Obsessive compulsive disorder

The exact cause of obsessive compulsive behavior is yet to be established. On the basis of some studies and research carried so far, possible causes include any one or a combination of two.

Genetics (family history): Multiple genes passed on through generations are likely to affect the sufferer whose close relative is diagnosed with OCD as well. The genetic connection proves to be higher if the onset of OCD is before age 14. Identical twins have a 70% chance of sharing the disorder.

Illness: If the person is suffering from other anxiety disorder like depression, , substance abuse disorder, a personality disorder, attention deficit disorder, he or she is most likely to experience a high level of anxiety. Certain auto immune diseases such as Sydenham's chorea, rheumatic fever, pediatric streptococcal infection may also cause obsessive compulsive disorder.

Serotonin Hypothesis: People diagnosed with OCD are believed to have abnormally low levels of brain chemical, the serotonin which helps carry messages from one nerve cell to another. This imbalance may interfere with the normal biological processes including mood, sleep, appetite, impulse control, aggression and pain.

Structural brain differences: Abnormalities in several parts of the brains including the thalamus, caudate nucleus, orbital cortex and cingulated gyrus may also be a cause for OCD.

OCD traits

The disorder is clearly visible right from early childhood. Check for one or more of the following traits which are generally associated with time, dirt, relationship and money. Unless and until the individual has trouble leading a normal life due to any or all of these traits, it is not diagnosed as a disorder.

• Keeping home perfectly organized.
  
  
• Extreme attention to details, rules, lists, orderliness even if it results in waste of time and doesn't result in completion of proposed activity.
  
  
• Exhibiting over perfectionism which interferes with task completion.
  
  
• Is a workaholic, overly devoted to work and productivity.
  
  
• Unwilling to delegate work as
  
  
• Highly rigid and stubborn.
  
  
• Leading a miserly spending style, self and others. Hoards money fearing future catastrophes.
  

Treating OCD

If left unattended, OCD can have devastating effects both in personal life and at the workplace. Normal life can be completely marred. Most importantly, individuals with OCD are close to acknowledging the need for help as compared to those affected with OCPD who do not conceive it as a problem, hence do not seek help until or unless someone forces the issue.

Antidepressant medications and behavior therapy are effectively used in treating OCD. Medication other than certain antidepressants is rarely prescribed. Instead individual psychotherapy or counseling helps treat OCPD. With family support and an empathetic attitude by those in contact, improvement is evident within few weeks of professional assistance.

Misophonia

Just few years back, in 2010, Misophonia was recognized as an emerging rare disorder. It continues to be so. Till date, Misophonia is a relatively unknown disorder. Misophonia is a disorder related to hearing particular sounds. Psychologists call these individuals as Misophones. Their relationship with sounds isn't normal. Hearing particular sounds send Misophones into an unbearable frenzy.

Misophonia Unclassified

Research on Misophonia is limited. The classification is still discussed. Studies are conducted by neurosurgeons, cognitive neurologists, clinical psychologists, neuro psychiatrists and animal psychics. Is Misophonia a Neurological, Psychiatric, or Auditory Disorder? There is an ongoing debate whether Misophonia can be classified as its own psychological disorder or it is just a symptom of underlying psychiatric disorder such as Obsessive Compulsive Disorder or generalized anxiety.

Misophonia is mostly regarded as a neurological disorder and is termed as selective sound sensitivity syndrome (4S) - a condition in which a person reacts extremely negatively to certain sounds that don't bother most people.

Upsetting, Annoying, Enraging Sounds



Literal meaning of Misophonia is 'hatred to sounds'. 'Miso' means dislike or hatred, 'phonia' means sounds. The sounds are everyday sounds. Nothing exceptional. The sounds can be loud or soft ones. Hearing these sounds make individuals with Misophonia angry, irritated, anxious, agitated, – all negative responses. From feeling moderate discomfort, the sounds can set in an intense panic and full-fledged rage.

• Awful tickling noise
  
• Tapping feet on floor
  
• Annoying chomping noise
  
• Sound of nails on a chalkboard
  
• Rumbling of a snoring person
  
• Crunching on snacks
  
• Clinking of silverware
  
• Rubbing of chalk against the blackboard
  
• Sound of heavy breathing
  
• Shifting of a table
  
• Candy wrapper crushing
  
• Throat clearing
  
• Slurping on soups
  
• Excited squeals
  
• Leg fidgeting
  
• Clocks tickling
  
• Teeth brushing
  
• Snapping fingers
  
• Clicking keys in computer
  
• Pen clicking
  
• Car alarms
  
• Chewing
  
• Coughing
  
• Scratching
  
• Typing

Reasons for behavior

There are 4000 plus Misophones who post on web forums. Misophonia behavior is still being researched. In all probability, people with Misophonia could have unusually strong neural connections between sound-processing parts of their brains and their limbic systems (emotional systems) which regulate emotion. Simply put, it is due to criss-crossing of wires - the wires that affect hearing get crossed with wires that affect emotions.

