Interview with Idoia Castro: OCD from the point of view of a psychologist

Obsessive-Compulsive Disorder (OCD) It is one of the psychological disorders that is heard the most, both in conversations in everyday life and in cultural products: series, books, movies, etc.

It has earned a reputation for being a curious, attention-grabbing phenomenon that expresses striking personality traits that are sometimes represented as if they were a form of charisma: the obsession with order, the desire for everything to go well and adjusting to plans, etc. However, the real OCD, the one that really exists, is much more complex than that, and can greatly damage people's quality of life. That is why it must be treated by specialists.

On this occasion we interview one of those people who are experts in intervening in patients with problems such as Obsessive-Compulsive Disorder: the psychotherapist Idoia Castro Ugalde, Director of the Bilbao psychology center Abra Psicólogos.

• Related article: "Obsessive-Compulsive Disorder (OCD): what is it and how does it manifest?"

Interview with Idoia Castro: understanding Obsessive-Compulsive Disorder beyond the topics

Idoia Castro Ugalde She is a psychologist specialized in the clinical and health field, and has worked in the world of psychotherapy for more than 20 years. On this occasion, she tells us about Obsessive-Compulsive Disorder from the point of view of those who, as a professional, have helped many people to face this psychological alteration and to overcome it.

What exactly is OCD?

Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and / or compulsions.

Obsessions are recurring and persistent thoughts, impulses or images that are experienced at some point in the disorder, as intrusive and unwanted and causing a degree of anxiety or discomfort in most people significant.

Compulsions are behaviors or mental acts, of a ritual and repetitive type that the person performs in response to the obsession, or according to rules that "must be applied" in a rigid way. The objective of compulsions is to prevent or reduce anxiety or discomfort (caused by the obsession), or to avoid some dreaded event or situation; however, these behaviors or mental acts are not realistically connected with those that would be intended to neutralize or prevent them, or they are clearly excessive.

Obsessions or compulsions take a long time and cause clinical discomfort or impairment significant in the social, labor or other important areas of the functioning of the person who suffers.

The content of obsessions and compulsions varies from one individual to another. Among the most frequent are contents related to cleaning (pollution obsessions and cleaning compulsions), symmetry (obsession with symmetry and compulsions to repeat, count and order), taboo thoughts (aggressive obsessions, religious and sexual compulsions and related compulsions) and harm (fear of harming oneself or others and compulsions of verification). Other people have difficulty throwing things away and accumulate objects.

It is common for people to have symptoms in more than one dimension.

Is it related to what is known as "magical thinking"?

Superstition has been linked over the years to various psychological disorders.

The concept of "magical thinking”Can be considered as the most used within cognitive psychology to refer to superstitious thoughts. It would be a type of cognitive distortion. Specifically, through magical thinking the person makes a causal attribution of the influence that an event has on actions or thoughts when in fact, there is no such causal relationship.

Superstitious beliefs are a type of "magical thinking" that has been transmitted from generation to generation and generally, they are associated with good or bad luck, for example “the bad luck that can bring us when we cross a black cat".

The "magical thinking" in a non-clinical environment, is part of the normal development of children up to approximately 10 years (moment from which they begin to distinguish between reality and fantasy), in "primitive" societies and minimally in Western societies, related to uncertainty or lack of knowledge to explain certain topics.

In both children and adults, "magical thinking" plays a relevant role in OCD. To a large extent, this differentiates it from other types of anxiety disorders and it appears that a high level of magical thinking is related to a worse prognosis of the disorder. The person with OCD may believe that if she performs a certain mental or behavioral ritual (compulsion) she will prevent the disaster she fears (obsession) from happening.

Regarding people who suffer from OCD, they vary in the degree of knowledge they have about the accuracy of the beliefs that underlie obsessive-compulsive symptoms. Many people recognize that these beliefs are clearly or most likely not true; others believe that they are probably true and some people are completely convinced that the beliefs related to OCD are true. The latter case, in which the person has little or no awareness of disease, and believes strongly conviction the content of her magical thinking could be linked to a worse long-term evolution of the TOC.

Is there a profile of a person with a greater propensity to develop Obsessive-Compulsive Disorder?

To this day, we do not know the exact causes of OCD. There are a number of factors under study, which seem to influence its appearance.

Environmental factors could include head injuries, infectious processes and autoimmune syndromes, the fact of having been physically or sexually abused in childhood and stress.

In the socio-environmental factors there are certain educational styles that promote hyper-responsibility and perfectionism, a rigid moral or religious formation, an overprotective educational style, parental models with behaviors with a low tolerance for uncertainty, excessive importance of the relationship between beliefs that overestimate the importance of thinking and the responsibility or implication of one's own identity in what is thought (for example, “thinking something bad is the same to do it ”) and / or exaggerate the connection between thought and reality in what has been called“ thought-action fusion ”(for example,“ thinking something can make happens ”).

There are also temperamental factors: internalization symptoms, greater negative emotionality and inhibition of behavior in childhood.

