Obsessive- Compulsive Disorder

Obsessive- Compulsive Disorder

I. Introduction

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                        Obsessive-Compulsive Disorder, mental disorder in which a person experiences recurrent, intrusive thoughts (obsessions) and feels compelled to perform certain behaviors (compulsions) again and again. Most people have experienced bizarre or inappropriate thoughts and have engaged in repetitive behaviors at times. However, people with obsessive-compulsive disorder find that their disturbing thoughts and behaviors consume large amounts of time, cause them anxiety and distress, and interfere with their ability to function at work and in social activities. Most people with this disorder recognize that their obsessions and compulsions are irrational but cannot suppress them (Karno & others, 2000).

            Obsessive-compulsive disorder usually begins in adolescence or early adulthood. It is thought to affect between 2 and 3 per cent of people worldwide and is ranked by the World Health Organization as the tenth highest cause of worldwide disability. The disorder affects men and women equally.

            The intent of this paper is to: (1) understand the obsessive-compulsive disorder; (2) know the symptoms of Obsessive-Compulsive Disorder; (3) be aware of the causes of this disorder and; (4) learned how this disorder can be treated.

II. Background

A. Obsessive-Compulsive Disorder

            As with the generalized anxiety and phobic disorders, we can see aspects of ourselves in the obsessive-compulsive disorder. We may at times be obsessed with senseless or offensive thoughts that will not go away. Or may engage in compulsive, rigid behavior—rechecking the locked door, stepping over cracks in the sidewalk, or lining up our books and pencils “just so” before studying.

            Obsessive thoughts and compulsive behaviors cross the fine line between normality and disorder when they become so persistent that they interfere with the way we live or when they cause distress. Checking to see that the door is locked is normal; checking the door 10 times is not. Hand washing is normal; hand washing so often that one’s skin becomes raw is not. At some time during their lives, often during their late teens or in their twenties, 2 to 3 percent cross that line from normal preoccupations and fussiness to debilitating disorder (Karno & others, 2000).

            One such person was billionaire Howard Hughes. Hughes would compulsively dictate the same phrases over and over again. Under stress, he developed an obsessive fear of germs. He became reclusive and insisted that his assistants carry out elaborate hand-washing rituals and wear white gloves when handling documents he would later touch. He ordered tape around doors and windows and forbade his staff to touch or even look at him. “Everybody carries germs around with them,” he explained. “I want to live longer than my parents, so I avoid germs” (Fowler, 1999).

a)      The Psychoanalytic Perspective

            Psychoanalytic theory assumes that, beginning in childhood, intolerable impulses, ideas, and feelings get repressed. This submerged mental energy nevertheless influences our actions and emotions, sometimes producing feelings of anxiety, depression, or other maladaptive symptoms that mystify even the sufferer. One of the Freud’s classic cases concerned a 5-year-old boy known as Little Hans, whose phobia of horses prevented (in those days before cars) his going outdoors. Freud’s controversial speculation was that Little Hans’ fear of horses expressed his underlying fear of his father, whom Hans viewed as a rival for his mother’s affections.

            Alternatively, the forbidden impulses may break through as thinly disguised thoughts, which may provoke acts aimed at suppressing the associated anxiety. The result: obsessions and compulsions.  Repetitive hand washing, for instance, may help suppress anxiety over one’s “dirty” urges.

b)     The learning Perspective

            Learning researches link general anxiety with learned helplessness. In the laboratory, researchers can create chronically anxious, ulcer-prone rats by giving them unpredictable electric shocks (Schwartz, 2001). Like the rape victim who reported feeling anxious when entering her old neighborhood, the animals are apprehensive in their lab environment. For many victims of post-traumatic stress disorder, anxiety swells with any reminder of their trauma.

            When the shocks become predictable—when preceded by a particular conditioned stimulus—the animal’s fear focuses on that stimulus and they relax in its absence. So it can happen with human fears. Recently, ma car was struck by another whose driver did not see a stop sign. For months afterward, I felt a twinge of unease with the approach of any car from a side street. Perhaps Marilyn’s phobia was similarly conditioned during a terrifying or painful experience associated with a thunderstorm.

            Conditioned fears may remain long after we have forgotten the experiences that produced them (Jacob &Nadel, 2000). Moreover, some fears arise from stimulus generalization. A person who fears heights after a fall may be afraid of airplanes without ever having flown. Someone might also learn such a fear through observational learning—by observing other’s fears. Compulsive behaviors similarly reduce anxiety. If washing your hands relives your feelings of unease, you will likely wash your hands again when the feelings return.

c)      The Biological Perspective

            Biologically oriented researchers explain our anxiety-proneness in evolution, genetic, and psychological terms.

