begins in childhood.
Trichotillomania (TTM)
Another disorder with symptoms resembling OCD is trichotillomania. Trichotillomania (TTM) is also known under the description: Hair pulling disorder (TTM). The patients with TTM experience a long-term urge to pull out their hair, and they are not able to resist the impulse.
Body Dysmorphic Disorder (BDD)
Some phobias are also accompanied by impulse control and/or other body focused repetitive behaviours. One of such phobias is Body Dysmorphic Disorder (Dysmorphophobia). Patients with Body Dysmorphic Disorder (BDD) are preoccupied with an imagined defect of their physical appearance. The patients can spend hours checking and rechecking their appearance in the mirror. They frequently undergo surgery, trying to reach a perfect appearance of their face or body. They tend to repeat the surgery because they remain unhappy with the effect. The series of surgeries often end with a devastating effect of full body deformation.
Obsessive Compulsive Personality Disorder (OCPD)
In rare cases, Obsessive-Compulsive Disorder may be confused with other impulse control disorders, such as Obsessive Compulsive Personality Disorder (OCPD).
In comparison to Obsessive Compulsive Personality Disorder (OCPD), OCD is ego-dystonic, which means that the compulsions are incompatible with patient’s ego consciousness (self-concept of the patient’s personality), while in Obsessive Compulsive Personality Disorder they are ego-syntonic, which means that the content of the compulsions goes along with the patient’s self-concept. Patients suffering from Obsessive Compulsive Personality Disorder are not able to recognize that there is something abnormal about their behaviour.
Treatment of OCD with Medication
OCD left untreated tends to get more severe and can lead to full invalidism. However, with proper treatment, the symptoms of OCD can be fully suppressed, and the affected individuals can live normal lives. In more severe cases, the treatment always starts with medication, adding psychotherapy once the patient reaches a more stable phase. Only in milder cases, the use of psychotherapy as a stand-alone method can be sufficient. Combination of medication with psychotherapy in treatment of OCD is the state-of-the-art therapy.
Treatment of OCD with Antidepressants
The main medications used in treatment of OCD are antidepressants. Historically, the first effective medication used in the treatment of OCD was a tricyclic antidepressant called clomipramine.
OCD Treatment with SSRIs and SNRIs
Nowadays, the first-line medications are the antidepressants belonging to the group of selective serotonin reuptake inhibitors (SSRIs). Recent research also showed good efficacy of some antidepressants from the group of selective serotonine-norepinephrine reuptake inhibitors (SNRIs).
OCD Treatment with Atypical Antipsychotics
There is also evidence that atypical antipsychotics can be helpful. In cases where antidepressants are insufficiently effective, augmentation with a low-dose atypical antipsychotic is recommended. Augmentation refers to adding substances to an antidepressant that individually show little or no antidepressive or, in this case, “anti-OCD” effects. When combined with an antidepressant, these substances enhance the antidepressant’s effectiveness against OCD symptoms, leading to an overall improved effect. This augmentation is successful in approximately one-third of patients who did not respond to monotherapy with an antidepressant.
OCD Treatment with Mood Stabilizers
In severe cases, in order to suppress the OCD symptoms, a combination of an antidepressant, an antipsychotic, and/or a mood stabilizer could be necessary.
Dosage and Treatment Duration
SSRI dosage for OCD should generally be in the upper range, but dosage should always be discussed with the treating physician. It may take at least 4 weeks for the medication to take effect and 8–12 weeks to reach its maximum effect. Discontinuation should always be gradual, particularly following the course of additional cognitive-behavioral therapy.
Considering long-term effects, medication therapy should always be combined with cognitive-behavioral therapeutic measures.
Treatment of OCD with Psychotherapy
The main psychotherapeutic technique used in treatment of OCD is a variation of CBT (Cognitive Behavioral Therapy) called Exposure and Response Prevention (ERP). ERP gradually exposes the patients to situations triggering the compulsions, trying to block the usual compulsive act associated with the obsession.
During Exposure and Response Prevention, the patient gradually confronts triggering stimuli under the guidance of a therapist and learns to manage the arising unpleasant feelings without performing compulsive actions. Ideally, exposure to triggering situations should occur in the patient’s everyday environment (e.g., at home). Through this process, the patient realizes that the feared consequences of the situation do not occur and that they can cope with the unpleasant feelings, leading to a decrease in anxiety, disgust, or tension over time, even without performing compulsions.
