Far beyond sorting colors, checking and rechecking door locks, washing hands 10 times a day or fearing germs, obsessive compulsive disorder (OCD), unrecognized by many and often stigmatized in films and books, causes great psychological and emotional suffering. It is characterized by strong, unwanted, and intrusive obsessions that cause a sense of impending danger and anxiety in the patient. To counter this, they can resort to constraints; repetitive behaviors that calm them but interrupt their routine and prevent them from leading a functional daily life. If left untreated, patients avoid frightening situations which, in some cases, condemn them to social isolation.
According to experts, the worldwide prevalence of OCD is close to 2% and the causes of the disorder are multifactorial. The symptoms are also very variable depending on the case: a patient whose obsession is the fear of contamination may need to take three showers in a row before leaving home. Another patient whose fear is hurting a loved one may spend several hours of their day picking up any object they see on the street, so that no one trips. However, not all behaviors are directly related to the object of their obsessions. A young child may be unable to pay attention in school because he constantly counts to 100 in his head during lessons, convinced that if he does, his parents will not leave him.
Antonio Galán, president of the OCD Madrid association, has been fighting the disease for years. “Living with it is a pain in the neck. When the thoughts come, the feeling is like a panic attack,” he says. Galán, for example, is afraid of losing his job, and at home he folds his clothes and organizes his closet to neutralize this fear. But many patients know that repeating these behaviors will not solve the problem or allay the fear, which is very frustrating for them. “Besides, it’s cumulative; the more episodes you have and the more behaviors you need to neutralize them, the more exhausted you end up being,” he says. To avoid this, many people who do not receive the necessary help prefer to stay at home, isolating themselves socially and emotionally. “The way to deal with this disorder is therapy, so that there is a change in behavior,” says Galán, who says his condition improved a lot by seeking help.
The most common treatment is cognitive behavioral therapy, explains Nieves Álvarez, a psychologist at the OCD Madrid association. With this widely used technique around the world, patients confront their obsessions through controlled exposure to their fear. “It turned out to be the most effective method, although sometimes it fails,” she admits. To adequately treat OCD, experts recommend that the therapist specialize in this type of treatment and also combine it with other more recent methods, such as mindfulness.
An alternative treatment
There is another option for those who have received treatment for years without experiencing noticeable improvement. A study conducted by Bellvitge Hospital and the Institut d’Investigacions Biomèdiques de Bellvitge in Barcelona, Spain, and published in October, concludes that deep brain stimulation is a safe and effective technique for treating OCD, reducing obsessive symptoms to long term in 42.5%. Brain stimulation, used successfully to treat conditions like Parkinson’s disease, is a reversible operation that has been performed for over 40 years. It involves implanting electrodes through small holes in the skull to stimulate specific points in the brain. “In the case of obsessive disorders, patients who undergo this operation must have spent at least five years with severe symptoms and be resistant to all the usual approaches,” explains María del Pino Alonso, psychiatrist in the OCD unit of the Bellvitge Hospital and study director.
To be considered a serious case, professionals consider two factors: spending more than eight hours a day on uncontrollable behaviors, and being unable to work, study or have a normal social life. “For many of these patients, it is very difficult to live independently, as they need help maintaining hygiene, getting in and out of the house or eating,” says Alonso. The analysis followed the evolution of 25 patients with severe OCD for an average of 6.4 years (from 2007 to 2020), one of the largest samples ever undertaken in the world. “60% of cases experience a significant improvement in symptoms. This is a good proportion if you take into account that many of them had been in treatment for more than 10 years without improving much before undergoing the operation, ”explains Alonso.
Yet the technique is not widely used. Up to 5% of those affected are thought to be resistant to all treatments, says Alonso, who says many more should have the surgery and attributes the rare use of brain stimulation for psychiatric disorders to patients and psychiatrists who do not know that the option exists.
Although OCD is considered a chronic disorder, some psychologists claim that the symptoms can go away completely. “It’s hard,” says Galán, “but with hard work and commitment to therapy, you can live a perfectly normal life.”