            We humans seem biologically prepared to develop fears of heights, storms, snakes, and insects—dangers that our ancestors faced. Compulsive acts typically exaggerate behaviors that contributed to our species’ survival. Grooming gone wild becomes hair pulling. Washing up becomes ritual hand washing. Checking territorial boundaries becomes checking and rechecking a door known to be locked (Rapoport, 1999).

            The biology of general anxiety disorder, panic and even obsessions and compulsions is measurable as overarousal (Baxter & others, 2002). PET scans of persons with obsessive-compulsive disorder reveal unusually high activity in an area of the frontal lobes just above the eyes and in a more primitive are deep in the brain. Some antidepressant drugs control obsessive-compulsive behavior by muting this activity, one of those messenger molecules that shuttles signals between nerve cells (Rapoport, 1999).

 III. Discussion

A. Obsessive-Compulsive Disorder

             Obsessive-Compulsive Disorder, mental disorder in which a person experiences recurrent, intrusive thoughts (obsessions) and feels compelled to perform certain behaviors (compulsions) again and again. Most people have experienced bizarre or inappropriate thoughts and have engaged in repetitive behaviors at times. However, people with obsessive-compulsive disorder find that their disturbing thoughts and behaviors consume large amounts of time, cause them anxiety and distress, and interfere with their ability to function at work and in social activities. Most people with this disorder recognize that their obsessions and compulsions are irrational but cannot suppress them (Karno & others, 2000).

            Obsessive-compulsive disorder usually begins in adolescence or early adulthood. It is thought to affect between 2 and 3 per cent of people worldwide and is ranked by the World Health Organization as the tenth highest cause of worldwide disability. The disorder affects men and women equally.

            An example of obsessive-compulsive disorder is Compulsive gambling. Compulsive gambling can take the form of an anxiety disorder: obsessive-compulsive disorder. This occurs when an individual gets an obsession about gambling such that he or she cannot stop thinking about gambling and these intrusive thoughts dominate their thinking. When such thoughts are expressed in behavior the compulsion can become fixed and the gambling behavior is repeated over and over again. The combination of obsessive thoughts and compulsive behavior is experienced as being impervious to change and causes considerable distress and disruption. The gambler is aware of the obsessive-compulsive nature of his or her behavior and the negative consequences but feels powerless to stop.

            In phobias and obsessive-compulsive disorders, also considered anxiety disorders, fear is experienced when an individual tries to master other symptoms. A phobia is an irrational fear of a specific object, activity, or situation that is classed as a disorder when it becomes so intense that it interferes with everyday life. Among the most disturbing of these is agoraphobia, the fear of open spaces. The most common phobic problem among people seeking psychiatric help, it often prevents them from leaving their homes for any reason. Obsessions are repetitive thoughts, images, ideas, or impulses that make no sense to the person, who can fear being unable to avoid committing a violent act, for example, or worry over whether some small duty has been performed. Compulsions are repetitive behaviors performed dutifully to try to ward off some future event. Examples of such behavior include repeated washing of the hands or counting and recounting possessions or other objects

B. Symptoms

            Obsessions can include a variety of thoughts, images, and impulses. Common obsessions include fears of contamination from germs; doubts about whether doors are locked or appliances are turned off, nonsensical impulses such as shouting in public, sexual thoughts that are disturbing to the individual, and thoughts of accidentally and unknowingly harming someone. People with obsessions may avoid shaking hands with other people because they fear contamination, or they may avoid driving because they fear they will injure someone in a traffic accident (Karno & others, 2000).

            People usually perform compulsions to relieve the anxiety produced by their obsessions, although not all people with obsessions perform compulsions. The most common compulsions involve cleaning rituals and checking rituals. For example, people with obsessions about germs may wash their hands dozens of times each day until their skin becomes raw. People with obsessions about neatness and symmetry may constantly rearrange or straighten objects on their desk. People with checking compulsions must repeatedly check to make sure they locked doors and windows or turned off taps. Other compulsions include counting objects, hoarding vast amounts of useless materials, and repeating words or prayers internally (Fowler, 1999).

            Obsessive-compulsive disorder can have disabling effects on people’s lives. People with severe cases of this disorder may need hospitalization to help treat the compulsions. In less extreme instances, individuals with compulsions often must allow a great deal of extra time to complete seemingly routine tasks, such as preparing to leave the house in the morning. Individuals may avoid going to certain places or engaging in certain activities because they feel embarrassed about their behavior.

