Obsessive Compulsive Disorder

Obsessive Compulsive Disorder The Diagnostic and Statistical Manual defines obsessions and compulsions as follows; Obsessions are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. Compulsions are repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification. The Symptoms associated with OCD are severe and easily recognizable. One generally accepted causes of OCD is stress. Stress is a term used by many, is somewhat misunderstood, and often used to describe a negative condition or emotional state.

People experience various forms of stress at home, work, in social settings, and when engaged in activities to simply have fun, such as playing sports. There are several generally accepted subdivisions of OC’s. Amongst them are Washers, Checkers, Cleaners, Hoarders, Repeaters, Orderers, and Pure Obsessives. Washers are those OC’s that generally have a fear of germs, dirt, or contamination from substances like bodily fluids, dirt, dust, bacteria, viruses, excretions, and the like. Washers that are compulsive can spend hours washing themselves, or parts of their body, to the exclusion of all else, trying to rid themselves of contamination. They may also avoid contact with things to avoid being contaminated.

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Cleaners are those OC’s that feel that other things are contaminated or dirty, and spend much time cleaning their surroundings. For instance, a cleaner might spend hours dusting their home, and then go back and start again as soon as they have finished, because dust has settled in the meantime. Checkers have a problem remembering or being sure that they have or have not done something, and therefore go back to check whether they have or not. For instance, a woman may get up 10 to 15 times a night to make sure all windows and doors are still locked, although they were every other time. Hoarders collect things..almost anything.

They usually cannot even stand to throw away garbage, and often will let it just sit around them. An inability to get rid of things is the significant symptom of this class of OC. Repeaters are OC’s that feel compelled to do things a right number of times. This may serve to protect them from some imagined danger, or prevent possible harm to themselves. Repeaters generally fear that if they do not do things the right number of times, something bad will happen, although some may just have to do things just right for no apparent reason. Orderers have to have things organized absolutely the right way.

An orderer might be reluctant to let anyone touch their possessions, fearing they will be misarranged. Orderers might spend hours just aligning a piece of paper on a desktop, or straightening a bookshelf. The last type is the Pure Obsessive, which is also the most difficult OC to treat. These OC’s suffer from obsessive thoughts of a disturbing nature, generally. An example might be a person who constantly obsesses over whether they will hurt their child, even though they know they wouldn’t..they can’t stop worrying that they might.

About 2.3% of the U.S. population (3.3 million Americans) has OCD in a given year. OCD affects men and women equally. OCD typically begins during adolescence or early childhood; at least one-third of these cases of adult OCD began in childhood. There are many different treatments for OCD. Treatments for OCD have been developed through research supported by the NIMH and other research institutions.

These treatments, which combine medications and behavioral therapy, are often effective. Several medications have been proven effective in helping people with OCD such as, clomipramine, fluoxetine, fluvoxamine, and paroxetine. A number of other medications are currently being studied. A type of behavioral therapy known as exposure and response prevention is very useful for treating OCD. Treatment proven most effective: The treatment I found to be most effective, after reading all the studies I read was the behavioral therapy. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts and then, is taught techniques to avoid performing, the compulsive tasks and to deal with the obsessions.

Studies of behavioral therapy for OCD have found it to be very effective treatment to those who complete it. For the treatment to be successful, it is important that the therapist be fully trained to provide this specific form of therapy. It is also helpful that the patient be highly motivated, be positive and have a determined attitude. Psychology.

Obsessive Compulsive Disorder

.. ng and waning course. That is, symptoms may get somewhat better for months or even years, only to get worse again before returning to a lower level of severity. “Only about 5 to 10 percent of OCD sufferers enjoy a spontaneous remission in which all symptoms of OCD go away for good (Wayne K. Goodman, MD, University of Florida Brain Institute, 1999).

Another 5 to 10 percent experience progressive deterioration in their symptoms.” Stress can make OCD worse, but trying to eliminate all stress is unlikely to quell OCD. In fact, it is better for most people with OCD to keep busy. Idleness can be the breeding ground for increased obsessional thinking. Changes in the severity of OCD may be related to fluctuations in the body’s internal chemical environment. Women with OCD often report that their symptoms become more severe the week before their Obsessive Compulsive Disorder- pg. 7 menstrual period. Presumably, this is related to the natural ebb (or reflux) and flow of hormones that regulate the menstrual cycle.

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Diet has not been shown to influence OCD (Hollander E. Stein 1997). Causes and Explanations The Perspective Classic psychoanalytic theory suggests that obsessions come from repressed id impulses. The id is the primitive, pleasure, risk taking, biological urge, aggressiveness and fantasy-oriented agent of the personality (Nat DeAnda Ph.D. Los Medanos College 00).

These impulses are more likely to be present in persons who suffered emotional wounds in early childhood and who are socialized and lead a comforting, morally conventional life (Frank J. Bruno, Psychological Symptoms 1994). Put differently, the superego, the moral component of personality, sets moral guideline, which limit the flexibility of the ego (Wood and Wood, The World of Psychology, Third Edition, 1999), but does not allow the expression of the id impulses in either consciousness or action. Richard is trapped in a loveless marriage. Being a traditional man dedicated to the social conventions of his family and culture, the thought of leaving his wife is morally unacceptable. As a solution, his id simply wishes to simply do away with his wife and children – the obvious obstacle to his happiness and to the possibility of a loving relationship. As farfetched as this sounds to most people, it must be remembered that there are married partners, both male and female, who actually act out such impulses and kill a spouse as well as children.

