Global Burden of Obsessive-Compulsive Disorder, Research Paper Example

Abstract

Obsessive compulsive disorder (OCD) is characterized according to DSM-IV classification as a condition that involves recurring, intrusive thoughts or images and ritualistic behaviors created to neutralize the above thoughts and images (Menzies & de Silva, 2003, p. 6). It is closely related to other anxiety-based, impulse control, eating disorders, as well as depression. The conditions and symptoms often overlap each other, therefore, the categorization of OCD is often debated and criticized. Prevalence of the disorder has been estimated by several authors, and while studies contradict each other, measuring the percent of the affected population between 1 and 3.3 percent  (Menzies & de Silva, 2003, p. 18). Still, the author confirm that because the condition is generally under-reported, the estimates might be lower than the actual figures. The below study is attempting to review the categorization of the illness, the research of symptoms, treatments and causes based on the analysis of recent scholarly articles, in order to reveal the most successful approaches towards understanding and treating OCD.

Introduction

Significance of the Problem

According to the National Institute for Mental Health (Kessler, Demler & Walters, 2005), one percent of the adult population in the United States experienced obsessive compulsive disorder. Other publications (Menzies & de Silva, 2003, p. 18) report 1.9 to 3.3 percent prevalence, however, it is important that the all the figures are based on estimation. Thomsen (2013) estimates that the condition affects one in every 50 people. Under-reporting, over-reporting and wrong diagnosis due to the overlapping symptoms of OCD and other mental illnesses can create unavoidable errors in measuring prevalence.  Kessler et al. (2005) makes an important statement that needs to be examined in relation with OCD. Half of reported cases of obsessive compulsive disorder were severe. The author also states that the most affected age group is 30-44. According to Subramaniam, Abdin, Vaingakar & Chong (2012, p. 2035), “the World Health Organization has identified obsessive–compulsive disorder (OCD) to be among the top 20 causes of years of life lived with disability for 15- to 44 -year olds”.  Ayouso-Mateos (2000) further conforms that “obsessive-compulsive disorder was estimated to be the 11th leading cause of non-fatal burden in the world in 1990” (p. 1.).

Definition of OCD

The commonly accepted definition and criteria of diagnosis will be used in the current research. The American Psychiatric Association (APA, 2000) defies the condition as the presence of intrusive and repetitive thoughts (obsessions) and urge to do something over and over again (compulsions). One important detail of the above definition is that in order to be diagnosed with OCD, a person does not need to have both obsessions and compulsions. The presence of one aspect of the illness can be a foundation for a positive diagnosis.

Directions for Research

The below paper is designed to review the risks associated with obsessive compulsive disorder; attempting to reveal patterns, determine high-risk groups and the most successful treatment options by reviewing case studies and clinical research publications. The author of the current study would also like to examine the etiological, social and neurological aspects of the illness; causes, alongside with literature related to the effectiveness of various drug interventions to treat the illness. Evidence-based research studies will be reviewed by the author to develop an intervention framework for an example case of OCD.

Diagnosis and Treatments

Commonly Known Causes

Taylor, Asmundson and Jang (2011) state that etiological factors play a significant role in the development of OC and OC disorder. Further, the authors also analyzed environmental factors, related to different behaviors associated with the mental illness. Taylor et al. (2011), therefore, find that the best method to investigate the factors contributing towards the development of OCD is to create twin studies that allow researchers to examine genetic, environmental and psychological aspects of the problem. The meta-analysis of 37 twin studies has revealed that environment had a greater impact on OC symptoms than genetic variance, therefore, the authors conclude that one’s living, family environment and socialization has an impact on the potential development of OCD. However, other aspects of life need to be considered as important variables determining the risk of developing obsessive-compulsive disorder.

Childhood trauma was examined as one of the potential causes of dissociative symptoms related to OCD (Belli, Yesilyurt, Vardar,  Akbudak & Oncu, 2013), however, behavioral patterns were found to have a more significant relationship with the development of OCD than childhood trauma points. Taylor et al. (2011) examined the different correlations between activities associated with obsessive compulsive disorder.  The report revealed some important aspects of client personality traits associated with the mental illness.

As a conclusion, the author of the current study would like to conclude that there is no single measurable cause of the development of OCD: the combination of genetic, psychological and environmental factors, however, can create a situation which increases the risk of developing obsessions and compulsions.

Review the DSM-IV-TR or DSM-5 symptom criteria

Taylor et al. (2011) state that OCD should not be classed as an anxiety disorder, but be put into a new category: OC spectrum disorders when carrying out DSM-V analysis. The categorization of mental illnesses related to compulsions and obsessions, fears and mood chances is indeed a difficult task, as several symptoms of different categories overlap each other. Even though both OCD and anxiety disorders are defined by APA (n.d.) by the category of “neurotic, stress-related, and somatoform disorders”, they should belong to different categories of neurotical illnesses, therefore, he investigates the opportunity of creating DSM-5 as a separate category, based on the difference in symptoms and to deal with the commonly debated boundary issues between various psychological conditions, already mentioned. As the purpose of the current study is not to debate the categorization of OCD, but to analyze the causes, symptoms and treatments, the authors will use the category DSM-IV-TR for diagnosis.