            In addition, family members of someone with this disorder may feel angry with the person because the compulsive behaviors intrude on their time together or interfere with the family’s functioning. For instance, some individuals hoard things, such as newspapers or magazines, because they believe they may someday need certain pieces of information. The piles of newspapers may cover the living areas and make other family members feel embarrassed to have guests in the home (see “Obsessive-Compulsive Disorder”. Grolier Encyclopedia of Knowledge, pp. 345-348, vol. 11).

C. Causes

            Like many mental disorders, obsessive-compulsive disorder appears to result from a combination of biological and psychological influences. Some people may have a biological predisposition to experience anxiety. Research also suggests that abnormal levels of the neurotransmitter serotonin may play a role in obsessive-compulsive disorder. Brain scans of people with obsessive-compulsive disorder have revealed abnormalities in the activity level of the orbital cortex, cingulated cortex, and caudate nucleus, a brain circuit that helps control movements of the limbs.

            The disorder may develop when these biological influences combine with a psychological vulnerability to anxiety. Some people may develop a psychological vulnerability to anxiety in childhood. They may come to believe that the world is a potentially dangerous place over which one has little control. People seem to develop obsessive-compulsive disorder specifically when they learn that some thoughts are dangerous or unacceptable and, while attempting to suppress these thoughts, develop anxiety about the recurrence of the thoughts and about the perceived dangerousness and intrusiveness of the thoughts (see “Obsessive-Compulsive Disorder”. Grolier Encyclopedia of Knowledge, pp. 345-348, vol. 11).

D. Treatment

            Treatment for obsessive-compulsive disorder includes psychotherapy (a process of interaction between a therapist and patient aimed at dispelling distress arising through disorders of emotion, thinking, and behavior), psychoactive drugs, or both. Mental health professionals consider exposure and response prevention, a type of cognitive-behavioral therapy, to be the most effective form of psychotherapy for this disorder. In this technique, the therapist exposes the patient to feared thoughts or situations and prevents the patient from acting on his or her compulsion. For example, a therapist might have patients with cleaning compulsions touch something dirty and then prevent them from washing their hands. This technique helps 60 to 70 per cent of people with obsessive-compulsive disorder (Fowler, 1999).

            Medications to treat obsessive-compulsive disorder include selective-serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, a drug, fluoxetine, used in the treatment of depression. Prozac was introduced in 1986 and by 2004 more than 40 million people worldwide had been prescribed the drug. It has been used successfully in the treatment of many disorders that have been traditionally treated by psychotherapy. As well as depression, it has also been used to treat obsessive-compulsive disorder, anxiety attacks, fear of rejection, lack of self esteem, and similar problems. It has been heralded as a great advance and many claims have been made about its wide-reaching benefits), paroxetine (Seroxat, Paxil), sertraline (Lustral, Zoloft), and fluvoxamine (Faverin, Luvox). SSRIs are thought to be more effective and have fewer side effects than the tricyclic antidepressant clomipramine (Anafranil) that is traditionally widely prescribed to help relieve symptoms of the disorder. About 80 per cent of people with the disorder show some improvement with a combined treatment of medication and behavioral therapy. However, many patients relapse when they stop taking the medication (see “Obsessive-Compulsive Disorder: Treatment”. New Standard Encyclopedia, pp. 467-471).

IV. Conclusion

            Obsessive compulsive disorder consists of the persistent intrusion of unwelcome thoughts or impulses (obsessions) and irresistible urges (compulsions) to carry out particular actions or rituals that reduce anxiety. Both of these characteristics are almost always present in the disorder. For example, a person may be obsessed with the idea that his house is going to be burgled and the family attacked, and he may check repeatedly that all the windows and doors are locked. The most common compulsions are checking things and washing. These actions may be performed hundreds of times each day.

References:

Schwartz, B. (2001). Psychology of learning and behavior (4th ed). Newe York: Norton. (pp. 185, 387).
Jacobs, W.J. & Nadel, L. (2000). Stress-induced recovery of fears and phobias. Psychological Bulletin, 92, 512-531.
Rapoport, J.L. (1999). The biology of obsessions and compulsions. Scientific American, pp. 83-89.
Karno & others, 2000. The epidemiology of obsessive-compulsive disorder in five US communities. Archives of general Psychiatry, 45, 1094-1099. (p. 567).
Fowler, R.D., 1999. Howard Hughes: A psychological autopsy. Psychology Today, pp. 22-33. (p. 234).
“Obsessive-Compulsive Disorder”. Grolier Encyclopedia of Knowledge, pp. 345-348, vol. 11.
“Obsessive-Compulsive Disorder: Treatment”. New Standard Encyclopedia, pp. 467-471.