Affiliations:Saint-Joseph University of Beirut, Lebanon
Journal reference: https://doi.org/10.1016/j.bbr.2015.08.031
Summary: In this article, authors explored how Obsessive-compulsive disorder (OCD) could alters memory and potential treatment to reduce this symptom.
“You can’t stop the waves but you can learn how to surf”
Obsessive-compulsive disorder (OCD) is a psychiatric condition featuring two main symptoms:
1) Obsessions (intrusive thoughts)
2) Compulsions (repetitive behaviors performed in daily routines)
These symptoms are often associated with multiple cognitive alterations such as memory, attention, flexibility, verbal fluency, planning and decision-making dysfunctions. In this article we focus on false memories in OCD patients and how they affect their daily activities.
OCD symptoms in real life
OCD patients get recurrent and repetitive ideas that cause high anxiety. These ideas push them to be compulsive in order to reduce the anxiety, the distress and the guilt and to further prevent painful images/scenarios from their imagination. One exemple to that is the act of compulsive hand washing, x time in a row. The hands are clean after the first time but the act of cleaning them again reduces the patient’s anxiety and the fear of getting a dangerous virus that could cause a chronic disease, spread to the entire family and potentially kill them.
In the same vein, OCD patients avoid doing normal daily tasks to reduce exposition to triggering tasks that could lead to self blame and panic attacks. They sometimes end up choosing the drastic option of staying in bed all day, which impacts their social relationships and increases the propensity to develop other symptoms such as anger issues and suicidal thoughts.
How does a doubtful/corrupted memory come into play?
Individuals with OCD often complain of their memory abilities. They tend to focus on details and end up missing the larger context of the situation. When they try to recall an anxious moment, they overanalyze it and end up creating new and false images/scenarios that lead them to false memories, doubt and guilt.
A false memory can for instance convince the patient that they skipped an action/ forgot to do something, pushing them to do it again. It is the case for OCD patients who wonder if they have sanitized their pillow in the morning. What if they haven’t? Did they forget? They can’t remember. If they can’t remember it must mean they haven’t done it. They would rather do it (again), “just to make sure”.
This repetitive compulsive checking will cause reduced memory confidence and if the patient keeps on checking nonstop, it will create even more compulsions and confusion, adding up new made-up images and feeding the obsessive-compulsive loop.
The cause of OCD is uncertain, but risk factors include:
1) Family history of OCD
2) Cocaine abuse
3) Past history of Alcohol Use Disorder/p>
4) Affective and phobic disorders
5) Micro episodes: the progressive buildup of bad rituals/routines that leads to OCD
Treatment is necessary to reduce the impact of OCD on daily life and it includes:
1) Behavioral therapy using Exposure Response Prevention (ERP).
Patients expose themselves to certain anxious situations and then try to skip the obsessive thoughts that cross their minds and avoid engaging in compulsive actions that normally alleviate their anxiety punctually.
2) Cognitive Behavioral Therapy (CBT)
This is a form of therapy that combines techniques from cognitive therapy and behavioral therapy. CBT aims to correct distorted thoughts (such as exaggerated sense of harm and personal responsibility) by logical reasoning and other approaches.
3) Cognitive restructuring
Through this therapy patients are asked questions to help them challenge the stereotyped and repetitive thoughts and images that enhance fear. It allows them to suppress obsessive thoughts and ideas by replacing them with new and logically accurate ones.
4) Sometimes consulting a psychiatrist is necessary: the main medicines prescribed are a type of antidepressants called selective serotonin reuptake inhibitors (SSRIs). An SSRI can help improve OCD symptoms by increasing the availability of a chemical called serotonin in the brain hence improving the mood as well.
In conclusion, OCD is more than just thoughts, more than wanting to organize things and being a neat-freak, more than cleaning and dusting. Beyond the obsessive thoughts and compulsive actions, OCD alters cognitive functions, namely memory. Patients doubt their memory and fabricate false memories that nourish their recurrent thoughts and strengthen their repetitive actions. To lessen the impact of OCD on memory, patients must seek treatment that is, psychological therapy with or without medicines.