Neil Hilborn is an American slam poet who writes and performs poetry. His poems often detail personal experiences and battles with mental illness. | Wikipedia
#4 M/C psychiatric illness and a leading cause of disability.
Obsessive-compulsive disorder cycle:
Obsessions are unwanted ideas, images, or impulses that repeatedly enter a person’s mind. Although recognised as being self generated, they are experienced as “egodystonic” (out of character, unwanted, and distressing). Compulsions are repetitive stereotyped behaviours or mental acts driven by rules that must be applied rigidly. They are often intended to neutralise anxiety provoked by the obsessions,
Obsessive–compulsive and related disorders (OCRDs):
OCRDs are often prevalent but under-recognized conditions that are characterized by repetitive and unwanted thoughts or behaviours. Some OCRDs include preoccupations and compulsive behaviours (such as body dysmorphic disorder), but others have predominantly motoric or behavioural symptoms (such as trichotillomania).
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):
Obsessive-compulsive disorder (OCD)
Body dysmorphic disorder (BDD)
Excoriation (skin-picking) disorder
OCRD as a result of another medical condition
Other specified OCRD
International Classification of Diseases, 11th Revision (ICD-11):
Tourette syndrome (also classified as a neurodevelopmental disorder)
Hypochondriasis (also classified as an anxiety disorder)
Olfactory reference syndrome
Genetic, psychological, and external circumstances all play a role.
OCD is characterized by substantial comorbidity (~90%)
Cortico–striato–thalamo–cortical (CSTC) circuits:
Involved in sensorimotor, cognitive, affective and motivational processes in OCD
Defence mechanisms involved:
Hallmarks of OCD are presence of obsessions and compulsions.
Obsessive thoughts: Constant and repetitive thoughts that are very hard to shake off. Although someone with OCD feels that the thoughts are illogical and unpleasant, it is hard to simply stop them using will power alone.
Compulsive behaviors: Certain rituals that are repeated over and over. For people with OCD, this is a way to try to get frightening thoughts out of their head and feel safe again.
Common sets of obsessions and compulsions in patients with OCD include concerns about contamination together with washing or cleaning, concerns about harm to self or others together with checking, intrusive aggressive or sexual thoughts together with mental rituals, and concerns about symmetry together with ordering or counting.
To receive a formal diagnosis, the DSM 5 requires > 1 hour/day to be consumed by the obsession or compulsions or that they cause significant daily stress.
Obsessions, compulsions or both
Time-consuming (distress to daily life)
Not physiologic effects of substance or medication condition
Not better explained by another disorder
Treatment of OCD comprises several components, starting with building a therapeutic alliance with the patient and psychoeducation, followed by psychological and/or pharmacological approaches, and, for patients with treatment-resistant OCD, neuromodulation and neurosurgery.