Obsessive Compulsive Disorder (OCD).

Obsessive Compulsive Disorder (OCD)

What is Obsessive Compulsive Disorder?

In order to understand what OCD is, we need to identify and distinguish between what is meant by an ‘obsession’ and what is meant by a ‘compulsion’

Obsession are recurrent, unwanted thoughts and images which seem involuntary and are intensely distressing. These obsessions are usually aggressive, sexual or blasphemous

Compulsions are actions of which the victim/patient feel compelled to carry out over and over again, perhaps learnt through rituals or rules.

Obsession and compulsions are often inter-related and that compulsions can be used to try and counteract obsessions. For example, compulsive hand washing may be an attempt to eradicate the obsessive preoccupation of having germs and dirt on the hands.

A person may however have only obsessive thoughts without their expression as compulsive behaviour.

Failure to complete the compulsion often results in severe anxiety or panic - but continuing to try to live with the rituals often also leads to anxiety or depression.

Examples of compulsions include excessive hand washing, cleaning, counting, checking, touching, arranging, hoarding, measuring, excessive neatness, and repeating tasks or actions.

Examples of obsessions are worrying excessively about germs, contamination, dirt, fearing having harmed others, intrusive sexual thoughts or urges, death and illness.

People with OCD are aware that their compulsions and obsessions are irrational or excessive. Perception of reality is not distorted. However, this knowledge is not sufficient to enable them to stop the obsessions and compulsions.

OCD affects approximately 2% of the population. Males and females are equally affected.Although the symptoms of OCD typically begin during the teenage years or early adulthood, children can develop the condition at earlier ages, even during the pre-school years. Research indicates that at least one-third of cases of OCD in adults began in childhood.

Symptoms of Obsessive Compulsive Disorder

Below is a list of symptoms one might expect to see in a person suffering from OCD:-

Excessive fear of contamination and germs, leading to excessive cleaning.
Constant checking things, such as doors, locks etc.
Constant counting, while performing routine tasks.
Feelings of having to do things a certain number of times or doing things in a certain order.
Obsessively arranging things in an methodical, orderly fashion.
Intrusive unwanted thoughts, often of a disturbing nature.
Intrusive unwanted ...

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Symptoms of Obsessive Compulsive Disorder

Below is a list of symptoms one might expect to see in a person suffering from OCD:-

Excessive fear of contamination and germs, leading to excessive cleaning.
Constant checking things, such as doors, locks etc.
Constant counting, while performing routine tasks.
Feelings of having to do things a certain number of times or doing things in a certain order.
Obsessively arranging things in an methodical, orderly fashion.
Intrusive unwanted thoughts, often of a disturbing nature.
Intrusive unwanted words or phrases repeating themselves in the individual’s mind.
Hoarding of objects, usually of no apparent value.
Trichotillomania (compulsive hair-pulling) may be associated with obsessive- compulsive disorder.
Depression, social phobia, and panic disorder are more common in people with OCD.

Diagnosing Obsessive Compulsive Disorder

The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) classifies OCD as an anxiety disorder since the recurrent obsessions and compulsions can be severe enough to be time-consuming, cause marked distress or significant impairment.

Diagnosis is based on the following:

Symptoms cause significant distress
Symptoms take up more than 1 hour a day
Symptoms significantly interfere with work, relationships, or daily functioning
The person recognises that his or her obsessions and compulsions are unreasonable or excessive.

Treatment for Obsessive Compulsive disorder

There are two methods of treatment for OCD, drug therapy and cognitive behavioural therapy. (CBT).

A combination of the two therapies is often an effective method of treatment for most people.

Drug therapy

Antidepressant medication is commonly prescribed (whether depression is present or not present). Clomipramine, a tricyclic antidepressant (TCA) used to be the usual treatment, this worked well. However TCAs have more side effects than the newer Selective Serotonin reuptake inhibitors (SSRI's). Therefore initially in most cases now, SSRI’s are prescribed because of the improved safety, tolerability, and equivalent effectiveness. However, no SSRIs except fluoxetine (Prozac) should be prescribed to children and adolescents under the age of 18, due to increased risks. Medications will usually relieve the symptoms of OCD, but often, if the medication is discontinued, relapse will follow.

