Obsessive-Compulsive Disorder (OCD)
Obsessive-Compulsive Disorder (OCD) represents a very common disorder, and current estimates indicate that it afflicts almost 3% of the population worldwide.
Its symptoms can be highly variable, to the point that it can be said that each person who suffers from it has "his or her own OCD." In fact, Obsessions and/or Compulsions can relate to a wide variety of themes: fear of filth and contamination, order and symmetry, moral and religious, sexual and aggressive, etc.
The doubts and impulses that characterize obsessions represent manifestations that force sufferers to repeat actions or thoughts (compulsions) in order to neutralize the discomfort caused by the obsessions, like an antidote. The obsessive patient lives in the anguish of these experiences, which eventually nullify his autonomy and deteriorate his social and family life.
OCD symptoms often arise as early as adolescence, but in women it frequently happens that symptoms appear in the postpartum period (in at least one third of cases).
The variability of the Obsessive-Compulsive Spectrum
DSM-5 separated Obsessive-Compulsive Disorder (OCD) and related from Anxiety Disorders. Among the reasons why OCD and related disorders have been differentiated from Anxiety Disorders is the lack of response to benzodiazepines and the hypothesis that at the origin of obsessions and compulsions lies a dysfunction in the circuits ranging from the frontal cortex to the basal ganglia. In this sense, OCD is now considered more as an expression of an altered codification of reward rather than a condition of anxious alarm.
The diagnostic category of Obsessive-Compulsive Disorder and related disorders includes:
Obsessive-Compulsive Disorder (OCD);
Body Dysmorphic Disorder;
OCD induced by substances or drugs;
OCD due to another medical condition;
Other specific or unspecified Obsessive-Compulsive Disorders (e.g. repetitive body-centered behavior, obsessive jealousy).
The inclusion of a specific chapter on OCD and related disorders in DSM-5 reflects the growing evidence showing the close relationship between these disorders at the level of diagnostic validators and the clinical utility of grouping them into a single chapter. Clinicians are therefore encouraged to investigate the presence of these conditions in a patient presenting with one of these disorders and to be aware of the overlap between these conditions. At the same time, there are significant differences between diagnostic validators and approaches to treatment of these disorders..
OCD and related disorders differ from normal worries and rituals typical of the developmental years, since they are excessive and persist beyond specific periods relative to the individual's level of development. The distinction between the presence of subclinical symptoms and a clinical disorder requires the assessment of a number of factors, including the individual's level of stress and impairment in functioning.
OCD and related disorders with a cognitive component have as a basic specifier the level of insight: in fact, insight in each of these disorders ranges from "good or adequate" to "poor" to "absent/with delusional thoughts." For individuals with OCD and related disorders with "absent insight/with delusional thoughts," it is important not to diagnose these symptoms as belonging to a psychotic disorder.
Treatment of OCD and Related Disorders
Given the high variability of manifestations that fall within the Obsessive-Compulsive Spectrum, it is crucial to be able to obtain the most accurate yet broad diagnosis possible in order to target specific goals for treatment.
In fact, the treatment of each subcategory of OCD is different and varies for each individual presenting with the disorder. This is because for each condition presented there exist different mechanisms, brain circuits, and immunological activation profiles, requiring different individualized interventions.
Since the 1980s, mainly Pharmacological Therapies (particularly SSRIs: Selective Serotonin Reuptake Inhibitors) and Cognitive-Behavioral Psychotherapy (CBT) have been used to treat OCD with good results. However, despite encouraging results, these first-line therapies prove ineffective for treatment-resistant forms of disorders.
The study of the specific mechanisms that exacerbate these disorders highlights the need for precision diagnosis that includes, in addition to clinical interviews, the prescription of specific examinations regarding the study of the inflammatory response profile, cognitive functioning and microbiome of the person suffering from the disorder.
Through these data, it becomes possible to design and structure high-level treatments, which must be personalized and targeted to these sources of dysfunction. This kind of personalization of treatment, however, goes beyond guidelines (Off-Label Treatments), which are found to be outdated and inadequate for the great variability with which Obsessive-Compulsive Disorders can present. Treatment of resistant disorders must be centered on the individual patient and not on the diagnostic label. This level of care requires a specific setting and expertise.
For the individualized and effective treatment of OCD and Obsessive-Compulsive Spectrum Disorders, Dr. Stefano Pallanti uses Neuromodulation Therapies (Transcranial Magnetic Stimulation or TMS, Continuous Direct Electrical Stimulation or tDCS), Pharmacological Therapies, Healing-oriented Psychotherapy, Natural Cures, and everything that has been scientifically validated in order to offer his patients the best cutting-edge care available!
Dr. Pallanti is one of the leading experts on OCD in the world.
He is a Board Member of the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS, UK) and for the European College of Neuropsychopharmacology (ECNP), Dr. Pallanti serves in several roles: Executive Committee Member (2016 – 2019), Obsessive-Compulsive and Related Disorders Network Member, Scientific Committee Board Member, Scientific Advisory Panel Member for Anxiety, Chair of the ECNP Neuromodulation Thematic Working Group.
From 2005 to 2007, Dr. Pallanti has held the positions of Member of the OCD Spectrum Workgroup, the Impulse Control Disorders Taskforce and the International Advisory Board of the American Psychiatric Association (APA) for DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; Chair D.J. Kupfer).
Dr. Pallanti is Author of the chapter “Incompleteness and Harm Avoidance in OCD“ included in the handbook "Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology, and Treatment" published by Oxford University Press. ISBN-13:9780190228163. DOI:10.1093/med/9780190228163.001.0001.