Obsessive-compulsive disorder, commonly known by its acromion ‘OCD,’ is a mental health disorder that causes an individual to have obsessive thoughts and compulsions; some individuals find themselves hoarding their belongings, whereas others find themselves obsessively washing their hands. Like most mental health disorders, OCD has been commonly stigmatized and misconstrued. Individuals with OCD are less likely to seek treatment or diagnosis because of negative public perception (Garcia-Siriano et al., 2014, Schwartz et al., 2013). The general public across all global regions views taboo-related thoughts as socially unacceptable (Cathey and Wetterneck, 2013). These taboo thoughts could be violent, aggressive, morally wrong, or sexual thoughts, which are all unfortunately common for individuals with OCD. Taboo thoughts can isolate an individual with OCD, as there is the risk of ostracization, if they open up to others who do not fully understand their disorder. At first glance, an individual who says they have violent thoughts is seen as a violent person, even though they may not have committed acts of violence, still the public views a person with such thoughts as a threat according to studies (Garcia-Siranio et al., 2014, Schwartz et al., 2013). This can make it difficult for individuals to seek a diagnosis as public perception of such symptoms can lead an individual to believe that they are a bad person rather than a person with an illness.
To look at the treatment of OCD, we must first look at the origin and causation of the disorder. As defined in the DSM-5, the obsessive-compulsive disorder has two main criteria: Compulsions and Obsessions. In order to be diagnosed with OCD, an individual must present both criteria more than once a day for two consecutive weeks. The obsessions can range in variety. An individual may be obsessed with past events, religious morality, sexual thoughts, death, etc. These obsessions could stem from anxiety, traumatic events, abuse, stress, and even biological factors such as the lack of serotonin in the brain. Compulsions follow the obsessions; the compulsions soothe the obsessive thoughts of individuals with OCD. For example, an individual who has an obsessional fear of their loved ones dying unexpectedly could try to soothe their thoughts by compulsively checking if they’ve locked their doors or by making sure they do not step on cracks on the floor because of superstitious belief that their loved ones could die if they step on the cracks on the floor. This individual, in their mind, is ensuring that they are not unintentionally causing the death of their loved one. Their obsessional fear for their loved ones can be potentially debilitating. The individual may be entirely consumed by these thoughts and compulsions to the point where they can no longer live a functional life.
The disorder was once referred to as ‘anxiety neurosis’ by Sigmund Freud in 1895. The disorder is heavily linked to anxiety, another mental health disorder that is described as a feeling of unease, such as worry or fear, as stated by the NHS. Anxiety is a significant component of OCD. Although they are not the same disorder, individuals with OCD can begin to feel anxious when they do not carry out their compulsions. An individual not acting out on their compulsions may result in increasing obsessional thoughts, difficulty in concentration, isolating from friends/family, or avoiding work/school.
Medication can be used to treat OCD, as the disorder has a biological component. These medications are quite effective as they alter the balance of chemicals in the OCD brain. The default prescribed medication is an SSRI (Selective Serotonin Reuptake Inhibitors), which is a medication that only acts on the serotonin system. If an SSRI fails to work, a TCA (Tricyclic Antidepressant) is prescribed, A TCA affects other brain regions, but according to the NHS, the drug has many side effects such as weight gain, dry mouth, and heart rhythm problems.
Biologically, OCD is the dysfunction in the neuronal loop running from the orbital frontal cortex to the cingulate gyrus, striatum (caudate nucleus and putamen) globous pallidum, thalamus back to the frontal cortex, as stated by Stanford Medicine. This means that in an OCD brain, there are errors that essentially cause excessive obsessional thoughts as the transmissions of nerves to the limbic system are disrupted. This causes dysregulation in emotions and emotional response, as there are high levels of serotonin found in the limbic system, which cannot be used effectively by the OCD brain. Not only this, but there is also under-activation in different regions of the brain, such as the orbitofrontal cortex and frontal operculum (Norman LJ, Taylor SF, Liu Y, et al.). Emotional responses are not regulated well in the OCD brain, manifesting through obsessional thoughts and compulsions.
Other treatments, such as talking therapy and exposure therapy, can be used to treat the disorder. The confrontation of thoughts and fixed ideas can help an individual with OCD navigate their condition and work to break down thoughts and feelings that they are too afraid to tell their loved ones. Cognitive behavioral therapy is the most common talking therapy used to treat OCD. It teaches individuals coping mechanisms and confronts conflicted feelings and attitudes through worksheets and constantly reviewing each thought and idea, exploring its origin and effect on the individual’s life.
When looking at the link between hypnotherapy and OCD, it is hard to find distinct long-term results in treating OCD with hypnotherapy as there is limited empirical research between them. Though the results are narrow, it is agreed between the researchers (Joesph Meyerson, Andres Konichezky, 2011) that hypnotically induced dissociation can aid in regulating and controlling pathological or excessive dissociation, rehabilitating adaptive dissociative strategies such as changing a dangerous compulsion to a safe compulsion and uncovering hidden psychological issues such as trauma.
Exposure therapy can use cognitive behavior therapy and hypnotherapy to explore the symptoms and manifestations of OCD compulsions and feelings. Exposure to OCD obsessions can affect individuals differently, but the therapy is designed to show them that their thoughts are exaggerated or sometimes wrong. The exposure therapy can range from contamination, talking or showing images/videos. It depends on what the individual should be exposed to; for example, an individual with germ contamination OCD could be exposed to an unwashed door handle. An unwashed door handle is very common as most people touch them when they’re at work or school. Exposing an unwashed door handle to a person with germ-contamination OCD shows them that germs are daily and part of everyday life, as germ-contamination OCD can be debilitating. Those with germ contamination OCD can stop going to work or school because of the fear of germs. Exposure therapy aims to break down this boundary and build strong attitudes towards their obsessional thoughts.
In hypnotherapy exposure therapy, a hypnotherapist confronts the obsessional thoughts while an individual is in a hypnotic trance. The trance-like state places the individual in a calm state of mind where they can explore past traumas and future aspirations, making it an effective tool for OCD treatment. However, though it can be effective, it can have severe side effects such as anxiety, new compulsions, increased obsessional thoughts, and panic attacks.
To conclude, the obsessive-compulsive disorder has two main criteria: obsession and compulsion. The primary treatment is SSRI medication and cognitive behavioral therapy. In relation to hypnotherapy, there isn’t enough empirical evidence to suggest long-term positive effects on the disorder. OCD continues to be a complex disorder to live with, along with the symptoms and heavy stigmatization, across all global regions.
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