Given the complexity of the disorder, multimodal cognitive-behavioral therapy approaches are typically used for moderate to severe cases of OCD. These approaches include additional cognitive-behavioral therapeutic methods as well as systemic, psychodynamic, and/or mindfulness-based elements.
The functionality of the obsessive symptoms is also considered in treatment. For instance, compulsions may serve to compensate for intense self-doubt or regulate relationships with close individuals. Involving family members in therapy is recommended, especially if they are involved in the rituals.
In the past, psychoanalytical/psychodynamic psychotherapy has been used with good effect, but there is little evidence-based data related to this psychotherapeutic technique.
Prevalence of OCD (frequency per 100 individuals of certain population)
OCD is the fourth most common psychiatric disorder after depression, substance abuse (alcohol and drug abuse), and anxiety disorders. The life prevalence of OCD (the probability of developing OCD during the entire life) varies in different countries and societies between 1 and 2%. Half of people develop OCD before age twenty. There is no gender difference in people affected by this disorder. OCD frequently co-occurs with other psychiatric disorders, such as bipolar and major depressive disorder, anxiety disorder (social phobia, generalized anxiety and panic disorder), as well as ADHD.
Course of Obsessive-Compulsive Disorder
Obsessive-compulsive disorder usually develops gradually. Over time, individuals may notice they spend a lot of time on compulsive actions or struggle to shake off obsessive thoughts. OCD can lead to problems at work, in relationships, or within the family. It becomes difficult to fulfill everyday obligations, and hobbies may become less enjoyable. Eventually, the compulsions can take over daily life.
OCD typically follows a chronic course, with periods of milder or more severe symptoms. There can also be periods without symptoms. The nature of the obsessions and compulsions may change over time.
Causes of Obsessive-Compulsive Disorder
In professional circles, it’s believed that OCD has various causes, which can also interact. These may include genetic predisposition, psychological stressors, or difficult life circumstances or crises. Personality factors, such as being particularly conscious, can also play a role.
Genetic Factors
Twin studies showed that the appearance of OCD happens more often by identical twins compared to non-identical twins. There is further evidence supporting the influence of genetics on OCD prevalence: individuals who suffer from OCD more frequently have first-degree family members affected by the same disorder. About 25% of OCD patients have an immediate family member with the same disorder. The OCD symptoms can be passed on from parents to children. This means that the biological vulnerability to OCD can be inherited.
Neurobiological Factors
These factors are related to the brain structure and, on a deeper level, to the neurotransmitters. The neurological factors are closely interlinked with genetics. Using neuroimaging technologies allows brain mapping, including the detection of functions in certain brain areas. Neuroimaging studies have shown that particular areas of the brain function differently in people with OCD as compared to a control group without OCD. This research suggests that OCD symptoms are related to a malfunction in communication in different parts of the brain, in particular the frontal part of the brain, such as the orbitofrontal and the anterior cingulate cortex. OCD could be caused by errors in the brain pathways, which link areas responsible for judgment and planning with those involved in the autonomous reactions linked to the brain structure called the amygdala. OCD sufferers also show abnormalities in neurotransmitter systems, especially the serotonergic, dopaminergic, and glutamate systems.
Environmental Factors
There are environmental stressors that can trigger the onset of OCD. These stressors include majorly stressful changes in living situations, illnesses, the death of a loved one, professional or school-related problems, or relationship concerns.
Models Explaining the Development of OCD
There are different models explaining the development of OCD, such as:
Neurobiological Models
Research suggests that OCD may involve dysfunction in certain parts of the brain (frontal cortex, basal ganglia, and limbic system). There may also be disruptions in brain metabolism related to the neurotransmitter serotonin.
Learning Theoretical Models
These propose that individuals try to avoid or reduce anxiety and tension through compulsive rituals. Additionally, the strong negative evaluation of obsessive thoughts leads to feelings of guilt, creating a vicious cycle of anxiety and compulsion.
Psychodynamic Models
These view potential causes of OCD in internal, often unconscious conflicts.
OCD Signs and Symptoms
OCD symptoms cause profound distress, consume significant time, and disrupt daily life. Common obsessive thoughts include contamination fears, violent or explicit thoughts, and an excessive focus on order and symmetry.
Compulsive behaviours range from double-checking to counting or arranging, each aimed at alleviating anxiety but leading to a vicious cycle.
Obsessions and Compulsions
Obsessions are invasive, unwanted thoughts or impulses that persist. Compulsions are repetitive actions. People with obsessions or compusions are not able to stop them voluntary. Performing them, they get short relive from anxiety. However, the relief is short, and the cycle perpetuates.