In state mental hospitals, there are numerous individuals called ” criminally insane” who have inflicted either death or great bodily injury on their loved ones. Obsessive Compulsive Disorder- pg. 8 OCD Works as a Cycle The purpose of the compulsion, or ritual, is straightforward. It reduces the anxiety associated with the obsession via the power of magic. If the underlying conflict remains, the obsessions and compulsions repeat themselves (Baer L, Jenike MA, Personality Disorders in OCD, 1992) Treatments and Professional Help Although the exact cause of OCD is not known, recent medical research has shown that biological factors are involved. As with panic disorders and depression, OCD may be caused by an imbalance of chemical messengers such as serotonin, in the brain.

Serotonin deficiency is associated with anxiety, depression and suicide (Wood and Wood, The World of Psychology, 1999). The important thing to remember is that there is help available. Here are some ways in which the professions of psychiatry and clinical psychology can help. Psychodynamic Approach Taking the psychodynamic approach, a therapist can help Richard attain deeper understanding of an obsession that he can attain on his own. An obsession is structured somewhat like a dream. It’s manifest content must often masks a latent content (i.e. a forbidden wish).

The manifest content must be decoded in order for its meaning to be revealed. A therapist can help Richard overcome his resistance by methods such as free associations on his part to various aspects of the obsession. Obsessive Compulsive Disorder- pg. 9 Drug Therapy Drug therapy is medication prescribed by a doctor to relieve the symptoms of an illness. Most recently, certain antidepressant medications in the selective serotonin reuptake inhibitors class (SSRI’s), paroxetine HCL, and tricyclic antidepressants have been found to be effective for controlling symptoms of OCD (Albert Rothenburg, MD, The Psychiatric Clinic of North America 1998) Cognitive-Behavior Therapy Cognitive behavior therapy can help Richard reduce the anxiety associated with obsessions and reduce and eliminate compulsions. Techniques of cognitive-behavior therapy usually include facing the very situations that are most feared (this is called exposure), without resulting into compulsive rituals (this is called response prevention).

Other cognitive-behavioral techniques to address specific obsessions or compulsions are sometimes used. Humanistic Approach Taking a humanistic approach, a therapist may offer Richard emotional support. Humanistic therapists encourage personal growth and seek to teach clients how to fulfill their potential and to take responsibility for their behavior and for what they become in life (Wood and Wood, The World of Psychology, 1999). Conclusion In this essay, I have included a plethora of information from various sources which pertain to the obsessive-compulsive disorder. Obsessions or compulsions cause emotional pain, take up a lot of time, or strongly disrupt the person’s normal routine of work, school, or social Obsessive Compulsive Disorder- pg. 10 life. Obsessions are thoughts, impulses or images that come to mind over and over again, and that seem foolish to the person and can cause a lot of anxiety or distress.

Compulsions are attempts to reduce anxiety or prevent some feared event or situation by carrying out certain acts over and over and over again. Common compulsions are, hand washing, putting things in order, checking things, praying counting, and repeating words softly. Some or all the time, the person with OCD feels that the obsessions and compulsions are foolish and excessive – yet the person usually cannot avoid them for long without great effort. Observation From extensive pondering, I have formed a solution concerning Richard’s case. You have to take in consideration that it is not Richard, represented by his whole personality, who wants to inflict injury on his loved ones.

Rather, it is his id, a primitive part of his personality. He is nowhere near acting out his hostile impulses. Instead, they are blocked – repressed into the unconscious realm. However, his ego, the conscious agent of the personality, senses danger to his loved ones. This danger signal is converted, for the purposes of censorship and protection against the id’s wishes, into hostility directed against the self. In other words, the unconscious logic is, “There is danger to my wife and children. The source of this danger is me.

Therefore I must die for their safety.” The unconscious obsession is, Today is the day I will die.” And the unconscious mental processes are blocked from view. Although not given much information on the case study, in my opinion, hypothetically, I believe the condition that Richard is in is genetic, and probably obtained it from one of his parents. Research evidence points to a biological basis for obsessive compulsive disorder in some people, and several twin and family studies suggest that a genetic factor may be involved Obsessive Compulsive Disorder- pg. 11 (Rassmussen and Eisen, 1990). Given that Richard repeatedly says that he is going to die, this tells me that he shows some signs of carelessness.

And carelessness is an indication that someone is suffering from depression. A sign of depression in Richard can also indicate that his serotonin levels are abnormal. If I were Richard’s doctor or psychiatrist, I would prescribe to him antidepressant medication, which increases the availability of serotonin in the synapses (Murphy and Pigott 1990) so his mood and impulsivity can be controlled. Recommendations for Future Study In more recent years, it had become generally known that the incident of OCD is much higher than previously thought (Hollander E. Stein DJ, Obsessive Compulsive Disorder, NY 1997).

There are approximately five million Americans who suffer from this condition. Future study should focus more on decreasing this number to a minimum. Medication should works for all OCD patients, not just some. In my opinion the most successful treatments of OCD involves cognitive-behavioral therapy, humanistic therapy, and family guidance. There is no need to endure chronic, mental, and emotional suffering. If someone has OCD, they should be assured that there are ways out. The professions of psychiatry and clinical psychology will always be there to offer help so that those with OCD can live a more a contented and “time well spent” life.



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