OCD:

Obsessive-Compulsive
Disorder
By: Ryleigh O’Brien, Katie Celarek, and Emily Wiezorek
What is it?
● Obsessive-compulsive disorder is characterised by intrusive thoughts or images (obsessions),
which increase anxiety, and by compulsions which decrease anxiety. The most recent revision
of the diagnostic criteria for obsessive-compulsive disorder in the Diagnostic and Statistical
Manual of Mental Disorders (DSM) emphasises that compulsions can be observable behaviours
or mental rituals
● It affects around 2% of the world’s population
○ There are many subcategories that can go into OCD such as:
■ Body Dysmorphic Disorder
■ Hoarding Disorder
■ Trichotillomania (Hair-Pulling Disorder)
■ Excoriation (Skin-Picking)
■ Disorder Substance/Medication-Induced Obsessive-Compulsive
■ Related Disorder Obsessive-Compulsive
■ Related Disorder Due to Another Medical Condition Other Specified Obsessive-Compulsive
■ Related Disorder Unspecified Obsessive-Compulsive and Related Disorder
Symptoms:
● The most common symptoms seen are:
○ Contamination concerns i.e frequent washing ,cleaning etc
○ Concerns about harm to self or others
● However, many obsessions and compulsions have been identified, including sexual,
religious, somatic, and musical symptoms
● The symptoms do not differ much between adults and children
○ However they do differ if they experience tics or not
● The mean age at the onset of OCD ranges from 22 to 36 years, with the disorder
developing in only 15 percent of patients older than 35 years
Diagnosis:
● Obsessive-compulsive symptoms have
been associated with various neurological
lesions of the
cortico-striatal-thalamic-cortical circuits,
which can arise after administration of
dopamine agonists (such as cocaine), or
after streptococcal infection
○ symptoms of obsessive compulsive
disorder must be accompanied by marked
distress and dysfunction
Epidemiology
● Obsessive compulsive disorder was the fourth most prevalent psychiatric disorder, with a
lifetime prevalence of 2-5%. Results of a cross-national study with similar methods showed that
prevalence did not differ by much across many different populations.
● The male to female ratio is similar to other anxiety/mood disorders where it is more common
in females than males
○ roughly 50 percent of adults with OCD are women
● If diagnosis with OCD, one is more than likely to be diagnosed with another anxiety/mood
disorder (comorbidity)
○ These findings also suggest that some patients with obsessive-compulsive disorder have
impulsive features, including symptoms of childhood conduct disorder and an increased
rate of suicide attempts
● There is a large failure to recognize/treat and mistreat OCD as well
○ On average, people with OCD see three to four doctors and spend more than nine years seeking
treatment before they receive a correct diagnosis. It takes an average of 17 years from the onset of OCD
to obtain appropriate treatment.
Treatment:
OCD in Different Cultures
United States
● OCD is one of the most widely recognized mental diagnoses in the United States
● OCD affects about 2.2 million adults or roughly 1% of the U.S population
● Equally common amongst men and women
● One third of effected adults first experience symptoms in childhood
● 25% of cases are reported happening as early as 14
● The average age of onset is 19
● Symptoms of OCD in the United states are identified by the DSM-V
Treatment in the United States
- Cognitive Behavioral Therapy (CBT)
- a type of treatment that helps individuals cope with and change problematic thoughts,
behaviors, and emotions.
- Exposure and Ritual Prevention
- The specific type of CBT used to treat OCD.
- This type of therapy is designed to break 2 types of associations:
- Association between sensations of distress and the objects, situations, or thoughts that
produce this distress
- Association between carrying out ritualistic behavior and decreasing the distress
- Medication
- While medication can work by itself, doctors recommend that patients take it in
congruence with a form of cognitive behavioral therapy.
Undiagnosed OCD in the U.S
● Despite the abundance of treatment options in the United States, many OCD cases go undiagnosed:
● Hiding symptoms:
○ Many people hide their symptoms and do not seek help. Some don’t know that OCD is treatable, while others are
reluctant to admit they need help.
● Discomfort discussing symptoms:
○ OCD can involve unwanted thoughts with disturbing content, including violence, sexuality, blasphemy and illness.
Some people with OCD are uncomfortable discussing these thoughts, even with a therapist or doctor.
● Fear of Change:
○ Some people with OCD are afraid to begin treatment because they feel a sense of safety and control over their
symptoms with their current coping mechanisms
● Unrecognized symptoms:
○ There are many common but less familiar symptoms that may not be recognized as signs of OCD. The disorder
can take many forms and isn’t limited to familiar or obvious types of OCD.
● Treatment affordability:
○ Those without health insurance or whose insurance policies do not fully cover mental health care sometimes
struggle to get the treatment they need.
Singapore
● 4.8% of the population have been diagnosed with OCD
○ 1 in 7 adults have been diagnosed
● OCD is highly comorbid with other psychiatric disorders including alcohol use disorder,
bipolar disorder, and depression
● It is the third most prevalent mental health condition behind major depressive disorder
and alcohol abuse
● Significantly associated with suicidal ideation and suicidality
● Equally common amongst men and women
● While the name OCD is loosely used in Singapore, the symptomatology aligns pretty
closely with the DSM-V
How OCD is Viewed
● Majority of individuals with OCD do not seek out any professional help
○ There is a large stigma around mental illnesses in general
● There is a significant treatment delay from the time an individual first experiences
symptoms until the actual time of treatment.
○ The average time for OCD is 11 years
● Singapore is very inconsistent in terms of the distribution of wealth
○ Studies show that if an individual in Singapore were to row up in poverty, then they would be
twice as likely to develop OCD in comparison to a child who did not live in Poverty
● Residents call OCD fits as being “Seized by Evil Spirit”
● Lack of funding
○ Singapore is considered an underdeveloped country and it can’t provide the necessarily help
needed to treat the overwhelming cases of OCD
○ Lack of healthcare professionals
India
● Epidemiology
○ lifetime prevalence of 0.6%. This rate is considerably lower compared to the
2-3% rate reported in the European and North American studies.However,
similar low rate ranging from 0.5-0.9% was observed in a study from Taiwan.
● Phenology
○ In a study that compared 200 patients with 200 controls reported a high rate of family
history of obsessional illness (26%) and premorbid obsessional personality (26%). Two
other studies also reported high rates of obsessive personality.
○ Males had early onset OCD and reported higher religious obsession, misc. compulsion
and ADHD
○ Females had high prevalence of cleaning compulsion and comorbid trichotillomania
■ Also have a higher sucidal risk
Comorbidity

