| Obsessive-compulsive Disorder |
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Obsessive-compulsive disorder ('''OCD''') is a Psychiatric Anxiety Disorder most commonly characterized by a subject's obsessive, Distress ing, Intrusive Thoughts and related compulsions (tasks or " Rituals ") which attempt to neutralize the obsessions. It is listed by the World Health Organization as one of the top 10 most disabling illnesses in terms of a diminished quality of life.Kohn, R. et al. "The treatment gap in mental health care". The World Health Organization, 2004. The phrase "obsessive-compulsive" has worked its way into the wider English Lexicon , and is often used in an offhand manner to describe someone who is Meticulous or absorbed in a cause (see also " Anal-retentive "). Such casual references should not be confused with obsessive-compulsive disorder; see Clinomorphism . It is also important to distinguish OCD from other types of Anxiety , including the routine Tension and Stress that appear throughout life. Although these signs are often present in OCD, a person who shows signs of Infatuation or Fixation with a subject/object, or displays traits such as Perfectionism , does not necessarily have OCD, a specific and well-defined condition. To be diagnosed with obsessive-compulsive disorder, one must have either obsessions or compulsions alone, or obsessions and compulsions, according to the DSM-IV-TR diagnostic criteria. The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000) describes these obsessions and compulsions:''Quick Reference to the Diagnostic Criteria from DSM-IV-TR''. Arlington, VA: American Psychiatric Association, 2000. Obsessions are defined by: # Recurrent and Persistent thoughts, Impulse s, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. # The thoughts, impulses, or images are not simply excessive worries about real-life problems. # The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action. # The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality. # The tendency to haggle over small details that the viewer is unable to fix or change in any way. This begins a mental pre-occupation with that which is inevitable. Compulsions are defined by: # Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. # The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive. In addition to these criteria, at some point during the course of the disorder, the sufferer must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause Impairment in social, Occupational , or school functioning. OCD often causes feelings similar to those of Depression . CAUSES AND RELATED DISORDERS It was the general belief in the 14th, 15th, and 16th centuries that those who experienced blasphemous, sexual, or other obsessive thoughts were Possessed by The Devil . Based on this reasoning, treatment involved banishing the " Evil " from the "possessed" person through Exorcism .Baer, L.; M. A. Jenike & W. E. Minichiello. ''Obsessive Compulsive Disorders: Theory and Management''. Littleton, MA: PSG Publishing, 1986. Today the community of scientists studying obsessive-compulsive disorder has been split into two factions by a disagreement over the exact cause of the illness. On one side is a group who believe that obsessive-compulsive behavior is a psychological disorder. On the other side are scientists who believe that obsessive-compulsive behavior is caused by abnormalities in the Brain . A majority of researchers now believe in this biological hypothesis of OCD. promises to bring increased understanding of the disorder's pathogenesis."1 Psychological explanations Freud In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts which manifested as symptoms. Freud describes the clinical history of a typical case of 'touching phobia' as follows: : Biological explanations There are many different theories about the cause of obsessive-compulsive disorder. Some research has discovered a type of size abnormality in different brain structures. The majority of researchers believe that there is some type of abnormality in the for OCD.) Recent research has revealed a possible Genetic Mutation that could be the cause of OCD. Researchers funded by the National Institutes Of Health have found a Mutation in the human serotonin transporter gene, HSERT , in unrelated families with OCD. Moreover, in his study of identical twins, Rasmussen (1994) produced data that supported the idea that there is a " Heritable factor for Neurotic anxiety".Rasmussen, S.A. "Genetic Studies of Obsessive Compulsive Disorder" in ''Current Insights in Obsessive Compulsive Disorder'', eds. E. Hollander; J. Zohar; D. Marazziti & B. Oliver. Chichester, England: John Wiley & Sons, 1994, pp. 105-114. In addition, he noted that environmental factors also play a role in how these anxiety symptoms are expressed. However, various studies on this topic are still being conducted and the presence of a genetic link is not yet definitely established. Technological advancements have allowed for the possibility of brain imaging. Using tools like Positron Emission Tomography (PET scans), it has been shown that those with OCD tend to have brain activity that differs from those who do not have this disorder.Tennen, M. 2005, June. "Causes of OCD Remain a Mystery". It has been theorized that a miscommunication between the orbital-frontal cortex, the Caudate Nucleus , and the Thalamus may be a factor in the explanation of OCD. The Orbitofrontal Cortex (OFC) is the first part of the brain to notice whether or not something is wrong. When the OFC notices that something is wrong, it sends an initial “worry signal” to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to interpret the worrying event. The caudate nucleus lies between the OFC and the thalamus and it prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in compulsive behaviors in an attempt to relieve this apprehension. This over activity of the OFC is shown to be attenuated in patients who have successfully responded to SSRI medication. The increased stimulation of the serotonin receptors 5-HT2A and 5-HT2C in the OFC is believed to cause this inhibition. SYMPTOMS AND PREVALENCE OCD is manifested in a variety of forms. Community studies have placed the prevalence between one and three percent, although the prevalence of clinically recognized OCD is much lower, suggesting that many individuals with the disorder are unaccounted for clinically.