Obsessive Compulsive Disorder (OCD) is a psychopathological picture that, due to its clinical expression, can condition life in a very important way. Since it is also a condition of chronic course, it is possible that at some point in its evolution it concurs with other disturbances of the psychic sphere that overshadow the prognosis.
In fact, most studies that address the issue underline that suffering from OCD is a risk factor for comorbidities of a very different nature. This circumstance becomes a therapeutic challenge of enormous magnitude for the psychology professional who addresses it, and an emotional deed for the patient who faces him.
“Comorbidity” is understood as the presence of two or more disorders in a single individual and moment, in such a way that the result of their concomitance accrues much more than the simple sum of them. It is, for this reason, a unique journey for each patient, since it also interacts with those personality traits that are their own.
This article will address some of the mental health problems that may arise throughout the lives of those suffering from OCD (the comorbidities of OCD) although it is essential to emphasize that their appearance is not mandatory. We will only talk about an increase in risk, that is, an additional element of vulnerability.
- Related article: ” Obsessive-Compulsive Disorder (OCD): what is it and how does it manifest itself?“
Obsessive compulsive disorder
Obsessive-Compulsive Disorder (OCD) is a clinical picture characterized by the presence of intrusive thoughts followed by ritual acts with a clear functional relationship , aimed at reducing the discomfort generated by the former. With the passage of time, the link between them tends to be strengthened, so that thinking and acting enter a cycle from which it is not easy to escape.
The most common is that the person is aware that their “problem” is irrational or disproportionate , but there are cases in which such an assessment may not be present, especially when it comes to children or adults with poor introspection.
There are effective treatments for him, both psychological (exposure to mental contents, cognitive restructuring and a long etcetera) and pharmacological (especially with antidepressants inhibiting the reuptake of serotonin and tricyclics). If an adequate program is not articulated, the evolution is usually progressive and insidiously detracts from the quality of life of the sufferer. In addition, it is a mental health problem that occurs very often with other disorders, as will be seen hereafter.
TOC comorbidities
As we saw earlier, OCD is a condition of enormous clinical relevance for the person who suffers from it, with a great capacity to condition the development of their daily lives. In addition, the possibility that a series of secondary mental problems that complicate its expression and its treatment have also been documented . This phenomenon (known as comorbidity) involves interactions between the problems that are referred to, from which derived combinations of a deep idiosyncrasy derive. In the text we are dealing with we will address some of the most relevant.
1. Major depression
Mood disorders, and more specifically major depression, are perhaps one of the most frequent comorbidities in OCD. The two study with intrusive thoughts and generate intense discomfort , which is associated with an altered activity of structures located in the prefrontal region of the brain. When they are presented together they usually affect each other, so obsessive ideas and their general impact are accentuated. Or what is the same, both the OCD and the depression itself are aggravated.
The most common is that sadness and loss of ability to experience pleasure arise as an affective response to limitations imposed by the TOC on the activities of daily life, since in severe cases it becomes an enormously invasive pathology. It has also been suggested that both entities are linked to alterations in the function of serotonin , a neurotransmitter that contributes to the maintenance of mood and that could explain its remarkable comorbidity. Up to two thirds, approximately 66% of subjects with OCD, will suffer from depression at some point in their life.
It is known that the prevalence of depressive symptomatology in these patients directly affects the presence of obsessive ideas, reduces therapeutic adherence and increases the risk that the intervention will not be effective. It is therefore important to know well the synergistic effects of this dual pathology, articulate a therapeutic program in which possible adverse contingencies are foreseen and stimulate motivation throughout the process.
- You may be interested: ” Major depression: symptoms, causes and treatment“
2. Anxiety disorders
Another of the usual comorbidities of OCD occurs with anxiety problems; and especially with social phobia (18%), panic disorder (12%), specific phobias (22%) and generalized anxiety (30%) . The presence of these, as with depression, is a matter of special concern and requires the use of mixed therapeutic approaches, in which cognitive behavioral therapy must be present. In any case, the prevalence of these psychological problems is higher in patients with OCD than in the general population, from a statistical point of view.
One of the main causes corresponds to the overlap between the expression of OCD and that of anxiety. So much so that, a few years ago, the TOC itself was included in the category. Undoubtedly, the most frequent is to be “confused” with generalized anxiety, since in both cases there would be a concern for negative thoughts. However, they can be distinguished by the fact that in generalized anxiety the feared situations are more realistic (related to ordinary life issues) and that rumination acquires egosyntonic properties here (understood as useful).
Also , the panic disorder is very common in people with OCD, which is associated with a difficult autonomous hyperactivity disorder (of the sympathetic nervous system) to predict, and whose symptoms disrupt any attempt to develop life normally. Specific phobias, or irrational fears, are also common when exploring people with OCD. In this case they are usually related to very different pathogens (in the case of cleaning obsessions), and they must be distinguished from hypochondriacal fears of suffering from a serious disease.