Also, there seems to exist a connection with psychiatric conditions like anxiety, depression and obsessive-compulsive disorder. People with Misophonia develop a negative reaction to annoying sounds and gradually it becomes a natural behavior/reaction/response to these sounds.

Onset of Misophonia

Research conducted so far indicates that the symptoms often appear in late childhood, pre-teen or just before puberty and worsen with time. In some cases, Misophonia triggers are noticed in early childhood. If not attended to Misophonia persists entire lifetime. Initially the aversion is limited to a specific sound which later can include more sounds.

Reaction to specific sounds

Misophones respond differently to the sounds they hate. Mild feeling or severe response, the reaction could be any one of these. This is referred to as Misophonia Activation Scale.

• Aware of sounds that annoy them. Have not had any negative experience with those annoying sounds.
  
• Experience discomfort. Able to withstand the trigger and strive to move away from the annoying sound, divert self or if possible withstand the situation and related sound.
  
• Experience significant negative response. If a polite request to stop the annoying sound is turned down, he/she strives to escape the trigger event as it is difficult to endure it.
  
• Experience at least one fight or flight response.
  
• Experience a powerful fight or flight response. Feel the trigger event is a deliberate attempt to mock, irritate and insult the individual with Misophonia.
  
• Enthused to 'sarcastically' mimic the annoying sound or exhibit anger at the person making the sound. There is an urge to scream. Some people experience physiological reactions.
  
• Highly unbearable to hear specific sounds, there is a high possibility of verbal assault. If the offending sound doesn't stop, the Misophones exhibit physical discontent.
  
• The hatred of specific sounds is intense. Frantic effort to stop the sound. Express apathy of people in understanding the pain of individuals with Misophonia.
  
• More of a physical response phase, there is marked violent behavior towards self or others. Ready to inflict pain on self or others to relieve their pain.

Treating Misophonia

There is no official treatment sanctioned by the American Psychiatric Association. The search for a specific cure is on. There are many potential coping strategies. Effectiveness of these isn't yet proved but has provided the much needed relief. Many have benefited from these. At least, the symptoms are reduced. Before opting for any of the coping strategies, check with a consultant on Misophonia – audiological physician or an ENT surgeon.

Tinnitus retraining therapy (TRT): TRT teaches people with Misophonia how to improve their ability to tolerate the specific annoying noises. The combination of sound therapy and teaching/demystification/learning about mechanisms helps in remaining unprovoked.

Cognitive behavioral therapy: Initial sessions aim at deciphering the specific sounds, individual's thoughts and feelings associated with the sound. Subsequently, people with Misophonia are taught ways to improve thoughts thereby finding relief and feeling better.

Neurofeedback: Here is an expensive therapy that doesn't work for everyone and is not covered by most health insurance plan. Neurofeedback therapists or practitioners are trained to administer neurofeedback therapy. The session lasts 30 minutes. The therapy involves recording the waves of electrical activity emitted by the brain when EEG or Electroencephalography is administered. Electronic sensors attached to the ears and scalp read the brain waves when music and light/images are shown. The feedback is recorded and analyzed. The aim is to help the brain self-regulate or self-correct. Neuro feedback benefits the brain and body like improved sleep, heightened mental clarity and enhanced cognitive performances.

Sound therapy: Clinics that provide sound therapy play background noises to counteract trigger sound. The individual is conditioned to respond in a particular manner. The approach is to decondition the individual's response. Combined with psychological counseling, Sound therapy has proved effective for some individuals with Misophonia.

Clinical hypnosis: The focus is to help relax when the sound troubles the mind.

Check basics: Paying attention to the basics can help. A healthy and balanced diet combined with consistent and adequate exercise help manage stress thereby reducing the intensity of triggers.

Other options

• Ear plugs and sound masks to block out intriguing and annoying sounds.
  
• Music to distract from trigger and reduce reactions.
  
• Talk therapy and anti-depressants prescribed by health care provider.
  
• A stress ball to squeeze when feeling overwhelmed.
  
• Get plenty of sleep, regular exercise and manage stress.
  
• Create a room at home with sounds you enjoy to mask triggers.
  
• Let people around you know of Misophonia to gain support.
  
• Find support from Misophonia Association.
  
• Interact online where people share Misophonia coping strategies.

Mysophobia

Mysophobia is excessive fear of contamination due to dirt and germs. This is characterized by behaviors such as excessive washing of hands and avoiding social contact with groups for fear of catching an infection that is life-threatening. Such a person is likely to make excessive use of sanitizers and the like. Mysophobia is an extension of Obsessive Compulsive Disorder (OCD). A mysophobe might need cognitive behavior therapy to improve quality of life.