Obsessive Compulsive Disorder and Homeopathic Management

Dr Sripada

ABSTRACT
Obsessive-Compulsive Disorder (OCD) is defined by recurring obsessions and compulsions that disrupt daily life and cause significant distress. It affects 2-3% of the population, with symptoms often including contamination fears, doubt, and a need for symmetry. Diagnosis is based on ICD-10 and DSM-V criteria, requiring persistent symptoms for at least two weeks. Treatment typically involves SSRIs and behavioral therapy, with homeopathic approaches focusing on individualized remedies. This article examines the complexities of OCD, highlighting its diagnosis and management, especially through homeopathy.

KEY WORDS : Obsessive-compulsive disorder, Homoeopathic management, ICD 10, DSM-V

INTRODUCTION
Obsessive-Compulsive Disorder (OCD) is a chronic psychiatric condition that presents a significant challenge to both affected individuals and healthcare providers. Defined by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), OCD can severely impair a person’s ability to function in daily life, affecting social relationships, occupational performance, and overall well-being. The disorder is prevalent across various demographics, with an estimated lifetime prevalence of 2-3%, making it more common than schizophrenia. Despite advances in understanding the neurobiological and psychological underpinnings of OCD, the complexity of its manifestations necessitates a comprehensive management approach. Traditional treatments, including SSRIs and cognitive-behavioral therapy, provide essential relief, yet many individuals seek alternative or complementary therapies. Homeopathy, with its focus on individualized treatment based on the totality of symptoms, offers a promising avenue for managing OCD. This article delves into the multifaceted nature of OCD, providing insights into its diagnostic criteria, underlying mechanisms, and a range of therapeutic options, particularly highlighting the role of homeopathic remedies.

DEFINITION– Obsessive compulsive disorder described as recurring obsessions and compulsions “severe enough to be time consuming or cause marked distress or significant impairment.” (OCD) , People with the disorder recognize that their reactions are irrational or disproportionate.

OBSESSION – recurrent and intrusive thought, feeling, idea or sensation. Time consuming and interfere significantly with people’s normal routine, occupational functioning, usual social activities, relationships with friends and families.

COMPULSION – is a conscious, standardized recurring pattern of behavior such as counting, checking or avoiding.

Obsessions increase anxiety, whereas compulsion reduces it, but when person resists carrying out a compulsion anxiety increases.  A person experiencing this disorder having both obsession and compulsion as ego – dystonic.

Compulsions are of 2 types

1. Yielding compulsion– a compulsive act that gives expression to the underlying obsessive urge

2. Controlling compulsion– a compulsive act that tends to divert the underlying obsession without giving expression to it.

HISTORY :

• In 1838, JEAN ETIENNE ESQUAROL, 1^st described the 1^st case of obsessive doubting and grouped with monomania’s.
• JEAN PIERRE FALRET, named it as “the illness of the doubt”.
• In 1867, MOREL used the term “obsessive-compulsive disorder.

EPIDEMIOLOGY :

• Life time prevalence of OCD in general population is 2-3%.
• Its more prevalent then schizophrenia.
• Men and women are equally affected.

ETIOLOGY OF OBSESSIVE-COMPULSIVE DISORDER:
NEUROTRANSMITTERS – a dysregulation of serotonin is involved in the symptom formation of obsessions and compulsions in the disorder. Not significantly been proved though.

BRAIN IMAGING STUDIES – have shown increased activity ( metabolism and blood flow) in the frontal lobes, basal ganglia (especially the caudate) of patients with OCD.

GENETICS – family studies of patients with obsessive compulsive disorder have shown that 35% of their 1^st degree relatives suffered of obsessive compulsive disorder .

BEHAVIORAL FACOTRS – according to learning theorists, obsessions are conditioned stimuli, A relatively neutral stimulus becomes associated with fear or anxiety through a process of respondent conditioning by being paired with events that are by nature noxious or anxiety producing.Thus neutral objects and thoughts become conditioned stimuli capable of producing anxiety.

PSYCHODYNAMIC FACTORS – Sigmund Freud described 3 major psychological defense mechanisms that determine the form and quality of obsessive- compulsive symptoms and character traits are ISOLATION , UNDOING, REACTION FORMATION.

CLINICAL SYMPTOM PATTERNS:

CONTAMINATION – Most common obsession of contamination, followed by washing or accompanied by compulsive avoidance of presumably contaminated object. The feared object is often hard to avoid (example – dust, urine, germs, feces). Patients may literally rub the skin off their hands by excessive washing or may be unable to leave their homes because of fear of germs. Anxiety along with obsessive shame and disgust.

PATHOLOGICAL DOUBT – obsession of doubt followed by compulsion of checking. Obsession often implies some danger of violence ( such as forgetting to turn off the stove or not locking a door). The patients have an obsessional self – doubt and always feel guilt  about having forgotten or committed something.