- You may be interested: ” Types of Anxiety Disorders and their characteristics“
3. Obsessive compulsive personality disorder
People with OCD have a higher risk of showing a compulsive obsessive personality profile, that is, based on a perfectionism of such magnitude that it restricts the normal development of everyday life. It can often be a pattern of thought and behavior that was present before the emergence of the OCD itself, as a kind of land paid for it. The synergy of both would lead to the appearance of invasive mental contents that would aggravate the high self-demand, greatly accentuating behavioral and cognitive stiffness.
In general, it is known that subjects with an obsessive compulsive personality who suffer from OCD show symptoms of more intensity and greater scope, since their perfectionism is projected towards much more intense efforts to control the degree of invasiveness of obsessions, which paradoxically It gets worse.
4. Bipolar disorder
The literature has described that people with OCD have an exacerbated risk of having a bipolar disorder , although there are discrepancies at this end. While certain authors do not believe that both disorders have something in common, and attribute any possible similarity to particularities in acute episodes of OCD (compulsive behaviors similar to those of mania), others stress that the risk of bipolarity for these patients doubles of the general population .
It has been described that people with OCD who also suffer from a bipolar disorder indicate a greater presence of obsessive ideas, and that its content adapts to the acute episode that is being lived at each moment (depressive or manic). There is also evidence on the fact that those who suffer from this comorbidity report more obsessive thoughts (sexual, aggressive, etc.) and a greater number of suicidal attempts, when compared with patients with OCD without bipolarity.
5. Psychotic disorders
In recent years, based on novel empirical evidence, a label has been proposed to describe people living with both OCD and schizophrenia: schizo-obsession .
These are subjects whose psychosis differs greatly from that seen in patients without obsessive-compulsive symptoms; both regarding its clinical expression and the response to drug treatment or cognitive impairment profile, which indicates that it could be an additional modality within the broad spectrum of schizophrenia. In fact, it is estimated that 12% of patients with schizophrenia also meet diagnostic criteria for OCD.
In these cases, OCD symptoms are observed in the context of the acute episodes of their psychoses, or also during their prodromes, and they must be distinguished from each other. And it is that they are disorders that share a common neurological basis , which increases the probability that both coexist at some point. The shared structures would be the basal ganglia, the thalamus, the anterior cingulum and the orbitofrontal / temporal cortices.
6. Eating disorders
Certain eating disorders, such as anorexia or bulimia , may share some trait with OCD itself. The most important are perfectionism and the presence of ideas that repeatedly burst into the mind, triggering reinsurance behaviors.
In the case of eating disorders, these are thoughts associated with weight or silhouette, together with the constant verification that it has not changed in size or that the body remains the same as the last time it was looked at. This is why both must be distinguished with attention during the diagnostic phase, in case the criteria of both are met.
Cases of OCD have been documented in which an obsession with food contamination (or that the food could be infested by a pathogen) has reached such magnitude that a restriction of intake has precipitated. It is in these cases that it is particularly important that an exhaustive differential diagnosis be carried out, since the treatment of these pathologies requires the articulation of very different procedures. In the event that they get to live together at some time, it is very possible that the purging or physical overexertion behaviors increase .
7. Tics disorder
Tics disorder is an invasive condition that is characterized by the inevitable presence of simple / stereotyped motor behaviors, which arise in response to a perceived urgency of movement, which is only relieved at the time it is “executed.” It is, therefore, very functionally similar to what happens in the TOC, to the point that manuals such as the DSM have chosen to include a subtype that reflects such comorbidity. Thus, it is considered that approximately half of the pediatric patients diagnosed with OCD show this type of motor aberrations , especially among men whose problem debuted at very early ages (at the beginning of life).
Traditionally it has been believed that children with OCD who also referred to one or more tics were difficult to approach, but the truth is that the literature on the subject does not show conclusive data. While in some cases it is pointed out that in children with OCD and tics the presence of recurrent thoughts with aggressive contents is greater, or that they are patients with a poor response to pharmacological and psychological treatment, in others there are no differential nuances that Merit more seriousness. However, there is evidence that TOC with tics shows a more noticeable family history pattern , so its genetic load could be higher.
8. Attention deficit hyperactivity disorder (ADHD)
Studies that have been conducted on the comorbidity of these disorders show that 21% of children with OCD meet the diagnostic criteria of ADHD , a percentage that drops to 8.5% in adults with OCD. This data is curious, since they are conditions that affect the same region of the brain (the prefrontal cortex), but with very different activation patterns: in one case by increase (OCD) and in the other by deficit (ADHD).
To explain such a paradox, it has been proposed that the excessive cognitive fluency (mental intrusion) of OCD would generate a saturation of cognitive resources , which would result in an affectation of executive functions mediated by this area of the nervous system, and therefore with an attentional difficulty. comparable to that of ADHD.
On the other hand, it is estimated that the reduction in the prevalence that occurs between childhood and adult life could be due to the fact that after 25 years the total maturation of the prefrontal cortex occurs (it is the last area of the brain in do it), and also the fact that ADHD usually “softens” as time goes by.
