Obsessive-Compulsive Disorder
Obsessive-compulsive disorder is a disease characterized by compulsive obsessions and compulsions interfering normal life. Obsessions are constantly arising unwanted views, concerns, thoughts, images or impulses that the patient cannot confront (Markarian et al., 2010). Compulsions are repetitive actions aiming at getting rid thereof (Markarian et al., 2010). Obsessions often cause anxiety and compulsive behavior or rituals serve to reduce this anxiety. As a result a person's life may be significantly impaired due to obsessive-compulsive disorder. Obsessive thoughts or actions can take much time and be so painful that the person is usually failing to have normal life.
However, obsessional thoughts differ from schizophrenic delusions because patients perceive them as absurd and illogical. People with OCD do not wash their hands in joy every half hour in the morning and five times zip up the zipper on the fly. They cannot simply get rid of such obsessions. Anxiety level is too high, and rituals allow patients to achieve temporary relief. On the other hand, such a love for rituals or lists of things unfolding on the shelves does not relate to the disorder, unless it makes a person uncomfortable.
Most problems in patients with OCD are caused by the obsessions of violent or sexual nature. Some people begin to fear that they may do something bad to other people, up to sexual violence or murder. Obsessional thoughts may take the form of individual words, phrases or even poetic lines. People suffering from OCD experience tremendous stress. On the one hand, they are horrified to themselves and feels guilty trying to resist their thoughts, when, on the other hand, they try to commit their rituals invisibly to others. In all other respects, their consciousness is functioning perfectly normal.
As a result, patients’ family and work are greatly affected. Unfortunately, most of the people with obsessive-compulsive disorder do not seek help for their illness because they are either confused or ashamed or afraid of being deemed "crazy." Thus, many people suffer from this disorder senselessly.
History
In ancient times, the disorder was often associated with mystical reasons: in the Middle Ages people who suffered from obsessions, were immediately sent to the exorcist. In the XVII century, the concept has been reversed: it was considered that such conditions arise due to excessive religious zeal.
In 1877, one of the founders of scientific psychiatry Wilhelm Griesinger and his disciple Karl-Friedrich Otto Westphal found out that the basis of obsessional neurosis was thought disorder, though it did not affect other aspects of behavior. They used the German term “Zwangsvorstellung”, which then was differently translated in Britain and the United States as obsession and compulsion, respectively, and turned into the modern name of the disease. And in 1905, a French psychiatrist and neurologist Pierre Janet has allocated this neurosis from neurasthenia as a separate disease and named it psychasthenia.
Opinions about the causes of the disorder differed. For example, Freud believed that obsessive-compulsive behavior referred to the unconscious conflicts that manifested themselves in the form of symptoms, and his German counterpart Emil Kraepelin attributed it to constitutional mental illness caused by physical causes.
Many famous people suffered from OCD, for instance, the inventor Nikola Tesla counted steps when walking and the amount of food servings. In case he failed to do that, lunch was considered to have been spoiled. A businessman and pioneer of American aviation Howard Hughes was in horror of dust and ordered his staff to clean them up four times with a large amount of foam and new bar of soap before visiting him.
Symptoms
The most common symptoms of OCD are complaints to repeated painful stereotypes, compulsive (obsessive) thoughts, images or desires, perceived as meaningless, which in a stereotyped form again and again come to the patient’s mind and cause an unsuccessful attempt of resistance. In addition, another symptom is stereotypical behavior, the meaning of which is to prevent any objectively improbable events. Obsessions and compulsions are experienced as alien, absurd and irrational. The patient suffers from them and tries to resist them. The most common obsession is fear of contamination and germs (Mysophobia), followed by many hours of washing; obsessive doubts, followed by compulsive checks (if the door is closed, if the gas is turned off), and obsessive slowness, where the obsessions and compulsions are combined together and the patient performs everyday activities very slowly, according to Boyd & Nihart (1998).
Causes
The exact causes of OCD are still not clear now, but all the hypotheses can be divided into three categories: physiological, psychological and genetic.
The first concept associates the disease either with functional anatomical brain particularities or irregularities in neurotransmitter metabolism - primarily dopamine and serotonin, norepinephrine and GABA (Ozaki et al., 2003). Some researchers have noted that many patients with obsessive-compulsive disorder were born with trauma at birth, which also confirms the physiological causes of OCD.
