OBSESSIVE COMPULSIVE DISORDER (OCD)

An obsession is defined as;

• An idea, impulse, or image which intrudes into the conscious awareness repeatedly.
• Patient tries to resist against it but is unable to
• Failure to resist leads to marked distress

An obsession is usually associated with compulsion. Compulsion is defined as

• A form of behaviour which usually follows obsessions.
• It is aimed at either preventing or neutralizing the distress or fear arising out of obsession.

OCD is characterized by persistent and recurring thoughts, urges or images that lead to repetitive behaviours or mental acts.

Lifetime prevalence is 2-3 % and the average age of onset is 20 years of age

• Genetic: Familial Transmission
• Psychological Trauma
• Biological: Secondary to many illnesses such as von Economo’s encephalitis, Basal ganglia lesions, Hypothalamic and Third ventricle lesions

• Depression is very commonly associated with OCD. It is estimated that at least half of the patients of OCD have major depressive episodes while many others have mild depression
• Major types of obsession commonly seen in clinical practice are washers and checkers
• In washers the obsession of contamination with dirt, germ body excretion and like. The compulsion is washing of hands, whole body repeatedly many times a day
• In checkers type, the person has multiple doubts, e.g. the door has not been locked, kitchen gas has been left open, etc. the compulsion, of course, is checking repeatedly to remove the doubt
• Ego Dystonic Behaviour or Thought patterns that are inconsistent with or repulsive to one’s self of self

Differential diagnosis

• Obsessive-Compulsive personality disorder: Excessive perfectionism and rigid control regarding real-life concerns
• Generalised anxiety disorder: Recurrent thoughts on real-life concerns
• Tic Disorder
• Hoarding Disorder: Difficulty discarding objects

• Clinical diagnosis is done based on ICD11 or DSM 5 criteria
• Y-BOCS ( Yale-Brown Obsessive Compulsive Scale) is used to assess the severity of the condition.

• Psychotherapy
• Cognitive Behavioural Therapy
• Satwavajaya chikitsa

Internal medicines:

• Aswagandha choorna + Sankhupushpi choorna + Kushta choorna
• Samana snehapana - Panchagavya ghrita, Mahatpanchagavya ghrita
• Drakshadi kashaya reduces associated anxiety
• Saraswatha choorna

Procedures

• Snehapana - Panchagavya ghrita, Mahatpanchagavya ghrita
• Vamana (more suited) or virechana
• Yogavasti – Doshahara kashaya vasti + Snehavasti with Panchagavya ghrita
• Teekshna Nasya with Vilwadi gutika
• Dhoopana – Haridra, daruharidra, Vacha, Hingu, jatamamsi