Genetic and molecular studies have demonstrated that there is a closer link between the biological and genetic factors, and the environmental factors in the development of the OCD. The human genome project has produced better knowledge and understanding of this relationship. The mode of inheritance of OCD is complex (Pauls, 2006). There is an array of risk factors that could increase the chances of developing the disorder.
These include having a close family member or relative suffering from the disorder, or similar symptoms, experiencing serious mental stress in life (that may increase the likelihood of obsessional thinking and performing rituals), pregnancy (as OCD is a neuroendocrinal disorder), etc. The condition tends to begin in children by the age of 10 or adolescence, and in adults it tends to begin by the age of 21 years (Mayo Clinic, 2008). In children the disorder tends to begin earlier in boys compared to girls, at in adults it tends to occur at the same age.
Overall, the disorder tends to occur more often in males compared to females in the ratio of 3:2 (Geller, 2006). Clinical Features Cases of OCD present in various manner, often creating a lot of problems in diagnosing the disorder. The condition OCD is characterized by the development of two symptom sets, namely Obsessions (which are nothing but persistent, repeated, unjustified and unwanted ideas), that bring about certain compulsions (behaviors or impulses that do not seem to be normal).
These obsessions and compulsions tend to occur excessive and clearly more than in normal (Mayo Clinic, 2008). The set of obsessions and compulsions clearly tend to disrupt normal life and functioning at the home, school, workplace, and in social settings. The manner in which the disorder presents itself may be very strange especially in children. Some children may want to obtain certain magical characteristics or develop excessive fear against a particular object or person. These obsessions often give rise to strange compulsions noted through the behavior of the child.
Usually the obsessions would be based on a particular theme such as fear of getting dirty or infected, putting things in perfect order, sexual thoughts (which can be dangerous to society as the individual can force sex on others), and aggressive feelings (which can lead to aggressive behavior) (Volz, 2007). The individual may not like to touch another person, object or engage in certain activities. They often get doubts whether the door has been locked or any hazard is occurring at home. They also get images of several obscene acts or shouting obscene words (Mayo Clinic, 2008).
The individual may also get certain religious obsessions and thoughts of hurting other people. Frequently, the obsessions seem to be very inappropriate to others (JAMA, 2004). However, in some patients, the entire cycle of obsessions and compulsions may be secretive, and the individual may not want others to know about them (JAMA, 2004). Common compulsions that occur in OCD include repeated irrational behavior. The individual often is forced to perform such behavior due to the irrational thinking patterns.
Some of the common compulsions that is performed by the individual include repeated washing and cleaning, counting, checking and rechecking, repeated need to see if the doors are locked or if any hazard is switched off, requesting for reassurances from other people, going to a spot and checking if any accident has occurred, ensuring that certain items are placed in a perfect fashion, etc. These compulsions are usually a constant preoccupation and tend to consume a significant portion of the individual’s time (Mayo Clinic, 2008). In other patients, although the clear symptoms of OCD are not present, certain traits may be seen.
The wide varieties of symptoms that occur in OCD often create a lot of problems for the physicians and other healthcare providers. The symptoms variance may be 40 % to 66 %. Several factor including age, sex, religion, socio-economic status, aggressiveness, occupation, etc, played an important role in determining the range of obsessions and compulsions (Stewart, 2008). The symptoms of OCD tend to worsen during menstruation, pregnancy and the puerperium period (Lochner, 2005). In boys sexual obsessions more often occur whereas in girls, compulsions tend to frequently occur (Mataix-Cols, 2008). Diagnosis
The diagnosis of OCD is made based on the history, family history, symptoms, signs, physical examination, psychiatric examination, blood tests, radiographs, Yale-Brown Obsessive Compulsive Scale Symptom Checklist (CYBOCS-SC) and other tests. The guidelines lay down under the Diagnostic and Statistical Manual – IV edition; Text Revision would help to establish the diagnosis. Certain guidelines have to be met. These guidelines are strictly followed by the healthcare providers and the insurance agencies to identity and review cases of OCD. For a person to be diagnosed as OCD, he should fulfill 5 groups of characteristics including:
Have either obsessions or compulsions 2. The obsessions and compulsions should clearly be in excess or inappropriate 3. The obsessions and compulsions should affect the functional ability at home, school, workplace or social settings, or cause significant distress 4. OCD may follow certain patterns including eating problems, hair pulling, substance abuse, sexual urges, etc 5. The symptoms are usually not associated with consumption of a substance or a general condition affecting the body (Behave Net, 2009). A history is taken to ensure that any close relatives or family members suffering from the disorder or similar disorders are identified.
A thorough physical examination is conducted to rule out any other physical disorders that may be important in the development of the symptoms. Blood tests are conducted to determine the presence of any drug in the blood which can play an important role in the development of the symptoms. Besides, thyroid function test are also done to ensure that the thyroid gland is functioning normally. The psychiatric evaluation helps to understand the thought patterns and the behavior patterns of the individual better (Mayo Clinic, 2008).