Statistical Data

Prevalence

Crino Slade & Andrews (2005) analyzed the prevalence of DSM-III and DSM-IV OCD in Australia. There was a difference in the one-month and 12-month prevalence. Among men the most affected population was aged 35-54. Among women, those aged between 18 and 54 were equally affected. This also indicates that there is a significance of long-term and short-term prevalence of the illness. As Ayouso-Mateos (2000, p. 1)  confirms, “obsessive-compulsive disorder is a chronic disease with periods of remission and relapse”, it is important to study the symptoms and prevalence over a longer period of at least a year (Ayouso-Mateos, 2000).

Incidence

In order to correctly measure incidence rates, one year prevalence statistics need to be created from research data when completing clinical studies. A comparison of lifetime, one-month and 12 month incidence studies reveal that prevalence rates change significantly. Comparing international studies, the WHO research (Ayouso-Mateos, 2000) revealed that among the world standard population, age-standard Incidence rate per100,000  people was 58 among men and 77 among women (p. 5, Table 7).

Risk Factors and Differences in Prevalence Across Groups

Analysis of results found by Crimo et al. (2005) found that one of the risk factors for OCD was unemployment. Prevalence was much higher among unemployed people than those who were working. Older people were, on the other hand, less likely to develop the condition than those  below 55 years old. Ayuso-Mateos found a significant difference between men and women, finding that prevalence among women was overall higher than among men. While research into genetic characteristics of patients has been concluded by Taylor (2011, p. 1371), the conclusion states that “although twin studies indicate that genetic factors play an important role in OC symptoms, little is known about the specific genes that are involved”.  Taylor (2011) also indicates that environmental factors, stress levels and traumatic experiences can increase the risk of developing OCD. Kessler et al. (2005. p. 625) found a “general pattern of disadvantaged

social status, including being female, unmarried, and having low socioeconomic status” that  increases risks.

Treatments and Related Research Studies

Cognitive-behavioral Therapy

Comparison of treatment outcomes  (Jonsson, Hougaard and Bennedsen, 2011)  found that cognitive behavioral therapy (CBT) delivered effective treatment and reduced patients’ symptoms, as well as the severity of the condition.

Clinical Research (Jonsson et al., 2011) compared the outcomes of group and individual cognitive behavioral therapies. The authors also determined some important predictors for treatment outcomes. The study revealed that while some research findings suggest that individual CBT is somewhat more effective, group CBT delivers steady positive results, while sparing health care resources.

Medications and Their Impact on the Nervous System – Clinical Trials

Zurowski et al. (2012) examined the relevance of orbitofrontal neurochemistry related to cognitive behavioral therapy outcomes. The authors stated that non-invasive methods are preferred when creating a treatment plan. Given that the results showed that females responded to medical treatment differently from men, while CBT delivered consistent results, avoiding medication would be preferable. Evidence from Kessler et al.’s (2005) study also indicates that OCD patients often develop drug dependence and abuse, causing an increase of co-morbidity across the population, drug treatment should only be considered as a last resort.

Demographic Differences in Prevalence

Women and men

Braber, de Geus, Boosma & van ‘t Ent. (2013) examined the brain structure of two Dutch twins in order to determine sex differences through MRI scan. The authors found that “sex could be a potential source of heterogeneity in brain imaging outcomes on OC symptomatology” (p. 520). While this is a genetic approach towards explaining sex-based prevalence and severity differences noted above, environmental and lifestyle factors should be included in the focus of the research in order to explain higher incidence rate among female population.

Ethnic minority individuals

Asian population survey (Subramaniam et al. 2012) found socio-economic correlates during the study. No significant differences in prevelance rates and severity were found between Asian and European-American populations. Indeed, the statistical data was similar; 3.0 lifetime and 1.1 %, over a period of 12 months. However, Williams, Domanico , Marques, Leblanc  & Turkheimer (2012) state that while it is assumed by researchers that ethnic minority groups are equally affected by OCD as mainstream population, they have to face more treatment barriers, and this creates mental health inequalities, resulting in lower rate of reporting and intervention, more complications and higher severity rate. The authors also confirm that “African Americans are notably underrepresented in the OCD literature”, and their health accessibility is much lower,  resulting in lower rate of clinical intervention for OCD.

Case example

Description of client symptoms

The client in the current case is a 36 year old woman, called Diana. She suffers from intrusive thoughts related to infections and she has been suffering since she was eight year old. She has been fearing from getting ill and therefore started washing her hands more than ten times a day. She started taking anti-bacterial wipes to work, developed a fear from public places. As she got married and had children, she started worrying about her children’s health and gave them a bath three times a day, made them wipe their hands with antibacterial wipes when they came home from school and playing. The severity of her symptoms have increased and her compulsions included regular 30-minute hand washing sessions after returning to home, which affected her family life and social relationships. Diana lost her mother when she was 8 and it is likely that her fear of dying and leaving her three children behind have triggered her obsessive thoughts and compulsions. She is of Hispanic background and lives in a rented accommodation with her three children. She is a single mother, as her husband left her because of her obsessions that he called “unbearable habits”. Diana delayed seeking treatment and decided to see a specialist.