INTRUSIVE THOUGHTS –  Intrusive obsessional thoughts without a compulsion. such obsessions are usually repetitious thoughts of a sexual or aggressive act that is reprehensible to the patient.

SYMMETRY – Need for symmetry or precision which can lead to compulsion of slowness.take hours to eat a meal or shave their face.

OBSESSIONAL CONVICTIONS – Notions that are often based on the magical formula of thoughts-equals-acts (thinking ill of my son will cause him to die).The obsessional beliefs are characterized by ambivalence.

OBSESSIONAL RUMINATIONS – Prolonged, inconclusive thinking about a subject to the exclusion of others interests. Subject often is religion or metaphysics. Endless internal debates about everyday activities.

OBSESSIONAL IMPULSES – Typically related to self- injury , injury to others, or embarrassing behaviour. Shouting in public places such as temples and or church. Leaping from a window or smothering an infant.

DIAGNOSIS ACCORDING TO ICD 10

• F42.0 predominantly obsessive thoughts or ruminations
• F42.1 predominantly compulsive acts (obsessional rituals)
• F42.2 mixed obsessional thoughts and acts
• F42.8 other obsessive compulsive disorders
• F42.9 obsessive- compulsive disorder, unspecified.

F42-obsessive compulsive disorder
Recurrent obsessional thoughts or compulsive acts. Obsessional thoughts are ideas, images or impulses that enter the individual’s again and again in a stereotyped form. They are almost invariably distressing ( because they are violent or obscene or simply because they are perceived as senseless) and the sufferer always tries, unsuccessfully to resist them. Recognized as individual’s own thoughts, even though they are involuntary and repugnant. Compulsive acts are stereotyped behaviors that are repeated again and again. Equally common in men and women ,Onset is usually in childhood or early adult life

DIAGNOSTIC GUIDELINES :
For definite diagnosis, obsessional symptoms or compulsive acts, or both, must be present on most days for at least 2 successive weeks and be a source of distress or interference with the activities.                                                                                                                                        The Obsessional symptoms should of the characteristics:

1. They must be recognized as individual’s own thoughts or impulses.
2. There must be at least one thought or act that is still resisted unsuccessfully, even though others may be present which the sufferer no longer resists.
3. The thought of carrying out the act must not be in itself be pleasurable (simple relief of tension or anxiety is not regarded as pleasure in this sense
4. The thoughts, images or impulses must be unpleasantly repetitive.

DIAGNOSIS ACCORDING TO DSM-V
OBESSSEIVE- COMPULSIVE AND RELATED DISORDERS

• 300.3 – obsessive- compulsive disorder
• 300.7 – body dysmorphic disorder
• 300.3 – hoarding disorder
• 312.39 – trichotilomania (hair pulling disorder)
• 698.4 – excoriation ( skin- picking ) disorder , substance/ medication induced obsessive  compulsive and related disorder
• 294.8 – obsessive- compulsive and related disorder due to another medical condition.
• 300.3 – other specified obsessive- compulsive and related disorder
• 300.3 – unspecified obsessive- compulsive and related disorder

COMORBIDITY :

• ANXIETY DISORDERS – 76% ( panic disorder, social anxiety disorder, generalized anxiety disorder, specific phobia)
• DEPRESSIVE OR BIPOLAR DISORDER – 63%
• MAJOR DEPRESSIVE DISORDER – 41%
• OBSESSIVE-COMPULSIVE PEWROSNALITY DISORDER – 32%
• TIC DISORDERS – 32%
• SCHIZOPHRENIA WITH OCD – 12%

MANAGEMENT:

• SSRI’S (Serotonin-specific reuptake inhibitors)
• Such as fluoxetine, voxamine, paroxitine, citalopram (approved by US food and drug administration).
• Behaviour therapy
• Supportive therapy
• Family therapy
• In extreme cases (ECT to be administered)

MIASMATIC UNDERSTANDING:

PSORA	SYCOSIS	SYPHILITIC
Inconsistent and impractical thoughts	Excessive thoughts, fears are manifested outwardly	Obsessional thoughts (killing, stabbing etc) unable to resist the same
Thoughts resulting in anxieties and fears	Fear of making mistakes, repeatedly checking
Anxiety, worry and fear leading to repetitive thoughts	Restless mentally manifest in physical form	Obsessional thoughts leading into compulsions
Mental restlessness, wants to do something but don’t know what to do, pooling up of thoughts.	Repetitive behaviors,

 RUBRICS:

SYNTHESIS REPERTORY: 

• Mind-fastidious
• Mind-fastidious-cleanliness-for
• Mind-fastidious-disease-in
• Mind-fastidious- eating, in
• Mind- fastidious- food, about
• Mind- fastidious- order, of
• Mind- fastidious- personal appearance, about
• Mind- fastidious- possessions about his
• Mind-fastidious- stressed only when
• Mind- fastidious- work, in his
• Mind- delusions- dirty
• Mind-delusions-dirty- everyone is
• Mind-delusions- dirty- everything is
• Mind- washing- amel
• Mind- washing- desire to wash
• Mind-washing- desire to wash- bathing, mania for
• Mind- washing- desire to wash- always washing her
• Mind- washing- desire to wash- monomania

