The 8 Main Comorbidities Of Obsessive-Compulsive Disorder
Obsessive Compulsive Disorder (OCD) It is a psychopathological condition that, due to its clinical expression, can condition life in a very important way. Since it is also a condition with a chronic course, it is possible that at some point in its evolution it co-occurs with other disturbances in the psychic sphere that overshadow the prognosis.
In fact, most studies that address the issue emphasize 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 feat for the patient who faces it.
“Comorbidity” is understood as the presence of two or more disorders in a single individual at a time, such that the result of their co-occurrence is 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 unique to them.
This article will address some of the mental health problems that can arise throughout the life of those who suffer from OCD (the comorbidities of OCD) although it is essential to emphasize that its appearance is not mandatory. We will only talk about an increase in risk, that is, an additional element of vulnerability.
Obsessive-Compulsive Disorder (OCD) is a clinical condition 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 bond between them tends to strengthen, so that thinking and acting enter a cycle from which it is not easy to escape.
The most common thing 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 it, both psychological (exposure to mental content, cognitive restructuring and a long etcetera) and pharmacological (especially with serotonin reuptake inhibitor and tricyclic antidepressants). If an adequate program is not articulated, the evolution is usually progressive and insidiously reduces the quality of life of those who suffer from it. Furthermore, it is a mental health problem that very often occurs with other disorders, as will be seen below.
OCD Comorbidities
As we saw previously, 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 life. Furthermore, it has been documented the possibility that they may also appear a series of secondary mental problems that complicate their expression and treatment This phenomenon (known as comorbidity) involves interactions between the problems referred to, from which combinations full of profound idiosyncrasy derive. In the text at hand we will address some of the most relevant.
1. Major depression
Mood disorders, and more specifically major depression, are perhaps one of the most common comorbidities in OCD. Both present with intrusive thoughts that generate intense discomfort, which is associated with altered activity of structures located in the prefrontal region of the brain. When they occur together they tend to affect each other, thus accentuating obsessive ideas and their general impact. Or in other words, both OCD and depression itself get worse.
The most common thing is that sadness and the loss of the ability to experience pleasure arise as an affective response to the limitations imposed by OCD on the activities of daily life, since in severe cases it becomes an enormously invasive pathology. Also It has been suggested that both entities are linked to alterations in serotonin function, a neurotransmitter that contributes to the maintenance of mood and that could explain its notable comorbidity. Up to two-thirds, approximately 66%, of people with OCD will suffer from 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 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, to articulate a therapeutic program in which possible adverse contingencies are anticipated and to stimulate motivation throughout the process.
2. Anxiety disorders
Another of the common comorbidities of OCD is anxiety problems; and especially with social phobia (18%), panic disorder (12%), specific phobias (22%) and generalized anxiety (30%) The presence of these, as occurs with depression, is a cause for 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, OCD itself was included in the category. Without a doubt, the most common thing is that it is “confused” with generalized anxiety, since in both cases there would be a preoccupation with negative thoughts. However, they can be differentiated by the fact that In generalized anxiety, the feared situations are more realistic (related to issues of ordinary life) and that rumination here acquires egosyntonic properties (it is understood as useful).
Panic disorder is also very common in people with OCD, which is associated with autonomic hyperactivity (of the sympathetic nervous system) that is difficult to predict, and whose symptoms thwart any attempt to live a normal life. 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 cleanliness obsessions), and must be distinguished from hypochondriacal fears of suffering from a serious illness.
3. Obsessive-compulsive personality disorder
People who suffer from OCD are at greater risk of showing an obsessive-compulsive personality profile, that is, based on perfectionism of such magnitude that it restricts the normal development of daily life. It can often be a pattern of thought and behavior that was present before the emergence of OCD itself, as a kind of fertile ground for it. The synergy of both would lead to the appearance of invasive mental contents that would aggravate high self-demand, greatly accentuating behavioral and cognitive rigidity.
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 into much more intense efforts to control the degree of invasiveness of the obsessions, which paradoxically It ends up making them worse.
4. Bipolar disorder
The literature has described that people with OCD have an exacerbated risk of suffering from bipolar disorder, although there are discrepancies on this point. While certain authors do not believe that both disorders have anything in common, and attribute any possible similarity to particularities in acute episodes of OCD (compulsive behaviors similar to those of mania), others emphasize 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 indicate a greater presence of obsessive ideas, and that their content adapts to the acute episode being experienced at each moment (depressive or manic). There is also evidence that those who suffer from this comorbidity report more obsessive thoughts (sexual, aggressive, etc.) and a greater number of suicide attempts, when compared to patients with OCD without bipolar disorder.
5. Psychotic disorders
In recent years, based on new empirical evidence, it has been proposed a label aimed at describing people living with both OCD and schizophrenia: schizo-obsession
These are subjects whose psychosis differs greatly from that observed in patients without obsessive-compulsive symptoms; both in terms of its clinical expression and the response to pharmacological treatment or the profile of cognitive impairment, 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 These are disorders that share a common neurological basis, which increases the probability that at some point both coexist. Shared structures would be the basal ganglia, thalamus, anterior cingulate, and orbitofrontal/temporal cortices.
6. Eating disorders
Certain eating disorders, such as anorexia or bulimia, may share some traits with OCD itself. The most important are perfectionism and the presence of ideas that burst into the mind repeatedly, triggering reassurance behaviors.
In the case of eating disorders These are thoughts associated with weight or silhouette, along with the constant checking that you have not changed size or that the body remains the same as the last time it was looked at. This is why both must be carefully distinguished during the diagnosis phase, in case the criteria for one and the other are met.
There have been documented cases of OCD in which an obsession with food contamination (or that the food could be infested by a pathogen) has reached such a magnitude that it has precipitated a restriction of intake. It is in these cases that it is particularly important to carry out an exhaustive differential diagnosis, since the treatment of these pathologies requires the articulation of very different procedures. In the event that they get to live together at some point, it is very possible that purging behaviors or physical overexertion will increase
7. Tic disorder
Tic disorder is an invasive condition characterized by the inevitable presence of simple/stereotypic motor behaviors, which arise in response to a perceived urge to move, which is only relieved the instant it is “executed.” It is, therefore, functionally very similar to what occurs in OCD, 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 pediatric patients diagnosed with OCD show this type of motor aberrations especially among men whose problem began at a very early age (at the beginning of life).
Traditionally, it has been believed that children with OCD who also reported 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 noted that in children with OCD and tics the presence of recurrent thoughts with aggressive content is greater, or that these are patients with a poor response to pharmacological and psychological treatment, in others no differential nuances are appreciated that warrant greater severity. However, there is evidence that OCD with tics shows a more noticeable family history pattern so its genetic load could be greater.
Studies that have been carried out on the comorbidity of these disorders show that 21% of children with OCD meet the diagnostic criteria for 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 due to increase (OCD) and in the other due to deficit (ADHD).
To explain this paradox it has been proposed that The excessive cognitive fluidity (mental intrusion) of OCD would generate a saturation of cognitive resources which would result in an impairment of executive functions mediated by this area of ​​the nervous system, and therefore with an attention difficulty comparable to that of ADHD.
On the other hand, it is estimated that the reduction in prevalence that occurs between childhood and adulthood could be due to the fact that from the age of 25, the complete maturation of the prefrontal cortex occurs (as it is the last area of ​​the brain in which do), and also to the fact that ADHD tends to “soften” as time passes.
