Long before Sigmund Freud, people who had obsessive thoughts were thought to be possessed by the devil and exorcism was the solution, but now with the knowledge of psychology these obsessive thought are attributed to unconscious conflicts that manifest as symptoms.[Bynum W.F et al 1985]

Obsessive compulsive disorder (OCD) is a mental disorder characterized by repeated and persistent unwanted thoughts, need to do something in a stereotyped and ritualistic way and also can involve counting things repeatedly. This disorder occurs parallel to obsessive compulsive personality disorder but the difference between these two will be clarified in the later part of this literature.[Fenske J.N 2009]

OCD presents with some unique signs and symptoms which may occur in normal people occasionally but repeatedly and persistent in people with OCD. Some other disorders like anorexia nervosa are also associated with OCD and also neurological studies have shown certain brain lesions in people with OCD. There is also increased risk of suicide in OCD patients.  [Angelakis I et all 2015]

 Some wide range drugs can be used to treat OCD alongside behavioral therapy.



METHODOLOGY
This paper was aimed at highlighting obsessive compulsive disorder as a psychological problem which has underlying medical, genetic or environmental basis. With respect to this paper, the study was done using retrospective method, this involved several science journals and articles. Obsessive compulsive disorder as the name goes is a disorder characterized by obsessions and compulsions.

OBSESSIONS: these are irrational motives for performing trivial or repeated actions even against ones will.

COMPULSIONS: an urge to say something or do something that may be harmless or better if left undone.

In OCD, people feel the need to do things repeatedly and have some thoughts repeatedly including thoughts of harming people. Patients are unable to control their thoughts or activities, there are restless and feel relieved by doing them.
Some activities include stacking things in a peculiar manner, hyper-organization, counting things, checking if the door is locked so many times before bed, some may have difficulties throwing things out, that is hoarding. These afore mentioned activities can be done by normal people, but when it starts to negatively affect one’s life and takes up too much of one’s productive time, it can then be called a disorder.

As mentioned in the introduction, obsessive- compulsive disorder[OCD] and obsessive compulsive personality disorder[OCPD} occur parallel to each other and the similarities between them is that both are associated with orderliness, hoarding ,unwanted thoughts and actions. The major difference between them is that OCD is an anxiety disorder and OCPD is a personality disorder. There are two major types of obsessive compulsive disorder, they are the primarily obsessional and primarily compulsive disorders.[Grant J.E 2014]


FORMS OF
PRIMARILY OBSESSIONAL OCD: this occurs when OCD presents without compulsions per se but the individual will perform more covert mental rituals and sometimes may struggle to avoid these thoughts and that’s where it interferes with the patient’s wellbeing and mostly public functioning.

PRIMARILY COMPULSIVE OCD: here, the patient feels inexplicably moved to do certain things to mitigate the anxiety that stems from dodging the act. Example include excessive hair picking [trichotillomania], skin picking [dermatomania], and nail biting [onychophagia]. Individuals are aware that their actions are stupid but still do it regardless.


CAUSES OF
The main cause of the disease is unknown but just like most diseases, genetics and the environment plays the key roles in its course.

GENETICS: studies in genetics have shown that identical twins were more often affected than non-identical twins or even siblings of the same biological parents. In children diagnosed with the disorder, genetics contributes 45-65% of the problem unlike when the disease is diagnosed in adulthood. Also heritable neurological issues predispose a person to OCD.
Also, in OCD studies of genetically unrelated families, a mutation in the human serotonin transporter gene [hSERT] has been found affirming the relationship between underlying medical issues and psychological problems.

ENVIROMENT: infections such as group A streptococci have been found to cause syndromes connected to rapid onset of OCD in children and adolescence.


BRAIN LESIONS IN .
Magnetic resonance imaging [mri] scans of people with OCD shows a different pattern of brain activity when compared to normal people. Lesions in the striatum have been found in people with OCD and also neurotransmitter imbalance in other parts of the brain. Unusual Serotonin and dopamine activity may contribute to OCD. The meso-cortical dopamine pathway and serotonergic hypofunction in the basal ganglia have been found in people with OCD.

People with OCD have more gray matter in the lenticular nuclei and reduced Grey matter in the cingulate gyrus.[Markarian .Y 2010]


DIAGNOSIS
According to the year 2000 edition of the Diagnostic and statistical manual of mental disorders [DSM], one must have obsessions, compulsions or both to be diagnosed with OCD. Such obsessions as the DSM states, are recurrent and persistent thoughts, impulsivities, and intrusive images marked with anxiety and distress and lies outside the range of normalcy.[DSM 2013]

Compulsions become clinically significant when they must be met with to bypass some psychological distress. People with OCD react to compulsions with a motive that if they don’t, they might not be able to prevent a dreaded event or situation. Most times during the course of the disorder, the individual must recognize that the obsessions and compulsions are unreasonable and excessive.