Medication usually works within 4 weeks but may take up to 10 weeks to work fully. If successful, it is usual to take medication for at least a year. The doses needed to treat OCD are sometimes higher than those needed to treat depression. Symptoms can improve by up to 60% with medication.

Cognitive Behavioural Therapy (CBT)

CBT involves exploring the nature of anxiety and stress responses. The therapist will then gradually expose the individual to the feared object or idea, either directly or by imagination, and then discourages or prevents them from carrying out the usual compulsive response. The aim is for the individual to gradually experience less anxiety from the obsessive thoughts and become able to forgo the compulsive actions for extended periods of time.

Explaining:

Obsessive Compulsive Disorder (OCD)

With respect to the psychodynamic approach

According to this theory, obsessions are ego defence mechanisms that try to occupy the mind, and displace any other threatening thoughts. Laughlin (1967) believes that the occupation of obsessive thoughts in the mind inhibits the arousal of anxiety, by acting as a more tolerable substitute for the subjectively less acceptable anxious thought that could be in the mind.

Also we can suggest that obsessions and compulsions result from instinctual forces (forces beyond our control) perhaps due to fixations in psychosexual stages. E.g. harsh toilet training in the anal stage.

With respect to the biological approach

With advanced technological capabilities, MRI scans show that parts of the brain, including the hypocampus are enlarged in people who have OCD, although this is not sure why, more research needs to be done in this area.

Large evidence suggests that OCD is caused by chemical imbalances in the neurotransmitter ‘serotonin’ (5HT)

With respect to the Behaviourist approach

Compulsions are learned behaviours reinforced by anxiety reduction. This basically means we repeat things over and over to reduce levels of anxiety.

So if obsession induces anxiety, the compulsive behaviour which reduces the anxiety should be increased, so as to stop anxious feelings. Due to the fact compulsion only provides temporary relief from anxiety, when it starts again, the person is motivated to start compulsive behaviour again as well.

Compulsions however, can later serve to increase the frequency of the obsession which increases the strength of the inter-related obsession and compulsion disorder.

The above theory only accounts for the maintenance of OCD and doesn’t look at how OCD is developed in the first place.

To appreciate how OCD starts in the first place, according to the behaviourist theory, we need an understanding of the superstition hypothesis.

The superstition hypothesis suggests that we develop a chance association between our behaviour and a reinforcer. For example, in Skinners experiments with the pigeons, food was given at regular intervals, regardless of their behaviour. After a while they began to display idiosyncratic movements. Therefore the pigeons may have associated the chance of getting food and reinforcing the movement they displayed, once food was given, which allowed them to compulsively move idiosyncratically. Perhaps the pigeons believed that if they moved like that, they were more likely to get food.

This superstition hypothesis can also be explained with soccer players, when they only wear a particular pair of boots because they ‘were lucky last time’. There are compulsively wearing the same boots on the chance that the same reinforcement of winning will be given.

With respect to the cognitive approach (Beck 1976)

This approach assumes that people with OCD overestimate the likelihood of harm and therefore tend to avoid the ‘source of harm’ (unnecessarily)

One theory by Rachman (1993) suggested the ‘though-action fusion model’. This involved estimating the likelihood of intrusive thoughts as equivalent actions. For example, if a man had said he had seen an image of his dog lying dead, then it was as if he was ‘tempting fate’ and ‘increasing the chances that the dog would actually die.

The model of ‘thought-action fusion; comprises 2 components:

Likelihood TAF believes that thinking about an unacceptable or disturbing event, makes it more likely that it will actually happen.

Moral TAF The person believes that the thoughts they had were (almost) as bad as the actual event itself.

This lead psychologists to believe that people with OCD find it hard to distinguish thoughts from actions, which leads to compulsively repeating obsessive behaviour.