Identifying patterns helps categorize individuals into specific OCD types: washers, checkers, doubters and sinners, counters, and arrangers.
OCD and Anxiety
In the past, OCD was grouped under anxiety disorders which is understandable as the “driving force” behind the obsessions and compulsions is the anxiety. To plan effective interventions, it is important to distinguish between OCD and anxiety disorders because each disorder needs a different treatment approach.
OCD and Hoarding
Hoarding was first considered to be a part of OCD but is now seen as a separate condition, which is hoarding disorder. Distinguishing features include the emotional response to possessions and the nature of distress.
OCD-related hoarding serves as a coping mechanism, while hoarding disorders stem from a mix of pleasure and distress linked to possessions.
Self-Help Strategies for OCD
Much like a needle stuck on an old record, OCD makes the brain fixate on specific thoughts or urges. For “normal” individuals, revisiting tasks or fearing contamination is common. However, in OCD, these thoughts and behaviours are magnified.
Rituals like repetitive checking or excessive cleaning provide temporary relief from anxiety. However, the anxiety appears again soon after forcing the individual to repeat the ritual or imposing on him intrusive thoughts. Such rituals and/or thoughts can be seen as a defence mechanism. Despite their enoying or damaging effect, they are still “better” then the overwhelming anxiety.
The clutches, obsessions, and compulsions experienced with OCD can make a person feel trapped. The OCD symptoms tend to increase in frequency and severity, taking central stage in an individual’s life. They affect people’s social and professional performance, leading in extreme cases to full invalidism.
Effective Self-Help Strategies for OCD
Effective self-help strategies help to learn to resist compulsions, to face triggers gradually through exposure, and to challenge obsessive thoughts. Furthermore, building a support system, managing stress, and making lifestyle changes also contribute to overall well-being.
Identify your triggers:
- Recognize and record daily triggers.
- Rate fear intensity and document compulsions.
- Anticipate urges to resist compulsions effectively.
Learn to Resist Compulsions:
- Gradually expose yourself to triggers.
- Resist performing compulsive rituals.
- Build a fear ladder for systematic exposure.
Challenge Obsessive Thoughts:
- Accept and tolerate disturbing thoughts.
- Write down obsessive thoughts for perspective.
- Create a worry period for focused introspection.
Reach out for support:
- Build a strong support system.
- Connect with family and friends.
- Consider joining an OCD support group.
Manage Stress:
- Utilize sensory-focused self-soothing techniques.
- Practice relaxation methods like mindfulness and deep breathing.
- Exercise regularly for natural anxiety relief.
Make Lifestyle Changes:
- Prioritize regular exercise.
- Ensure adequate sleep for emotional balance.
- Avoid alcohol and nicotine for symptom management.
Treatment of OCD (Obsessive-Compulsive Disorder). Summary
The treatment of obsessive-compulsive disorder, especially with very severe life-changing symptoms, can be long and difficult. Evidence-based studies show that the best treatment results can be achieved by using psychiatric medication, mostly antidepressants, in combination with psychotherapy.
The most effective psychotherapeutic approach is Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP). During the course of treatment, the level of exposure is increased, and the patient has to learn how to suppress the compulsion and tolerate the discomfort and anxiety caused by not following the compulsion (“response prevention”). ERP has a strong evidence base and is considered the most effective treatment for OCD.
Early intervention is crucial to prevent the numerous consequences of the disorder. Even if the illness has persisted for decades, the right therapy can still be highly successful. While symptoms may not completely disappear for all patients, many experience a significant increase in quality of life as the intensity of obsessions and compulsions diminishes.
For more informations about OCD diagnosis and treatment in Dubai call: +971 4 4574240
FAQs about Obsessive-Compulsive Disorder (OCD)
Our German Clinic for Psychiatry and Psychology in Dubai provides diagnostics and therapy for OCD. Below we listed the common questions about OCD asked by our patients.
What is obsessive-compulsive disorder (OCD)?
Obsessive-Compulsive Disorder (OCD) is a mental health condition defined by persistent, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) that individuals feel compelled to carry out. These obsessions and compulsions can greatly disrupt daily life and lead to significant distress. We don’t recommend a self-diagnosis. Patients with OCD need a thorough clinical assessment.
What are the common symptoms of OCD?
Symptoms of OCD vary but may include obsessive thoughts about contamination, orderliness, aggression, or harm, as well as compulsive behaviours such as excessive cleaning, checking, counting, or arranging items in a particular way.