To diagnose for OCD, the tasks accompanying the disorder must be time consuming too, taking at least one hour of everyday. Rating scales like the Yale- brown obsessive compulsive scale (YBOCS) may be used in comparing the severity of the disease before and during treatment.


DIFFERENTIAL DIAGNOSIS
Obsessive compulsive disorder [OCD] should be distinguished from Obsessive compulsive personality disorder [OCPD] in that, OCD is egodystonic, that means that the behavior is not compatible with what would have been that persons way of life but OCPD is egosyntonic that is ,the disorder is somewhat compatible with the persons way of life.[ Elkin 1999]


MANAGEMENT, THERAPY AND MEDICATION
First line therapy for patients with OCD includes behavioral therapy, cognitive behavioral therapy and medication.
Psychoanalysis is also very effective in dealing with OCD. Exposure response prevention [ERP] is a strong move for patients with OCD. During ERP, patients are gradually modified to deal with the anxiety that comes with not performing ritual behaviors. Example, a patient may touch a ‘mildly’ contaminated thing like a ping-pong ball touched by a paper from a ‘contaminated’ location like school. The patient fairly habituates to the anxiety of not washing his/her hand with antiseptic soap repeatedly.[Hyman B.M 2005]

Drugs like selective serotonin reuptake inhibitors and tricyclic antidepressants especially clomipramine are good for treating OCD. It blocks the reuptake of serotonin and thus makes it more available for the brain.

Electroconvulsive therapy [ECT] has been found to be effective in severe cases. [Decloedt E.H 2010]

 
SUMMARY
Individuals who obsessively wash themselves with antibacterial soaps are prone to dermatitis and raw red skin. Psychological and pharmacological interventions may lead to substantial reduction in OCD symptoms. Males and females are affected equally and symptoms usually arise before age twenty.

Behavioral therapy and medications are used to treat obsessive compulsive disorders effectively.


REFFERENCES

1.
Angelakis, I; Gooding, P; Tarrier, N;Panagioti, M (25 March 2015). "Suicidality in obsessive compulsive disorder (OCD): A systematic review and meta-analysis.".Clinical Psychology Review 39 : 1–15.doi :10.1016/j.cpr.2015.03.002 .PMID 25875222 .

2.Bynum, W.F.; Porter, Roy; Shepherd, Michael (1985). "Obsessional Disorders: A Conceptual History. Terminological and Classificatory Issues.". The anatomy of madness: essays in the history of psychiatry.
London: Routledge. pp. 166–187.ISBN 9780415323826

3. Decloedt EH, Stein DJ (2010)."Current trends in drug treatment of obsessive-compulsive disorder" .Neuropsychiatry Dis Treat 6: 233–42.doi :10.2147/NDT.S3149 . PMC 2877605 PMID 20520787

4. Diagnostic and statistical manual of mental disorders :DSM-5 (5 ed.). Washington: American Psychiatric Publishing. 2013. pp.
237–242.ISBN 9780890425558

5. Elkin GD (1999). Introduction to Clinical Psychiatry. McGraw–Hill Professional. ISBN 0-8385-4333-2.

6. Fenske JN, Schwenk TL (August2009). "Obsessive compulsive disorder: diagnosis and management" . Am Fam Physician 80 (3): 239–45. PMID 19621834.

7.
Grant JE (14 August 2014). "Clinical practice: Obsessive-compulsive disorder."The New England Journal of Medicine 371(7):646–53. doi :10.1056/NEJMcp1402176 .PMID 25119610

8. "Hygiene of the Skin: When Is Clean Too Clean? Subtopic: "Skin Barrier Properties and Effect of Hand Hygiene Practices", Paragraph 5." . Retrieved 26 March 2009 

9. Hyman, B. M., & Pedrick, C.(2005). The OCD workbook: Your guide to breaking free from obsessive–compulsive disorder (2nd ed.) . Oakland, CA : New Harbinger, pp.
125–126.

10.Markarian Y, Larson MJ, Aldea MA, Baldwin SA, Good D, Berkeljon A, Murphy TK, Storch EA, McKay D (February 2010)."Multiple pathways to functional impairment in obsessive-compulsive disorder". Clin Psychol Rev 30 (1): 78–88.doi :10.1016/j.cpr.2009.09.005 .PMID 19853982

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