Are you the type of person who has a phobia of germs, dirt, or contaminated bodily fluids? Is the only way to feel safe and pure is for you to cleanse yourself countless times a day? Or maybe you’re the type of person who has to check things twice, three times or more. Perhaps you’re the type of person who has to do everything twice, or by a fixed number. Maybe you are the type of person who must have everything neatly placed, and if misplaced at all you throw a tantrum. If you are a person who happens to do any of these things then maybe you have OCD, the acronym for Obsessive-Compulsive Disorder.
Obsessive-Compulsive Disorder (formerly known as obsessive neurosis) “is categorized as an anxiety disorder because the main focus seems to be anxiety and discomfort that is usually increased by the obsessions (thoughts) and decreased by the compulsions or rituals (actions).” (Baer 3) According to Baer, Obsessions are defined as recurrent, persistent ideas, thoughts, images, or impulses that are experienced, at least initially, as intrusive and senseless. Compulsions are defined as repetitive, purposeful, and intentional behaviors that are performed in response to an obsession or according to certain rules or in a stereotypical fashion. (Baer 3)
Obsession-compulsive disorder usually begins in late adolescence in one to two thirds of reported cases. The problem is associated with significant life changes. Obsessive-compulsive disorder results from biological and psychological influences. Abnormal levels of the neurotransmitter serotonin may play a role in OCD. Catscans of people with OCD have discovered irregularities in the activity level of the orbital cortex, caudate nucleus, cingulate cortex, and a brain circuit that assists control movements of the limbs. (Pato 8) Many patients report having numerous neurotic problems during childhood. These patients become socially isolated, and consequently fall into a deep depression. This disorder affects males and females quite differently. People with OCD tend to have a high celibacy rate, particularly males. Both sexes tend to marry at an older age than other types of psychiatric patients, and they have a low fertility rate. (Rachman 6)
Most studies concluded that OCD patients possess higher than average intelligence. The average OCD patient has many types of compulsive behavior. The anxiety of OCD is caused through its persistence. (Mavissakalian 15) And maybe this is why cleaning and checking rituals are the most common types of obsessive-compulsive disorder. These patients carry out activities as disinfecting of objects, excessive hand washing until the hands are so clean that they crack and bleed, excessive showering, and excessive rinsing of dishes. Securing locks, alarm clocks, gas jets, and looking under the bed are some of the checking rituals OCD patients have. If the obsessive-compulsive person qualms and ponders when the ritual is not performed systematically. The task of this patient must be carried out to perfection or it will not be preventative or restorative. The checking ritual is described as intending to prevent some state of balance and order to avoid infectivity from some distressing stimuli. (Rachman 14)
Some obsessional people often feel a compulsive need to arrange things in their environment. To the observer, compulsive arranging seems identical with the activities of normal, neat-minded people. The major distinction is the accompanying experience of compulsivity.
The frustration experienced by the obsessional person is a result of disobedience of a different order severely disturbed by any deviation from the set order and feels compelled to reposition the status quo. (Reed 38) For example, if someone puts a document on your desk then this person just moved an item from your possession, in turn when you arrive, you have to remove the item and put anything that was interfered with back to a precise order.
Sigmund Freud was particularly fascinated in the obsessive-compulsive disorder. He referred to it as the obsessional neurosis, and in 1926 Freud wrote it was “unquestionably the most interesting and re-paying subject of analytic research. But as a research it has not been mastered.” (Cooper 9) Freud also found evidence of passive sexuality, and sexual experience yielding pleasure. The defenses used in obsessional neurosis are denial, repression, regression, reaction formulation, isolation, undoing, magical thinking, doubting, indecision, intellectualization, and rationalization. Washing is most frequently engaged to an undoing of a dirtying action. In analytic therapy, obsessive-compulsive neurosis is regarded as the second type of transference neurosis. In hysterics, the ego forms an alliance with the analyst to battle the neurosis.
In compulsive neurotics, the ego is split, with one part working logically while the other thinks in fantasy. (Cooper 14)
Obsessions and compulsions are also linked to toxic conditioned stimuli obtained by classical conditioning events. The response and stimulus are used identically because they have double properties. An example of this is fear. Fear is a response, but also it is an obsessive thought of hurting, which would make it a stimulus also. The interaction between the repeated ruminations and mood turbulence increases the provocation of the individual and increases the tendency to reflect even further. Temporary relief produced from the ritual, or motor act terminates an aversive condition. This makes the resolution prototype likely to be repeated the next time producing a disturbing thought. The classical conditioning will result an anxiety. This will now become a conditioned stimulus for a response. When this stimulus is then paired again to another neutral stimulus, the conclusion also acquires aversive connotations and its presence will bring out anxiety. While this is occurring, the original anxiety response is likely then to expand into a general feeling of discomfort, in which is now turned into the obsessive-compulsive disorder. (Cooper 21)
Obsessive-Compulsive Disorder is also linked to many diseases and disorders, such as Tourette’s syndrome. Tourette’s syndrome is a neuropsychiatric and behavioral disorder with childhood onset that is characterized by a motor disorder. It involves both motoric and vocal tics that can range from relatively mild to very sever over the course of a patient’s lifetime. OCD occurs in about one out of a hundred cases in the general population. 30-60% of Torette’s Syndrome patients have reported obsessive thoughts and compulsive rituals that occur many years after the motor tics start.