Regarding genetic factors, the probability of having OCD when having first-degree relatives of adults with the disorder is approximately two times higher than among those without first-degree relatives with OCD. In the cases of first-degree relatives with OCD, which started in childhood, the rate increases 10 times.

In neurophysiological factors there are dysfunctions of certain cortical areas of the brain that seem to be strongly involved.

Finally, as neurochemical factors, the hypothesis that has the most scientific support is serotonergic.

Taking into account that psychological disorders often overlap each other, what are the mental disorders that usually go hand in hand with OCD?

Many of the people who suffer from OCD also have other psychopathologies.

According to the American Psychiatric Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 76% of the adults with OCD are also diagnosed with an anxiety disorder (panic disorder, social anxiety, generalized anxiety or specific phobia) or 63% have another diagnosis of depressive or bipolar disorder (the most common being depressive disorder higher). OCD onset is usually later than that of comorbid anxiety disorders, but it often precedes depressive disorders.

Obsessive-compulsive personality disorder is also common in people with OCD, approximately 20-30%.

Tic disorder appears in up to 30% throughout the life of people with OCD, and in children you can see the triad composed of OCD, tic disorder and deficit disorder attention / hyperactivity.

They also occur more frequently in people who suffer from OCD, compared to those who do not suffer from it, certain disorders such as: body dysmorphic disorder, trichotillomania (hair pulling), excoriation disorder (scratching the skin) and oppositional disorder challenging.

Finally, in people with certain disorders, the prevalence of OCD is much higher than in the population. general, so when one of these disorders is diagnosed, it should also be evaluated on the TOC. For example, in patients with certain psychotic disorders, eating disorders, and Tourette's disorder.

As a professional, what strategies do you usually use to intervene in patients with this psychological disorder?

Currently, and since the emergence of "third generation therapies" such as Acceptance and Commitment Therapy (ACT), and Mindfulness I use an integrative intervention for the treatment of OCD, complementing Cognitive-Behavioral Therapy (CBT) with these new techniques.

Cognitive-behavioral therapy tries to solve psychological problems and suffering, based on the relationship between feelings, thoughts and behaviors. We know that most people sometimes have negative thoughts, or intrusive thoughts that appear automatically in our minds. CBT teaches us to identify these types of negative thoughts, and to change them for other rational thoughts that adjust to reality. Thus, through cognitive restructuring we can face our lives in a more adaptive and realistic way.

When it comes to OCD, it is important to differentiate between normal intrusive thoughts and obsessive thoughts, which can be defined as negatively and biased assessed intrusions.

When these normal intrusive thoughts are assessed negatively and catastrophically, the person begins to experience a level elevated anxiety and worry, and interprets intrusive thoughts as serious, dangerous, and necessary take care. The compulsions of OCD have the effect of neutralizing the worry and relieving the anxiety caused by the obsession. In this way the ritual behavior (compulsion) is negatively reinforced and the disorder is consolidated.

In therapy, we teach patients to identify their own intrusive thoughts, for in function of their idiosyncrasy, work and equip them with the most cognitive and behavioral tools effective.

Acceptance and Commitment Therapy tries to change the relationship that the person has with their own symptoms. You have to do something that is probably against your common sense, such as "accepting" the symptoms rather than trying to "eliminate" them. The first step in managing obsessions and compulsions is to "accept" them, rather than resist or fight them.

As I pointed out before, there is a high coexistence of obsessive-compulsive symptoms with other disorders, such as depressive disorders and other anxiety disorders.

In this case, ACT applied in a complementary way to cognitive-behavioral therapy is aimed at improving some of the symptoms. derived from associated disorders such as depression and anxiety (since these cause the symptoms of OCD), making it possible to reduce the frequency of intrusions and ruminations, and to reduce the level of anxiety caused by TOC.

The treatment is carried out individually, according to the needs and idiosyncrasies of each patient and in some cases where necessary, it is combined with psychopharmacological treatment, under prescription medical.

Early psychotherapeutic intervention is essential in patients with OCD, to avoid chronicity of the disorder, since without treatment remission rates are low.

How does the recovery process take place in which the patient overcomes the disorder?

Treatment through CBT, ACT and Mindfulness addresses obsessions and compulsions with various cognitive and behavioral techniques, such as cognitive restructuring, exposure with response prevention, acceptance of certain symptoms, and management of relaxation techniques, among other.

Learning these techniques equips patients to be able to manage OCD symptoms should they reappear at some future time. Post-treatment results generally show a significant decrease in anxiety levels, and of the discomfort experienced and the reincorporation of the person to the important areas of functioning of his life.

The importance of motivation and collaboration on the part of the patient should be highlighted, both to attend the sessions as well as to carry out the tasks at home that are scheduled to be done as personal work, outside of the sessions in consultation. This is essential for the success of the treatment, as is the participation, collaboration and support of the significant others in your environment (partner, family, friends).

Finally, once the treatment itself is finished, we consider it important to carry out follow-up and relapse prevention sessions.