{3 The fact that many individuals do not seek treatment may be due in part to Stigma associated with OCD. Another reason for not seeking treatment is because many sufferers of OCD do not realize that what they are suffering from is OCD, mainly because the typical depiction of the disorder in the media and elsewhere only covers a few of the many symptoms of OCD. The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession-related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks: repeatedly checking that one's parked car has been locked before leaving it; turning lights on and off a set number of times before exiting a room; repeatedly washing hands at regular intervals throughout the day. Symptoms may include some, all, or perhaps none of the following:
There are many other possible symptoms, and one need not display those above to suffer from OCD. Formal diagnosis is performed by a Mental Health Professional . Furthermore, possessing the symptoms above is not an absolute diagnosis of OCD. OCD sufferers are aware that such thoughts and behavior are not Rational , but feel bound to comply with them to fend off feelings of panic or dread. Because sufferers are consciously aware of this irrationality but feel helpless to push it away, untreated OCD is often regarded as one of the most vexing and frustrating of the major anxiety disorders. Due to their insight into the abnormal nature of their compulsions, most OCD sufferers will meticulously hide their behaviors from others in order to avoid negative attention. This, combined with the fact that with some sufferers the compulsions are purely mental, means the disease is often nicknamed "the secret illness". In an attempt to further relate the immense distress that those afflicted with this condition must bear, Barlow and Durand (2006) use the following example.Barlow, D. H. and V. M. Durand. ''Essentials of Abnormal Psychology''. California: Thomson Wadsworth, 2006. They implore readers not to think of pink elephants. Their point lies in the assumption that most people will immediately create an image of a pink elephant in their minds, even though told not to do so. The more one attempts to stop thinking of these colorful animals, the more one will continue to generate these mental images. This phenomenon is termed the "Thought Avoidance Paradox”, and it plagues those with OCD on a daily basis, for no matter how hard one tries to get these disturbing images and thoughts out of one's mind, feelings of distress and anxiety inevitably prevail. Although everyone may experience unpleasant thoughts at one time or another, these are usually warranted concerns that are short-lived and fade after an adequate time period has lapsed. However, this is not the case for OCD sufferers.Carter, K. "Obsessive-Compulsive Disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. 14 Feb. 2006. Obsessive-compulsive disorder is often confused with the separate condition Obsessive Compulsive Personality Disorder . The two are not the same condition, however. OCD is ''ego dystonic'', meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ''ego syntonic''—marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD, by contrast, are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with Anxiety ; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions.Carter, K. "Obsessive-Compulsive Personality Disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. 11 April 2006. This is a significant difference between these disorders. Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is ''still'' not sure, and it is ''still'' better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary. Some OCD sufferers exhibit what is known as ''overvalued ideas''. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP Therapy on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually Delusion al, is often unable to fully realize what sorts of dreaded events are reasonably possible and which aren't. OCD is different from behaviors such as Gambling addiction and Overeating . People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is placed in the anxiety class of Mental Illness , but like many chronic stress disorders it can lead to Clinical Depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life—particularly its substantial consumption of time—can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available. Related disorders People with OCD may be diagnosed with other conditions, such as Anorexia Nervosa , Social Anxiety Disorder , Bulimia Nervosa , Tourette Syndrome , Compulsive Skin Picking , Body Dysmorphic Disorder , and Trichotillomania . There is some research demonstrating a link between Drug Addiction and obsessive compulsive disorder as well. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of Coping with the heightened levels of anxiety), but drug addiction among obsessive compulsive patients may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among sufferers of OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark ( 1998 ), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an "out of control" type of feeling.5 Some cases are thought to be caused at least in part by childhood Streptococcal infections and are termed PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The streptococcal Antibodies become involved in an Autoimmune process. Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be "caught" via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that Antibiotics may eventually be used to treat or prevent it. |
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