Anxiety and Obsessive-Compulsive Disorder.

Anxiety and Obsessive-Compulsive Disorder.

Historically, Obsessive-Compulsive disorder and generalised anxiety disorders were regarded as anxiety disorders but research has shown that they differ. Anxiety disorders display both common and unique features. How can we distinguish the two?

Overlap

Anxiety is an umbrella term for a variety of anxiety-related conditions. Anxiety disorders affect 18.1% of the population in the US. A common diagnosis (DSM-5) within the anxiety umbrella is a generalized anxiety disorder, excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). Distressing thoughts are present both in generalised anxiety disorder and OCD but 

the latter is characterised by the fact that these obsessive thoughts trigger compulsive actions. A person with a generalised anxiety disorder will experience worries as well as physical symptoms (such as hyperventilation) without having to take compulsive actions. Generalised anxiety disorder and OCD are not mutually exclusive: it is possible to have both but one does not require the other. 11% of people diagnosed with OCD also have anxiety disorders.

The overlap between anxiety disorder and OCD is due to shared genes, shared brain mechanisms and shared treatments.

The similarities are based on a shared genetic and biological foundation that are linked to the experience which can be summarised as distress and negative affectivity The overlap between anxiety, depression, and obsessive-compulsive disorder – PubMed (nih.gov) Anxiety and Obsessive-Compulsive disorders are both associated with the way individuals react to threats especially the threats in their environment. Neuroimaging has been used to analyse the mechanisms. 

Both anxiety and OCD trigger debilitating symptoms. So, the question that follows is what is causing them. Well, the answer is the Amygdala is located in the emotional part of our brain, more specifically the limbic system. It is tiny and has an almond shaped structure. It reacts to new or threatening objects. When the amygdala is triggered it sends signals to both our brain and our body in order for the body the adjust to the fight or flight event. Many reactions such as heart beat, blood pressure and adrenalin release are activated. The helps the body get equipped to protect itself. The amygdala is really fast at reacting and is such as that we literally have nothing to do consciously to prepare ourselves in such situations. The reactions triggered by the amygdala happen just like this.

The treatment for anxiety including generalised anxiety disorder is usually a combination of CBT and medication.

What is CBT?

Cognitive behavioural therapy or CBT is a psycho-social intervention which intends to reducing the symptoms of various mental health conditions especially depression and anxiety. It focuses on challenging and changing the thoughts and beliefs.  CBT helps clients improve emotional regulation and develop coping strategies to solve problems. CBT is composed by evidence-based therapies that are based on the idea that the way a person behaves and feels is highly influenced by their thoughts.

Treatments for anxiety and OCD are usually the same drug or same choice of drugs.

Obsessive Compulsive Disorder

There has been a major shift regarding OCD over the last decade: from untreatable long-lasting psychiatric disorder to a manageable one. Yet it is important to highlight that there is a long way to go before OCD can be described as easily treatable or treatments highly effective. Nowadays, a substantial proportion of the OCD population receiving treatment, is not actually treated. Obsessive-compulsive disorder: Evidence-based treatments and future directions for research (nih.gov) 

What is OCD?

OCD is described by intrusive, troubling thoughts (obsessions), and repetitive, ritualistic behaviours (compulsions) which are prolonged, weaken functioning and/or cause distress. Each time an obsession occurs, there is a huge increase in anxiety and distress. The compulsions are usually a way to deal with the anxiety and distress, a way to reduce it. The most common compulsions are: cleaning, washing, checking, repeating, praying touching, tapping rubbing and avoidance. Cultural backgrounds have not been linked to the prevalence of OCD. Indeed, research has shown very few differences across different countries. Yet, the symptoms expression does vary from one country to another. Cultural differences such as religion impact the way symptoms are expressed. For example, in Judaism an emphasis on cleanness has been highlighted as well as religious obsession in Muslim communities.

Besides, there are associated conditions to OCD. The most prevalent ones being anxiety disorders, depression and alcohol abuse. 

The main treatment for OCD is cognitive-behavioural therapy CBT. OCD it is usually treated with a type of CBT called exposure and response prevention. The latter emphasise on targeting the obsessions and compulsions experienced by the patient. What happens during sessions? A patient works along with the therapist to slowly be able to expose themselves to the source of the obsession without actually taking compulsive action. The main goal of this type of therapy is to make them realise that a compulsive thought does not need to be followed by a compulsive action and that it is possible to sit with the discomfort of their thoughts. This enables them to overcome OCD.

Future directions

There have been major improvements in the treatment of OCD especially in comparison to 30 years ago but, there are many areas where improvements are possible/necessary. The incorporation of technology in the treatment of OCD have been proven to be a success and further research and efforts would be beneficial.

Charlotte Cremers
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MS, University of Tartu
Sleep specialist

Using the acquired academic and professional experience, I advise patients with various complaints about mental health - depressed mood, nervousness, lack of energy and interest, sleep disorders, panic attacks, obsessive thoughts and anxieties, difficulty concentrating, and stress. In my free time, I love to paint and go on long walks on the beach. One of my latest obsessions is sudoku – a wonderful activity to calm an unease mind.

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