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OBSESSIVE COMPULSIVE DISORDER: “It’s a Great Pity That the Notion People Can be “a Little OCD” Has Trivialised What Can be a Devastating Illness”

Obsessive Compulsive Disorder is a complex psychiatric condition that involves a pattern of intrusive thoughts, images, or urges that cause distress and anxiety. These obsessions are often followed by repetitive behaviours or mental acts, known as compulsions, which are performed in an attempt to alleviate the anxiety generated by the obsessions. Although individuals with OCD may recognise that their thoughts and behaviours are irrational, they find it difficult to control or suppress them.

The exact cause of OCD remains unknown. However, research suggests that a combination of genetic, neurobiological, and environmental factors contributes to the development of the disorder. People with a family history of OCD are at a higher risk, indicating a potential genetic predisposition. Additionally, imbalances in brain chemicals, particularly serotonin, have been implicated in the manifestation of OCD symptoms and certain life events, such as trauma or significant stress, can also trigger or exacerbate the condition.

It is a condition that is not only difficult to treat, but it is also still very much misunderstood and at times trivialised. For those engaged in a daily battle against OCD, It can cripple their ability to function and leave them haunted by the rituals that stalk them each and every day.

However, new research, carried out by a team of academics and Trevor Robbins, Professor of Neuroscience, at the University of Cambridge which was published in Nature Communications, has discovered an imbalance in brain chemicals in OCD that could lead to radically different and improved treatments.

The Atlantic Dispatch had the pleasure to sit down with Professor Trevor Robbins to learn more about Obsessive Compulsive Order and just how debilitating it can be.

You recently wrote an article in The Conversation where you mention how people often jokingly remark that they have OCD. But just how debilitating can OCD be for an individual and is there a proper understanding of just how much it can affect a person?

Robbins: Severe OCD can result in people not venturing outside their homes for months on end. Performing rituals for long periods each day prevents them from engaging in useful activities and being plagued by intrusive, unpleasant thoughts.

A common experience is ego dystonia- a feeling of not being in control of your own behaviour. Unsurprisingly, this can also lead to severe depression as well as anxiety and suicidal ideation. Sometimes OCD converts into schizophrenia.

It is a great pity that the notion that people can be “a little OCD” as this has trivialised what can be a devastating illness. It is true that compulsivity varies along a spectrum and probably is expressed in minor ways in our everyday behaviour- but compulsivity is not the same as compulsions, which only occur at high levels of the former.

Why do so many cases of OCD go undetected? Is it a difficult condition to truly diagnose? Do you feel it is quite possibly a condition that maybe isn’t taken as seriously as it should be and can it get worse the longer it is taken to diagnose?

Robbins: Yes, the syndrome is not taken as seriously as it should be because of the issues raised above, and also because of media trivialisation (the TV show Cleaners, and Jack Nicholson in As Good as it Gets.) This may also account for why people do not present with the disorder, as well as the stigma associated with such behaviour which sounds as though it should be easy to correct but isn’t. And it gradually gets worse. Most cases of adult OCD in fact started during childhood and adolescence and should have been treated then.

What are some of the symptoms of OCD? And what makes those different from say somebody who has a slight tendency to always put their left shoe on first for example?

Robbins: Repetitive checking is the most prevalent symptom. Spending long periods checking the door is locked for example can prevent people from going to work. Repetitive hand-washing sometimes associated with fears of contamination with germs is also common and crippling- e.g. if done with bleach. Perfectionism and ‘just right’ behaviours are also ritualised.

Obsessions causing harm to others can cause repetitive avoidance behaviours which prevent social intercourse. Compulsive hoarding may also be part of OCD although some think it is a separate disorder. We think that some of these are related to uncontrolled habits and routines (like putting on your left shoe first) which have developed into compulsions.

How important is your research that has discovered an imbalance in brain chemicals in OCD that could lead to radically different and improved treatments? What could this potentially mean for people with the condition?

Robbins: We think it is important to understand the brain basis of mental health disorders and hence discover new treatments, whether these are behavioural/cognitive, drug-related, neuromodulatory (such as transcranial magnetic stimulation) or surgical in severe cases. Our discovery of neurochemical imbalance in OCD provides one target for such treatments to correct.

It seems that now more than ever we are seeing more awareness of neuroscience.  How important is it that we continue to promote an understanding of everything that neuroscience involves?

Robbins: Neuroscience is important for understanding how our thinking and behaviour are controlled by the brain, for enhancing how education works and for treating a range of mental health disorders from Alzheimer’s disease to depression and schizophrenia.  

With thanks to Trevor Robbins, Professor of Neuroscience, at the University of Cambridge

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