● Prevalence of tic disorders (39%), hypochondria (13%), body dysmorphic disorder

(3%) and trichotillomania (3%) were significantly greater in OCD subjects
○ For example: Tic related OCD had an early age at onset, over representation
in males, aggressive obsessions, cleaning compulsions and comorbid
trichotillomania.
● Looking at a study of comorbidity in 218 OCD subjects, 17% had major depression
and 7% had an anxiety disorder. Comorbidity rates were low and there were not
many differences between those with and without comorbidity except that female
subjects were more likely to have depression
Outcomes
● In an 11-13 year follow-up study of 75 subjects with OCD, Reddy et al.
reported a favorable outcome in majority of the subjects: 43% had no OCD,
33% had subclinical OCD and only 24% had clinical OCD.
● Interestingly, 37% were in true remission (‘no OCD’ and not on any treatment)
for a median period of 132 months. Those who had ‘mixed’ OCD and
comorbidity had poorer outcome.
○ Age of onset and duration of illness had no effect on outcome.
● Optimistic outcome reported in this study is somewhat different from the
findings of studies from other parts of the world which have reported lower
rates of remission.
Treatment
● Uses the DSM model for labels
● Indian research on various aspects of OCD has shown broad
similarities with that of research from the other parts of the world.
Clinical profile of OCD seems to be similar to what is described in the
literature. Comorbid patterns also appear to be similar across
cultures. Follow-up studies have shown that prognosis is favorable in
the long-run.
○ Overall, There is surprisingly limited amount of data from India on
treatment aspects of OCD.
Conclusion
● OCD has many similarities across the globe
● Comorbidity is a common occurrence when one is diagnosed with OCD
● Males have onset first, followed by females
○ However, their compulsions/obsessions are usually different
● The DSM is a consistent use of symptomatology and diagnosis of OCD
across the globe
● Overall, the United States has the most prevalence of OCD across the
globe
○ They are the most accepting of it as well
References:
Cherian, Anish V., et al. “Gender Differences in Obsessive-Compulsive Disorder: Findings from a Large Indian Sample.”
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