Obsessive-compulsive disorder (OCD) is an important mental disorder owing to its prevalence and associated disability, and it is a key example of a set of conditions known as obsessive-compulsive and related disorders.
Introduction of Obsessive-Compulsive and Related Disorders
OCD is a chronic and disabling disorder characterized by recurrent, intrusive, and irresistible thoughts (obsession) and repetitive behavioral or mental acts that are performed in response to these thoughts (compulsion). Over 90% of people with OCD meet the criteria related to other psychological disorders, including depression, bipolar disorder, eating disorders, anxiety disorders, personality disorders, and schizophrenia, thus complicating the diagnostic process and treatment. Another difficulty is caused by a delay in the start of the treatment because of the embarrassing nature of OCD (not to mention a lack of insight into the illness); on average, it takes 10 years from the first symptoms to appear before help is sought and around 17 years until appropriate treatment is undergone.
Obsessive-compulsive and related disorders (OCRD) are a group of disorders that affect a wide range of ages in both genders worldwide. This group includes OCD, body dysmorphic disorder (BDD), hoarding disorder (HD), trichotillomania (hair-pulling disorder, TTM), excoriation (skin-picking disorder, ExD), substance/medication-induced OCRD, OCRD due to another medical condition, and other specified OCRDs.
Neural Circuits of OCD
The defects in cognitive and affective processing in patients with OCD could be mediated by alterations in specific neural circuits. Early work established that OCD could emerge in individuals with specific neural lesions. Data from studies using animal models of stereotyped behaviors and grooming have contributed to understanding the neural circuitry of OCD, besides, advances in functional and structural brain imaging methods have also been particularly important in advancing the field and have given impetus to influential models of OCD neurocircuitry. Such models have integrated data from neuroimaging and cognitive-affective studies by hypothesizing the involvement of parallel, partly segregated, cortico-striato–thalamocortical (CSTC) circuits that are involved in sensorimotor, cognitive, affective, and motivational processes in OCD. Indeed, data from functional and structural imaging studies support this hypothesis by demonstrating alterations in several brain regions that comprise these circuits in patients with OCD compared with healthy individuals. Other models have also implicated alterations in frontolimbic, frontoparietal, and cerebellar networks.
Treatment of OCD
Treatment of OCD comprises several components, starting with building a therapeutic alliance with the patient and psychoeducation, followed by psychological and/or pharmacological approaches, and, for patients with treatment-resistant OCD, neuromodulation, and neurosurgery. Cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs) are the first-line treatments for OCD. Unresponsive patients can receive augmentation with other treatment modalities. Neurosurgery is only considered in highly refractory and severe cases. Alternative interventions have also attracted interest but require more evidence. Although general principles of management exist, they need to be individually tailored. For example, some comorbid conditions (such as depression) respond to first-line OCD pharmacotherapies, whereas others (such as bipolar disorder) might require additional interventions.
Although OCD is important in psychiatric disorders, the treatment of it is still a tricky problem. Further research is needed to improve the effectiveness of OCRD treatment. A lot of work such as novel biomarker discovery, target development, relative preclinical model development, and etc. may promote this process.
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