Obsessive Compulsive Disorder (OCD) it is a psychopathological condition which, due to its clinical expression, can condition life in a very important way. Since it is also a chronic disease, it is possible that at some point in its course it may occur together with other disorders of the psychic sphere that eclipse the prognosis.
In fact, most studies addressing the issue point out 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 professional psychologist who faces it, and an emotional exploit for the patient who faces it.
“Co-morbidity” is understood as the presence of two or more disorders in single people at the same time, so that the result of their co-occurrence becomes much more than the mere sum of them. It is, for this reason, a unique journey for each patient, as he also interacts with the personality traits that are specific to him.
In this article, some will be discussed mental health problems that can occur throughout the life of those with OCD (OCD comorbidities) although it is crucial to emphasize that their appearance is not mandatory. We will only be talking about an increase in risk, that is to say an additional element of vulnerability.
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 first. Over time, the bond between them tends to grow stronger, so that thought and action enter a cycle from which it is not easy to escape.
The most common is for the person to know that their “problem” is irrational or disproportionateBut there are cases where this 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 content, cognitive restructuring and long etc.) and pharmacological (especially with antidepressants that inhibit the reuptake of serotonin and tricyclics). If an adequate program is not articulated, the evolution is generally gradual and insidiously decreases the quality of life of those who suffer from it. In addition, it is a mental health problem that is very often accompanied by other disorders, as we will see below.
Comorbidities related to OCD
As we have seen above, OCD is a clinical condition of enormous clinical importance for the person who suffers from it, with a great capacity to condition the development of his daily life. In addition, the possibility that they may also appear has been documented. a series of secondary mental problems that complicate their expression and treatment. This phenomenon (called co-morbidity) involves interactions between the problems at play, resulting in combinations loaded with profound idiosyncrasy. In the text before us, we will address some of the most relevant.
1. Major depression
Mood disorders, and particularly major depression, are perhaps one of the most common comorbidities in OCD. Both run with intrusive thoughts and generate intense discomfort, Which is associated with altered activity of structures located in the prefrontal region of the brain. When presented together, they tend to influence each other, so obsessive ideas and their overall impact are emphasized. Or what is the same, OCD and the depression itself get worse.
Most common is that sadness and the loss of the ability to experience pleasure appear as an emotional response to the limitations OCD places on activities of daily living, as in severe cases it becomes an extremely invasive condition. too much both entities have been suggested to be linked to alterations in serotonergic function, A neurotransmitter that helps maintain mood and could explain its remarkable comorbidity. Up to two-thirds, or about 66% of people with OCD will experience depression at some point in their lives.
It is known that the prevalence of depressive symptoms in these patients directly affects the presence of obsessive-compulsive disorder, reduces treatment adherence and increases the risk that the intervention will not be effective. It is therefore important to understand the synergistic effects of this double pathology, to articulate a therapeutic program in which any undesirable contingencies are anticipated and to stimulate motivation throughout the process.
2. Anxiety disorders
Another common comorbidity of OCD occurs with anxiety problems; I especially with social phobia (18%), panic disorder (12%), specific phobias (22%) and generalized anxiety (30%). The presence of these, as with depression, is of particular concern and requires the use of mixed therapeutic approaches, in which cognitive behavioral therapy should 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 is the overlap between the expression of OCD and that of anxiety. So much so that a few years ago TOC itself was included in this category. Perhaps the most common is that it is “mistaken” for generalized anxiety, since in either case there is a concern for negative thoughts. However, they can be differentiated by the fact that in generalized anxiety the feared situations are more realistic (Related to subjects of the ordinary life) and that the rumination acquires egosintónicas properties here (it is understood like useful).
Panic disorder is also very common in people with OCD, which is associated with autonomic hyperactivity (sympathetic nervous system) that is difficult to predict, and the symptoms interfere with 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 linked to very different pathogens (in the case of cleaning obsessions), and should be distinguished from hypochondriac fears of suffering from serious illness.
3. Obsessive-compulsive personality disorder
People with OCD are more likely to exhibit an obsessive-compulsive personality profile, that is, one based on perfectionism of such magnitude that it restricts normal development of daily living. It can often be a pattern of thought and behavior that was present before the onset of OCD itself, as a kind of breeding ground for it. The synergy of the two would lead to the emergence of invasive mental contents that would worsen the high demand for oneself, considerably accentuating behavioral and cognitive rigidity.
It is generally known that subjects with obsessive-compulsive personality who suffer from OCD exhibit symptoms of greater intensity and magnitude, as their perfectionism is projected towards much more intense efforts to control the degree of invasion of the obsessions. , which paradoxically ends up making them worse. .
