Obsessive-Compulsive Disorder (OCD) & OCD Personality

We often hear the label "your OCD!" or something to that extent, which may describe meticulous behaviors like cleaning and organizing. It's a socially accepted term for some, but a psychiatric diagnosis for others. In fact, there's even differences in the actual diagnosis, versus having OCD personality disorder; a cluster C classification among the 10 known and accepted personality disorders. Technically, OCD is a mental health disorder in which obsessions and/or compulsions cause significant distress, are time consuming or interfere with normal activities including occupational or social function and may affect relationships. This condition affects 1-2.5% of the population and is considered the fourth most common mental illness. (R)

OCD Personality

OCD personality disorder is a fixed pattern with long standing traits characterized by a pervasive preoccupation with orderliness, perfectionism, and control (with no room for flexibility) that ultimately slows or interferes with completing a task. In other words, someone with OCD personality may have this the rest of their life with little improvement. Personality disorders are rigid and difficult to treat compared to mental health disorders, which may come and go based on situation and lifestyle factors.

Mechanisms

OCD is likely a combination of genetic and environmental influences. Certain genes link to neurotransmitter dysfunction including glutamate, dopamine and serotonin. (R) Common accepted cognitions (thought patterns) have included overestimation of threat, intolerance for uncertainty and need for perfection, control and importance of thought. And, surprisingly, pregnancy seems to be the initial onset for some women or particular time period where OCD is increased. (R) Another associated trigger of OCD may come on after an infection, termed PANS, or even PANDAS if strep induced. PANS is an acronym for pediatric autoimmune neuropsychiatric syndrome and may be described by a sudden onset of OCD and regressive behaviors in children including changes in language and social function. (R)

Signs and Symptoms of OCD

OCD really does boil down to both obsessions and compulsions. Obsessions are intrusive, unwanted anxiety-provoking thoughts that result in some form of action to reduce the emotional stress. Obsessions may include the fear of contamination, need for neatness or even symmetry, sexual or religious obsessions, and fear of making a mistake to name some. Compulsions, on the other hand, are described as behaviors that are designed to decrease the anxiety, although, this may be reinforcing the initial obsessions, however. Common compulsions include cleaning, hand washing, checking i.e. locks or windows, hoarding, and seeking reassurance from others. There's also mental compulsions where people repeat words silently to attempt to lower anxiety and discomfort. Hair pulling and skin picking (excoriation) are forms of OCD, too, that involve repetitive behaviors and diminished control.

Management

OCD can be debilitating for people as it controls their thoughts and dictates their day. Some avoid social and occupational activities as they prioritize (usually unconscious) their compulsions based on the avoidance of pain and anxiety from their obsessions. There's good evidence with various psychotherapies and medication, where some may need both. In regard to therapy, the gold standard is exposure and response prevention. Here, the idea is to expose one to the obsession and attempt to delay or fully prevent the response. This will rewire the brain and create small victories that will build momentum, confidence and decrease anxiety over time. Other treatment strategies include Selective Serotonin Reuptake Inhibitors (SSRI's) which is often used as first-line pharmacological management, although dosing is considerably higher than in depression and anxiety. Other medications include Clomipramine and depending on the exact case, D2 inhibitors can be used, too, but rarely. Naturally, N-Acetyl Cysteine (NAC) has been seen to help aid OCD with dosing well above 1000mg daily. (R) I tend to use NAC for anyone with mood dysregulation, anxiety, depression and OCD, because it works very well with minimal side effects. Other nutrients relevant for OCD include Folate (B9), Vitamin D, Curcumin, Valerian, Selenium, Zinc, Milk Thistle, Myo-inositol, and Glycine. (R)