KENT’S REPERTORY :

• Mind- anxiety- conscience, of (as if guilty of a crime)
• Mind- anxiety- thoughts from
• Mind – delusions- that he is
• Mind – delusions – everything is, that
• Mind- fastidious
• Mind- carefulness
• Mind- tidy
• Mind- perfectionist

THE REPERTORY OF PSYCHIC MEDICINES WITH MATERIA MEDICA

• Cleanliness, excessive (monomania of )- sulphur, silicea
• Order, excessive- (monomania of )- puls, lyco
• Order, up to minuteness, mania of – sulphur, puls, lycop, silicea, calc.carb
• Order (men wanting in ), in scientific works- alumina, hepar, nitric acid
• Order (men wanting) in the administration of their domestic affairs- calc.c, Natrum mur, carbo-v
• Order (men wanting in order) in their financial, commercial and industrial affairs – staph, nux, verat
• Order (women wanting in ) in the accounts of their household- caust, lycop, calc.c
• Order (women wanting in) in household cares- sulph, sili,alumina,staph
• Order (women wanting in their toilet) puls, nux, graph
• Precautions(minute), for everything, excess of – puls, sulph, silic, lach

THE CONCORDANCE REPERTORY OF THE MATERIA MEDICA – WILLIAM D. GENTRY

• Washing – mania, rage, quieted only by washing head in cold water – sabadila

BBCR REPERTORY

• Mind- fastidious
• Mind- careful

PHATAK’S REPERTORY

• Fastidious
• Dirty he is – lac can, lycopus, rhus tox, syphilinum

MURPHY’S REPERTORY

• Mind- fault finding disposition
• Mind- fear- contamination, germs of
• Mind- fear- dirt of
• Mind- washing, cleanliness, mania for
• Mind- washing, hands, always washes the

KNERR’S REPERTORY

• Mind and disposition
• Anxiety with restlessness
• Censorious
• Mania, monomania (for doing same thing and going to same places)
• Thoughts- anxious
• Thoughts (thinking) absorbed

HOMOEOPATHIC MATERIA MEDICA :
Arsenic Album: very conscious about the order of things and cannot rest if the things are not in their proper place. This compulsion can go to such an extent that even if a painting hanging on the wall is slightly tilted, the mind does not rest till it is properly placed and the patient leaves every other work for this. Such patients also demand neatness in clothing.

Nux Vomica : are oversensitive and of a careful and angry nature who demand all the things done as they want and easily get angry if the order is not followed..

Carcinosinum : who are very concerned about cleanliness and want a specific pattern to be followed not only in placing things, but also in their dressing style. For instance, they always like color matching while dressing up and also when decorating the room. They demand perfection in every work done to such an extent that it does not seem or look normal

Syphilinum and Medorrhinum : who feel the compulsion to wash their hands again and again due to the persistent thought of getting their hands contaminated or dirty by touching any object. Such patients feel that germs are present on each and every object and get into the habit of washing hands at very short intervals, without giving any consideration to other important work in their lives.

Calcarea Carbonica : who are mentally exhausted and constantly think of going mad or insane. This thought of going mad prevails in the patient’s mind day and night and he or she is unable to put it aside even during sleep.

This fear of going mad leads to great distress and to overcome it, the patient leaves all pending work aside and keeps himself or herself busy in breaking sticks or bending pins.

REFERENCES

• Michael G Gelder, Nancy C andreasen, Juan J Lopez, John R geddes. New oxford textbook of psychiatry vol 1. 2nd edition. United kingdom. Oxford university press, 2009. p. 765-770
• S Bhatia. Essentials of psychiatry. 7th edition. New delhi. CBS publishers and distributors (p) LTD, 2013. p. 304-308
• Benjamin James Sadock, MD Virginia Alcott Sadock, MD. Synopsis of psychiatry behavioural sciences/ clinical psychiatry. 10th edition. newyork,. Lippincott Williams and Wilkins a wolter Kluwer business (India) Pvt Ltd new delhi, 2013. p. 616-622
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• American psychiatric association, Diagnostic and Statastical manual of mental disorders (DSM- 5TM), 5th edition, british library cataloguing in publication data, 2013, pg.253-242.
• William . D. Gentry, MD, The concordance repertory of the Materia Medica, reprint edition 2002, New Delhi, B. Jain publishers (p) limited, 2002.
• Edited by Dr. Frederick Schroyens, foreword by George Vithoulkas, SYNTHESIS repertorium homoeopathicum syntheticum, edition 7.1, London, homoepathic book publishers, l998.

Dr Sripada,
PG Scholar
Father Muller Homoeopathic Medical College , Mangalore
Sripadasangulagi3@gmail.com