Usually during the preadolescent years. Research states that a single major gene or that the sex may determine if the disorder is related OCD or Tourette’s Syndrome. Females are more likely to have OCD without tics, when the diagnosis of the disorder was undetermined. (Sanberg 349) A device called the positron emission tomography (PET) scanner, studies the brain of patients with OCD. OCD patients have patterns of brain activity that differ from those of people without mental illness or with other mental illness. The PET shows abnormal neurochemical activity in regions known to play a role in certain neurological disorders. This suggests that these areas may cause the origins of OCD. “There is also evidence that treatment with medications or behavior therapy induce changes in the brain coincident with clinical improvement” (Strock)
Obsession patients often attempt to negotiate how the treatment is to be conducted. Many patients, especially those who have had the disorder for a long time, do not believe that treatment will be effective because they have tried so many other approaches beforehand. An important part of preparing the patient for treatment is to inform them that their disorder is chronic and that they will have to learn to understand themselves and their limitations in order to manage and control it. (Turner 49) There are many types of treatment for OCD patients. One patient may benefit from behavior therapy, while others will benefit from pharmacotherapy. Some may even use both medication and behavior therapy. Some may begin with medication to gain control over their symptoms and then continue with behavior therapy.
Exposure and response prevention is effective for many people with OCD. The patient intentionally and willingly deals with the feared object or idea, either by imagination or directly. The patient is urged to refrain from ritualizing with the patients loved ones. For example, a compulsive hand washer may be encouraged to touch an object believed to be tainted, and then advised to avoid washing for numerous hours until the provoked anxiety has greatly decreased. The process then moves to the patient’s ability to bear the anxiety and to control the rituals. Most patients even experience less anxiety from the obsessive thoughts and are able to oppose the compulsive urges. The patient needs to have an extremely positive outlook for life and to maintain a high self-esteem. Cognitive-behavioral treatment or psychotherapy may also provide effective for OCD. This alternative behavior therapy highlights changing the obsessive-compulsives beliefs and thinking patterns and is 60-70% helpful with OCD patients.
Drugs that affect the neurotransmitter serotonin can considerably reduce the symptoms of OCD. Serotonin reuptake inhibitors (SRIs) particularly approved for the use in the treatment of OCD was the tricyclic antidepressant clomipramine (Anafranil), and selective serotonin reuptake inhibitors” (SSRIs). Food and Drug Administration for the treatment of OCD approved flouxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil) and Sertraline (Zoloft). Medications relieve symptoms of OCD by alleviating the frequency and intensity of the obsessions and compulsions. You will typically see result in at least three weeks. Medications are helpful in controlling the symptoms of OCD, however, if the medication is discontinued, relapse is inevitable. About 80% of people with OCD that combine psychotherapy and medication show improvement.
Also, when the symptoms are gone, most people must continue taking the medication for the rest of their life. Many of them go on a lowered dosage, except it is possible that they will become addicted to the drugs if they ever stop taking it. (Strock) As long as you have a will to change and follow through with the treatment, then you may be able to surpass this disorder.
Baer, Lee, Michael A. Jenike, and William E. Minichiello. Second Edition Obsessive Compulsive Disorder: Theory and Management. Missouri: Mosby-Year Book, Inc., 1990
Cooper, Marlene. Behavioral Treatment Of A Client With an Obsessive-Compulsive Disorder: A Single Subject Design. New York: UMI Dissertation Services, 1988
Margaret Strock. “Obsessive-Compulsive Disorder.” National Institute of Mental Health (1999): Online. Internet. 22, Oct. 1999. Available http://www.nimh.nih.gov/publicat/ocd.htm#ocd4.
Mavissakalian, Matig, Samuel M. Turner, and Larry Michelson. Obsessive-Compulsive Disorder: Psychological and Pharmacological Treatment. New York: Plenum Press, 1985
****Pato, Michele Tortora, and Joseph Zohar. Current Treatments of Obsessive-Compulsive Disorder. Washington, DC: American Psychiatric Press, Inc, 1991
Reed, Graham F. Obsessional Experience and Compulsive Behaviour: A Cognitive-Structural Approach. Florida: Academic Press, Inc., 1985
Sanberg, Paul R., Klaus-Peter Ossenkopp and Martin Kavaliers. Motor Activity and Movement Disorder: Research Issues and Applications. New Jersey: Humana Press Inc., 1996
Turner, Samuel M. and Deborah C. Beidel. Psychology Practitioner Guidebooks: Treating Obsessive-Compulsive Disorder. New York: Pergamon Press, Inc., 1988