What causes OCD?
The exact cause of OCD is unknown, but it’s believed to involve a combination of genetic, neurological, behavioral, cognitive, and environmental factors. Certain life events, trauma, or stress may trigger or exacerbate symptoms in predisposed individuals.
Do I have OCD…
I worked as an engineer for ten years in Europe and for the last 5 years in Dubai. My wife thinks that I might have OCD. I agree that I’m a perfectionist, but this is not disturbing me. How can I exclude that I have OCD?
Answer
OCD (Obsessive-Compulsive Disorder) can appear as a variety of symptoms, such as washing compulsions, checking things countless times (e.g., locks on doors), performing rituals, arranging objects in a certain way, repeating words and phrases, or experiencing reciprocal thoughts often with disturbing content. The individual is not able to “brush out” such thoughts or urges for actions. Perfectionism without feeling restricted by it doesn’t necessarily mean that you have OCD. However, to exclude or confirm the diagnosis, you will need a psychiatric assessment.
I wash my hands frequently…
Since the pandemic, I noticed that I’m washing my hands at least 10 times per day. Where is the division line between hygiene and OCD? Where can I diagnose OCD in Dubai?
Answer:
Diagnosis typically involves a comprehensive evaluation by a psychiatrist or psychologist. The assessment includes a thorough review of symptoms, medical history, and possible contributing factors. Based on that we can secure or exclude the diagnosis of OCD.
Where and how to treat obsessive-compulsive disorder (OCD) in Dubai?
The assessment for OCD can be done at our psychiatric clinic in Dubai.
Treatment for OCD often involves a combination of psychotherapy, medication, and lifestyle modifications. Cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is considered the most effective psychotherapy for OCD. The most effective medications in the treatment of OCD are the antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs).
My husband suffers from OCD. How can I support him?
Supporting someone with OCD involves providing empathy, understanding, and encouragement while avoiding judgment or criticism. Encouraging them to seek professional help and participate in treatment, as well as learning about OCD together, can also be beneficial.
My OCD is taking over…
My OCD is getting worse. I work as an accountant in Dubai. At work I had to read several times the same sentence, which massively affected my work performance. If I stop the repetive re-reading, I feel extremely anxious. I feel that I will never get rid of it. I had psychotherapy for OCD in the past. There was some improvement, but the symptoms never went away. Now I am feeling hopeless. Is there anything you can do for me?
Answer:
As you know, OCD is an anxiety-based disorder. Once the patient tries to stop rituals or obsessive thoughts, he will be stiked by anxiety. In milder phorms of OCD, psychotherapy alone might be sufficient. For treatment of OCD in our clinic in Dubai, we use cognitive-behavioral therapy (CBT) or exposure and response prevention (ERP). However, when an OCD is debilitating, the most effective method is the combination of treatment with medication (usually with antidepressants). Untreated OCD can lead to severe social or professional consequences and to full invalidism.
Can OCD be treated and cured? Where can I find an OCD therapist in Dubai?
While there is no definitive cure for OCD, many individuals experience significant symptom relief and improvement with proper treatment and ongoing management. With therapy and medication, individuals can learn to better manage their symptoms and lead fulfilling lives.
At our German Psychiatric Clinic in Dubai, we offer comprehensive assessment and treatment of OCD.
Are OCD thoughts real?
Question:
I’m getting again and again negative thoughts that something terrible might happen to my family. Logically, I can’t spot any danger, but I’m not able to brush out the compulsive thoughts.
Answer:
Obsessive thoughts experienced in obsessive-compulsive disorder (OCD) are real in the sense that individuals genuinely experience them. However, these thoughts are often irrational, intrusive, and distressing, causing significant anxiety and disruption to daily life. It’s important to understand that while the thoughts themselves may not reflect objective reality, the distress they cause is genuine and can have a profound impact on the individual’s well-being.
I live in Dubai and have suffered from OCD for several years…
Question:
I still take medication prescribed in my home country. In the past few months, the OCD symptoms have been getting stronger. How do I get rid of the symptoms? What can I do on my own to control the OCD symptoms?
Answer:
Without a proper treatment, OCD tends to get chronic. Treatment for OCD lasts in avarage longer than treatment for anxiety or depression. Therapy for OCD lasting several years is not unusual.
The state-of-the-art therapy for OCD is a combination of medication with regular psychiatric monitoring and psychotherapy. There are self-help strategies complementary to the above-mentioned OCD treatment management.