Description of treatment for the symptoms

The case history of Diana includes information that she has previously had a negative reaction to some anti-depression medication. Therefore, the therapist will decide to use non-intrusive treatment and start with a one-on-one assessment followed by group cognitive behavioral therapy.

Treatment Plan

Trial period is determined in 4 weeks with two sessions of group CBT each week. Using Veale’s model (2009), the intervention based on cognitive behavioral therapy will focus on the problem (fear of contamination and infection), and the intervention will be founded on the findings of the initial assessment that determined the hierarchy of feared situations. In Diana’s case, the most feared situations identified are attending public toilets, hospitals and eating out.

Response prevention will be used on situations less feared initially, later moving on to the most feared ones.

Within the four weeks, therapists would be able to normalize intrusive thoughts and reduce anxiety associated with them. The therapist would also be able to identify the cognitive processes that lead to obsessions and compulsive behavior. Finally, on the 4^th week, distancing would be started which will reduce the patient’s urge to react to the thoughts.

Monitoring plan for the future will be based on weekly discussions after sessions with Diana about her beliefs related to contamination, illness and prevention. She will also be asked to write a diary on the occurrences of compulsive repetitive behaviors and avoidances related to fear of contamination. The intervention is likely to last for three months, depending on its effectiveness of Diana’s condition.

Conclusion

Summary of Findings

The above review of literature has revealed that OCD has a 1-3 percent lifetime severity across the world. Further, some risk factors associated with developing the condition have been determined, such as trauma, lifestyle, sex, minority level. It has also been concluded that ethnic and social minority groups’ lower health accessibility results in under-reporting and delayed health-seeking activities, increasing the risk of complication and severity.

 Implications for Mental Health Professionals

Mental health professionals should use group CBT as a non-intrusive baseline intervention method after positive diagnosis. If group cognitive behavioral therapy does not work, individual sessions might be introduced and finally, the introduction of  serotonin reuptake inhibitors might be needed if CBT does not work. It is, however, important to note that results of medication can only be seen after 2-3 months of drug therapy.

References

Ayuso-Mateos, J. (2000) Global burden of obsessive-compulsive disorder in the year 2000. Global Burden of Disease2000. WHO.

Belli, H., Yesilyurt, S., Vardar, M., Akbudak, M. & Oncu, F. (2013) Childhood trauma and dissociation in patients with obsessive compulsive disorder. West Indian Medical Journal 2013; 62 (1): 39-44

Braber, A., de Geus, E., Boosma, D. & van ‘t Ent, D. (2013) Obsessive–compulsive symptoms and related sex differences in brain structure: an mri study in dutch twins. Twin Research and Human Genetics. Vol. 16. No. 2; 516-524

Crino, R., Slade, T. & Andrews, G. (2005)  The changing prevalence and severity of obsessive- compulsive disorder criteria from DSM III to DSM-IV.  Am J Psychiatry 2005; 162:876– 882

Jonsson, H., Hougaard, E. & Bennesden, B. (2011) Randomized comparative study of group versus individual cognitive behavioural therapy for obsessive compulsive disorder. Acta Psychiatrica Scandinavica.  2011: 123: 387–397

Kessler, RC, Chiu, WT, Demler, O & Walters, EE. (2005) Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS- R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

Subramaniam, M., Abdin, E., Vaingakar, J. & Chong, S. (2012) Obsessive–compulsive disorder: prevalence, correlates, help-seeking and quality of life in a multiracial Asian population. Social Psychiatry and Psychiatric Epidemiology (2012) 47:2035–2043

Taylor, S., Asmudson, G. & Jang, K. (2011) Etiology of obsessive-compulsive symptoms and   obsessive-compulsive personality traits: common genes, mostly different environments. Depression And Anxiety 28 : 863–869

Taylor, S. (2011) Etiology of obsessions and compulsions: A meta-analysis and narrative review of twin studies. Clinical Psychology Review 31 (2011) 1361–1372

The American Psychiatric Association (n.d.) Obsessive-Compulsive Disorder. Retrieved from http://www.apa.org/divisions/div12/rev_est/anxiety.html#ocd

Thomsen, P. (2013) Obsessive-compulsive disorders. Eur Child Adolesc Psychiatry  22 (Suppl 1):S23–S28 Springer-Verlag Berlin Heidelberg 2012

Williams,  M., Domanico, J.,  Marques, L., Leblanc, N.  & Turkheimer, E. (2012) Barriers to treatment among African Americans with obsessive-compulsive disorder. Journal of Anxiety Disorders; 26 (2012) 555–563