4. Bipolar disorder
The literature has described that people with OCD have an exacerbated risk of developing bipolar disorder, although there are deviations at this extreme. While some authors do not believe that the two disorders have anything in common, and attribute possible similarities to the peculiarities of acute episodes of OCD (compulsive behaviors similar to mania), others point out that the risk of bipolarity for these patients doubles that of the general population.
It has been described that people with OCD who also suffer from bipolar disorder report a greater presence of thoughts obsessive, and that its content adapts to the acute episode that is experienced at a given time (depressive or manic). There is also evidence that people with this comorbidity report more obsessive thoughts (sexual, aggressive, etc.) and a higher number of suicide attempts, compared to patients with OCD without bipolarity.
5. Psychotic disorders
In recent years, based on new empirical evidence, it has been proposed a label to describe people living with both OCD and schizophrenia: schizo-obsession.
These are subjects the psychosis differs markedly from that seen in patients without obsessive-compulsive symptoms; both in terms of clinical expression and response to pharmacological treatment or cognitive impairment profile, indicating that it may be an additional modality in the broad spectrum of schizophrenics. In fact, an estimated 12% of patients with schizophrenia also meet diagnostic criteria for OCD.
In these cases, the symptoms of OCD are seen as part of the acute episodes of their psychosis, or also during their prodromes, and they must be distinguished from each other. And this is it these are disorders that share a common neurological basisThis increases the likelihood that at some point the two will coexist. The shared structures would be the basal ganglia, thalamus, anterior cingulate, and orbitofrontal / temporal cortex.
6. Eating disorders
Some eating disorders, such as anorexia or bulimia, may share certain characteristics with OCD itself. The most important are perfectionism and the presence of ideas that repeatedly pop up in the mind, causing reassurance behaviors to explode.
In case of eating disorders these are thoughts associated with weight or body shape, alongside the constant checking that no size has changed or that the body remains the same as the last time it was looked at. Therefore, the two must be carefully distinguished 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 the fact that food could be infested with a pathogen) reached such a magnitude that it precipitated restriction of ingestion. It is in these cases that it is especially important to carry out a thorough differential diagnosis, since the treatment of these pathologies requires the articulation of very different procedures. In case they could live together at some point, it is very possible that purging or overworking behaviors increase.
7. Tic disorder
Tic disorder is an invasive condition characterized by the inevitable presence of simple / stereotypical motor behaviors, which occur in response to a perceived urgency of movement, which is not relieved until it is “performed”. So it is functionally very similar to what happens in OCD, to the point that textbooks like DSM have chosen to include a subtype that reflects such comorbidity. Thus, it is considered that approximately half of pediatric patients diagnosed with OCD have this type of motor aberrationEspecially in men, the problem started at a very young age (early in life).
It was traditionally believed that children with OCD who also referred to one or more tics were difficult to treat, but the truth is that the literature on the subject does not present conclusive data. While in some cases it is noted that in children with OCD and tics the presence of recurrent thoughts with aggressive content is more prominent, or these are patients with poor response to pharmacological and psychological treatment, in others, it is not that they appreciate the differential nuances deserve greater gravity. However, there is evidence that Table of contents with tics shows a more notorious model of family history, Their genetic load could therefore be higher.
8. Attention deficit hyperactivity disorder (ADHD)
Studies on the comorbidity of these disorders show that 21% of children with OCD meet diagnostic criteria for ADHDA percentage that drops to 8.5% in adults with OCD. These data are curious, because 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 fluidity (mental intrusion) of OCD would generate saturation of cognitive resources, Which would result in an alteration of the executive functions involved in this area of the nervous system, and therefore with a difficulty of attention comparable to that of ADHD.
On the other hand, it is estimated that the reduction in the prevalence which occurs between childhood and adulthood could be due to the fact that from the age of 25 occurs the full maturation of the prefrontal cortex (since it is the “ last area of the brain, doing this), and also the fact that ADHD usually ‘softens’ over time.
- Lochner, C., Fineberg N., Zohar, J., Van Ameringen, M., Juven-Wetzler, A., Altamura, A., Cuzen, N., Hollander, E. … Stein, D .. ( 2014). Comorbidity in obsessive-compulsive disorder (OCD): report from the International College of Obsessive-Compulsive Spectrum Disorders. Integral psychiatry, 55 (7), 47-62.
- Pallanti, S., Grassi, G., Sarrecchia, E., Cantisani, A. and Pellegrini, M. (2011). Comorbidity of obsessive-compulsive disorder: clinical evaluation and therapeutic implications. Frontiers in psychiatry / Frontiers Research Foundation, 2 (70), 70.