Obsessive compulsive disorder (OCD) is broadly classified as an anxiety disorder that results in the individual attempting to resolve obsessive thoughts through repetitive behaviors, known as compulsions. Individuals with this disorder are often unaware that they are afflicted because they view their compulsions as reasonable responses to their thoughts. While many different individuals engage in this obsessive compulsive behavior on some level, it is categorized as a psychological disorder when it begins to interfere with normal life activities. As such, different individuals with OCD have different levels of affliction and the treatment process for individuals with this disorder therefore varies. It is necessary for researchers and clinicians to pay attention to this disorder because not much is currently known about it, despite the adverse effects experienced by many individuals living in the country. By gaining a greater understanding of OCD, we will be in a greater positon to help those who are afflicted with it.
Typically, OCD centers on a fear or a group of fears held by an individual. The compulsion is typically enacted as a way to cope with this fear. Common obsession symptoms include a fear of dirt of contamination, requiring objects to be orderly, having terrible thoughts about self-harm, and experiencing a series of unwanted thoughts (Mayo Clinic, 2013). While these obsession symptoms are the most common, it is possible for individuals with OCD to fixate on other things as a part of the obsessive component of the disorder. The compulsive symptoms are often related to the obsession symptoms in patients with OCD and are therefore variable depending upon an individual’s particular obsession. Individuals who are afraid of dirt may engage in ritualistic cleaning habits and avoid making contact with others for worry of germ transfer. Individuals that need to have objects orderly and clean may spend a lot of time arranging and rearranging them in terms of size and color.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, obsessions are formally defined as “recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress” and “individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action” (American Psychiatric Association, 2013). Meanwhile, compulsions are defined as “repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly” and “the behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive” (American Psychiatric Association, 2013). Therefore, the compulsion is a manner in which the afflicted individual chooses to make amends with the obsession, although afflicted individuals may not recognize that this is what they are doing.
Leonardo DiCaprio is an individual that is considered to have OCD according to the standards put forth by the DSM-V. When he was a child, he would need to purposely step on every gum mark he would see on the sidewalk. As an adult, he admits that he is a germaphobe and does the best he can to make as little physical contact as possible with those around him. According to DSM-V standards DiCaprio’s obsession appears to be related to cleanliness; as a child, this was related to his ability to need to notice gum on the streets. This tendency to pay mind to all the gum marks within his range altered to the need to pay attention to the cleanliness of both animate and inanimate objects as an adult.
It is believed that individuals develop OCD as a consequence of trauma, although family history and chemical imbalances in the brain are likely to be contributing factors. DiCaprio’s experience demonstrates a clear interplay between the environmental factors that cause the disease and the genetic. While it cannot be determined what caused his fascination with gum marks on the road, it is clear that this repetitive behavior eventually caused the evolution of his obsession to a more severe one, as this new mental state impacts a higher percentage of situations. Despite knowledge that genetics and environmental factors play a role in the development of OCD, the specific causes of the disorder are not currently known.
While major biochemical studies have been underway to understand the chemical basis of OCD, conventional treatment efficacy has proved to be a useful way to gain insight into the relationship between OCD and neurotransmitters. Many studies have shown that serotonin reuptake inhibitors (SRIs) function as antidepressants and have antiobsessional effects (Greenberg et al., 1997). As a consequence, it can be concluded that serotonin plays a role in OCD. It is likely that those afflicted by the disorder are able to reuptake higher amounts of serotonin than individuals without these obsessions. It is also possible that individuals with greater amounts of serotonin have more severely obsessive thoughts that those with lower amounts. This relationship also demonstrates that the genes that are likely markers for OCD could be related to neurotransmitter production, just as the environmental factors that cause the disease likely result in an alteration of the amount of serotonin produced.
In addition to the use of that serotonin reuptake inhibitors (SRIs) for treatment of OCD, psychotherapy has been found to be an effective treatment method (Abramowitz, 2008). However, this method is more effective for individuals that have had environmental triggers for the illness. For example, individuals that have developed obsessions as a consequence of traumatic events would benefit from therapy because this process will allow them to have a greater understanding of the event that triggered their psychosis. As a consequence, they will be given an enhanced ability to recognize when their compulsions are direct responses to this event and determine how to meaningfully remove this behavior from their reactive patterns. Often, the traumatic event may have occurred during childhood or at a time in life that the individual does not remember, so psychotherapy is an effective way to help these individuals recall these events and start breaking the repetitive cycle. Leonardo DiCaprio has been able to reduce the extent to which his disorder impacts his life in this manner. However, it is necessary to consider that for some individuals, a combination of medication and therapy is needed to accomplish this. While researchers can ascribe the efficacy of medication, therapy, or a combination of the two for the treatment of OCD, this effect is ultimately dependent upon the individual’s needs. OCD cases are very diverse in nature and a treatment method that works for one individual may not be applicable for the next. It is therefore necessary for medical professionals to personalize OCD care and to try different treatments in order to optimize this process for their patients.
Despite the progress that scientists and clinicians have made with regards to OCD, there is still much that is unknown. Researchers are continuing to examine the relationship between genetics and environmental factors that cause the disease to gain a greater understanding of who is at risk of developing the disorder and whether onset could be prevented. Furthermore, while a combination of medication and therapy is currently being provided to treat patients with OCD, pharmaceutical developers and therapists are working to develop more effective treatments. Therefore, while our knowledge of OCD has increased significantly over the past several decades, there is a need to continue to grow and understand the disorder. Even though OCD only impacts 1% of the adult population in the United States, more than half of these cases are considered to be severe in terms of symptoms. Therefore, there is a large number of individuals living in this country that are experiencing adverse effects of OCD with regards to their ability to live normal lives. In order to help these people and the many others that are likely to develop this anxiety disorder in the future, it is necessary to gain a greater understanding of the biological, chemical, and psychological basis of this disease.
Abramowitz JS. (2008). The Psychological Treatment of Obsessive-Compulsive Disorder. Can J Psychiatry, 51(7): 407-416.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Retrieved from http://beyondocd.org/information-for-individuals/clinical-definition-of-ocd
Greenberg BD, Altemus M, Murphy DL. (1997). The role of neurotransmitters and neurohormones in obsessive-compulsive disorder. International Review of Psychiatry, 9(1): 31-44.
Mayo Clinic. (2013). Obsessive-compulsive disorder (OCD). Retrieved from http://www.mayoclinic.org/diseases-conditions/ocd/basics/symptoms/con-20027827