Just as Sydenham chorea can present as a sequela from Streptococcus infections, the theory behind OCD is similar in that the strep infection, through molecular mimicry, causes autoimmune antibodies against the basal ganglia leading to obsessive thoughts and compulsive habits. The earlier onset of sudden OCD that is preceded by a Streptococcus infection has been known as PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections). Īn inability to cope with uncertainty, an increased sense of responsibility as well as magical thinking seem to predispose those to obsessive-compulsive habits. For example, mutations in the NMDA subunit “NR2” have been linked to fears of contamination and compulsive cleaning. In mice and human experiments, mutated NMDA can cause an increase in OCD-like behavior. There is a genetic predisposition, as 45 to 65% of the variance of OCD is attributable to genetic factors. The exact cause of obsessive-compulsive disorder (OCD) remains unknown, but it is likely multifactorial. These areas of the brain do not typically correspond with anxiety and fear as previously thought and further separate OCD as an “anxiety” disorder. The use of modern technology has allowed us to map areas of the brain that get affected by this disorder. However, only recently has the DSM listed OCD as less of an “anxiety” disorder, and more of a disorder similar to hoarding, body dysmorphia, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. Termed “obsessional neurosis” by Freud in 1895, OCD has had acknowledgment for centuries. Īs OCD has the possibility of hindering one’s social growth and development, the WHO lists OCD as one of the ten most disabling conditions by financial loss and a decrease in quality of life. The most common obsessions include fears of contamination, fears of aggression/harm, sexual fears, religious fears, and the need to make things “just right.” The compensatory compulsions for these obsessions include washing and cleaning, checking, reassurance-seeking, repeating, ordering, and arranging. These compulsions may be illogical or excessive. Compulsions are actions the patient feels pressured to do in response to the anxiety/distress producing obsessions or to prevent an uncomfortable situation from occurring. Obsessions are defined as intrusive thoughts or urges that cause significant distress the patient attempts to neutralize this distress by diverting thoughts or performing rituals. The behaviors or mental acts aim at reducing anxiety or distress or preventing some dreaded situation however, these behaviors or mental actions do not connect in a realistic way with what they are designed to prevent or are clearly excessive.ī. The obsessions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.Ĭ. The obsessive-compulsive symptoms do not arise from the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.ĭ. The symptoms of another mental disorder do not better explain the disturbance (e.g., excessive worries, as might be found in a generalized anxiety disorder preoccupation with appearance, as seen in a body dysmorphic disorder difficulty discarding or parting with possessions, as found in a hoarding disorder hair pulling, as in trichotillomania a hair-pulling disorder skin picking, as appears in excoriation disorder stereotypies, as found in a in stereotypic movement disorder ritualized eating behavior, as found in eating disorders preoccupation with substances or gambling, as seen in a in substance-related and addictive disorders preoccupation with having an illness, as found in illness anxiety disorder sexual urges or fantasies, as found in a paraphilic disorders impulses, as seen in a disruptive, impulse-control, and conduct disorders guilty ruminations, as occurs in a major depressive disorder thought insertion or delusional preoccupations, as found in schizophrenia spectrum and other psychotic disorders or repetitive behavior patterns, as found in an autism spectrum disorder).
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