What is OCD?
In everyday language, one might hear that another is “obsessed” or preoccupied with an idea or a person. However, that ‘obsession’ likely isn’t contributing to problems with day-to-day living.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), Obsessive Compulsive Disorder (OCD) is a condition in which a person has recurrent, uncontrollable thoughts, images, or impulses (obsessions) that lead to repetitive behaviors (compulsions) or mental acts (praying, counting, or repeating words silently), that the individual feels they must perform in response to an obsession or according to rigidly applied rules. These behaviors or mental acts are time-consuming (more than one hour a day), interfere with daily activities, and cause distress for that individual.
OCD does not discriminate. It affects all genders, all races, all ethnicities, all backgrounds, and both children and adults. The most common peaks of onset are 8-12 years of age and late teens to early adulthood; and it is estimated that about 1 in 100 adults and 1 in 200 children and teens currently have OCD. While OCD tends to run in families, heredity does not fully explain the etiology.
Comorbid conditions are common with OCD and include major depressive disorder, anxiety disorders, and neurodevelopmental disorders including tic disorders, Tourette syndrome, and attention deficit hyperactivity disorder. The gold standard for screening for OCD is the Yale-Brown Obsessive-Compulsive Scale, which is readily available online.
Providers should be aware of a disorder entitled PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) which has a sudden onset of OCD after infection and can present with severe and debilitating symptoms. Suspicion for the presence of PANDAS requires immediate neuropsychiatric referral for appropriate therapy.
OCD is treatable with a combination of cognitive behavioral therapy (CBT) and medication support. The most effective sub-type of CBT for treatment of OCD is Exposure and Response Prevention (ERP). ERP involves confronting the obsessions that cause anxiety and choosing to NOT respond with a compulsive behavior under the guidance of a therapist. This process is designed to “retrain the brain” that an obsession should no longer be viewed as a threat. PAs working in the behavioral health field may be trained to conduct CBT or ERP, but if not, referral to an experienced provider is warranted.
PAs make an impact by recognizing signs and symptoms of OCD, and when needed, connecting patients and families to resources and mental health providers for additional care. For more information on the disorder or to find a provider who may be able to assist patients in your area, please contact the International OCD Foundation at https://iocdf.org/
References:
- Schuyler M, Geller DA. Childhood Obsessive-Compulsive Disorder. Psychiatr Clin North Am. 2023 Mar;46(1):89-106. doi: 10.1016/j.psc.2022.10.002. Epub 2022 Dec 26. PMID: 36740357.
- Obsessive-Compulsive and Related Disorders. Diagnostic and Statistical Manual of Mental Disorders. August 2024. doi:1176/appi.books.9780890425787.x06_Obsessive_Compulsive_and_Related_Disorders
- Sigra, S. Hesselmark, E, & Bejerot, S. Treatment of PANDAS and PANS: a systematic review, Neuroscience & Biobehavioral Reviews, Volume 86, 2018, Pages 51-65, ISSN 0149-7634, https://doi.org/10.1016/j.neubiorev.2018.01.001.