There are several psychiatric disorders that disturb the mood, thought and behavior, known as mental illness. Obsessive-compulsive disorder is one such illness which leads to anxious and irrational thoughts. Individuals suffering from obsessive compulsive disorder experience intrusive thoughts and ideas that generate distress, and repetitive behaviors that become compulsions . Individuals show patterns of irrational behavior, which provides temporary relief from anxiety, distress and fear. While all obsessions are mental events, compulsions are both mental and behavioral. Individuals are aware of their obsessions or compulsions as senseless and excessive; however, when confronted with a fearful situation, they lose their insight. The classification of obsessive-compulsive disorder depends on the topography of the ritualistic activity. While few obsessive-compulsives show one type of ritual, most of them manifest multiple obsessions and compulsions . For example, an individual suffering from obsessive-compulsive disorder might fear from germs and wash his hand repeatedly. It is easier to classify the symptoms than individuals.
Ritualistic washing is one of the most common obsessive compulsions performed to decrease the discomfort associated with obsessions about germs or diseases. For example, a person who fears contact with the germs that cause AIDS clean themselves in order to prevent contracting AIDS and spreading it to others. In addition to washing themselves, some patients wash the environment too. Another common compulsion is repetitive checking . Patients repeatedly check to ensure that a fearful event will not happen or did not happen. For example, persons fearing from a burglar attack repeatedly check the locks of the doors and take their valuables with them all the time. Other rituals are repeating, ordering and counting. Hoarding is another ritual that involves the accumulation of excessive amounts of materials, such as subscribing to multiple newspapers with the fear that they might not be available in the future. Sometimes, the obsessions appear delusional, leading to the possibility of schizophrenia . Approximately, 2.5 percent of adult population suffers from obsessive-compulsive disorder at least once in their lifetime.
Mowrer’s two-stage theory helps to understand the acquisition and maintenance of fear and avoidance behavior to explain the symptoms of obsessive-compulsive disorder . According to the theory, a previous event or object comes to elicit fear after experienced with an event that causes distress and anxiety. Distress leads to physical and mental events to reduce the fear. Reducing the fear and alleviating distress becomes a compulsion, which leads to repeated ritualistic activities. Another researcher Salkovskis proposed that the intrusive thoughts interact with the person’s belief system in such a way that the obsession leads to automatic negative thoughts . The dysregulation of the neurotransmitters, such as dopamine and serotonin contributes to obsessive-compulsive disorder. Dopamine regulates the mood, thought process, behavior, appetite, heart rate, blood rate, physical activity, satiety and muscle movement of the body. On the other hand, serotonin regulates the sleep-wake cycle, sexual behavior, feeding, motor activity, perception of pain and temperature regulation .
The Yale-Brown Obsessive Compulsive Scale helps to diagnose obsessive-compulsive behavior based on five items, namely, washing, checking, hoarding, ordering and mental neutralizing for assessing severe obsessions and compulsions . Self-report instruments and questionnaires also help to verify the symptoms. The Maudsley Obsessive-Compulsive Inventory is another valid and reliable questionnaire that provides the severity estimates for washing, checking, slowness and doubting. Similarly, the Padua Inventory also assesses the obsessive compulsions based on four scales, namely, contamination, impaired mental control, checking and loss of control of actions. Lynfield Obsession/Compulsive Questionnaire also helps to understand the psychometric properties of obsessive-compulsive disorder. Other diagnostics are the Compulsive Activity Checklist and Obsessive Thoughts Questionnaire . The diagnosis of obsessive-compulsive disorder is difficult due to the presence of a high rate of comorbidity in the individuals with the illness.
Patients suffering from obsessive-compulsive disorder require the support of their family in order to get better results. Obsessive-compulsive disorder involves several symptoms that cause severe family disruption and affects different aspects of family functioning. Individuals suffering from obsessive-compulsive disorder show reduced levels of problem solving, affective responsiveness, behavior control, communication and affective involvement in household issues . Also, obsessive-compulsive disorder in a person leads to lower rates of education, employment and earnings. Marital relationships suffer due to obsessive-compulsive disorder. However, it is the responsibility of the people surrounding the patient to act in such a way that helps the patient to overcome the disorder and behave normally. The nature and frequency of the obsessive compulsions reduce with constant monitoring of the patients. Modification of the daily routines, both for the patient and the family give better results. On the other hand, rejecting attitudes towards the patient and family stress contribute to the rise of obsessive-compulsive disorder .
In the past, people considered the obsessions and compulsions shown by obsessive-compulsive disorder as symptoms of religious somber. In the early nineteenth century, mesmerism, phrenology and faculty psychology proved the cause of -compulsive disorder as a neuropathological condition . Obsessive-compulsive behavior was refractory to treatment. Even treatments like pharmacotherapy and exposure procedures, such as systematic desensitization, image flooding, satiation and paradoxical intention could not yield impressive results. Similarly, operant-conditioning procedures, which aimed at punishing obsessions and compulsions, could not control the obsessions. Traditional talk therapy reduced the frequency of rituals in some cases; however, the results were not up to the mark . Behavior therapy techniques assisted a few patients to overcome obsessive-compulsive disorder, but there was no perfect solution that could reduce distress and bring the patient to normal condition. In certain cases, forceful treatment gave adverse results and prevented the patient from responding to any kind of therapy. Scientists in the past could not assess the techniques of treatment as several patients were unresponsive to the treatment.
The advances in medicine in the recent years gave fruitful results in the treatment of obsessive-compulsive disorder. Prolonged exposure to obsessional cues and strict prevention of rituals, also known as EX/RP proved successful in 66 percent of the cases by reducing the frequency of the rituals performed by the patients . EX/RP focuses at verbal reinforcement of successful abstinence and attempts to stop the rituals through explicit rationale and clear instructions. Tricyclic clomipramine or anafranil and fluvoxamine prove effective results in the treatment of obsessive-compulsive disorder. Pharmacotherapy with serotonin reuptake inhibitors, such as citalopram, fluoxetine, sertraline and paroxetine aims at reregulating the function of the neurotransmitter serotonin by increasing the availability of serotonin at post-synaptic receptors . It is important to monitor the blood levels of the patient at regular intervals as these drugs cause several side effects, such as sedation, sexual dysfunction, dyskinesiasis and weight gain . Queasiness is a common side effect and reduces gradually as the patient gets used the medicine. The ongoing research should discover effective therapies and techniques in the treatment of obsessive-compulsive disorder so that the patients resist the frequency of the ritual activities and behave normal.
Works Cited
Giddens, S. (2008). Obsessive-Compulsive Disorder. The Rosen Publishing Group.
Mark Zelman, P., Raymond, ., Tompary, ., Holdaway, P., & Mary Lou Mulvihill, P. (2010). Human Diseases: A Systemic Approach. Pearson Education.
Pedrick, C., & Hyman, B. M. (2011 ). Obsessive-Compulsive Disorder. Twenty-First Century Books.