Supporters of psychological theory believe that the disease is associated with personal characteristics, temperament, psychological trauma and wrong reaction to the negative environmental impact. Sigmund Freud suggested that the onset of obsessive-compulsive symptoms was associated with the defense psyche mechanisms such as insulation, elimination and reactive formation. Insulation protects people from disturbing passions and impulses thrusting them back into the subconscious. Such elimination aims at dealing with pop-repressed impulses. Finally, reaction formation is a manifestation of behavior patterns and consciously experienced adjustment, opposite to the arising impulses.
There are also scientific evidences that the occurrence of OCD may be due to genetic mutations. The latter were found in unrelated families whose members suffer from OCD; in the serotonin transporter gene, hSERT (Ozaki et al., 2003). Studies of identical twins also confirm the existence of hereditary factors. Moreover, patients with OCD are more likely to have close relatives with the same disorder than healthy people.
Diagnosis
In order to make an accurate diagnosis, obsessional symptoms or compulsive acts, or both should last a maximum number of days for a period of at least 2 weeks in a row and be a source of distress and disturbance activity. According to Fornaro et al. (2009), obsessional symptoms should have the following characteristics: they have to be regarded as patient’s own thoughts or impulses, there has to be at least one thought or act to which the patient unsuccessfully resists, the idea of action performing should not be pleasing in itself (simple reduction of anxiety or tension is not considered in this respect as pleasant), thoughts, images or impulses has to be unpleasantly repetitive.
It’s worth noting that performing compulsive actions does not always necessarily correlate with specific concerns or intrusive thoughts, and can be aimed at getting rid of spontaneously arising feeling of inner discomfort and / or anxiety.
The differential diagnosis between OCD and depression may be quite difficult, as these two types of symptoms often occur together, according to Fornaro et al., (2009). In the acute episode, preference should be given to disorder, the symptoms of which came first; if both of them are present, but none is dominant, depression should be typically considered as primary.
Random panic attacks or mild phobic symptoms are not an obstacle for the diagnosis. However, obsessional symptoms developing in the presence of schizophrenia, a Gilles de la Tourette's syndrome, or organic mental disorder should be treated as part of these conditions.
Treatment
Exposure and response prevention (type of behavioral therapy) often helps people with obsessive-compulsive disorder, according to Huppert & Roth (2003). Exercising such a therapy, patients are recommended to play the situation or to meet people that cause discomfort or obsessions resulting in rituals. Discomfort or anxiety will gradually reduce if a person does not allow himself or herself to perform rituals after repeated contacts with the provoking stimulus. Thus, a person is aware that the ritual is not necessary in order to relieve the discomfort. Improvements usually persists for many years, probably because people who have mastered this method of self-help, continue to practice it without much effort on their own, after formal treatment ended.
Medications also help many people with obsessive-compulsive disorder. Three medications such as clomipramine, fluoxetine and fluvoxamine are officially approved for use in the treatment of this condition. In some cases there may be used other antidepressants, but much less frequently. Usually, the best treatment is a combination of medication and behavioral therapy.
Conclusion
So, OCD is an anxiety disorder known for causing obsessive thoughts followed by compulsive actions. The most common symptoms are repeated checking, excessive washing, and preoccupation of obsessive thoughts. The most efficient way of OCD management is a combination of behavioral therapy and medications.
References
Boyd, M., & Nihart, M. (1998). Psychiatric nursing. Philadelphia: Lippincott.
Fornaro, M., Gabrielli, F., Albano, C., Fornaro, S., Rizzato, S., & Mattei, C. et al. (2009). Obsessive-compulsive disorder and related disorders: a comprehensive survey. Annals Of General Psychiatry,8(1), 13. doi:10.1186/1744-859x-8-13
Huppert, J., & Roth, D. (2003). Treating obsessive-compulsive disorder with exposure and response prevention. The Behavior Analyst Today, 4(1), 66-70. doi:10.1037/h0100012
Markarian, Y., Larson, M., Aldea, M., Baldwin, S., Good, D., & Berkeljon, A. et al. (2010). Multiple pathways to functional impairment in obsessive–compulsive disorder. Clinical Psychology Review,30(1), 78-88. doi:10.1016/j.cpr.2009.09.005
Ozaki, N., Goldman, D., Kaye, W., Plotnicov, K., Greenberg, B., & Lappalainen, J. et al. (2003). Serotonin transporter missense mutation associated with a complex neuropsychiatric phenotype.Molecular Psychiatry, 8(11), 895-895. doi:10.1038/sj.mp.4001415
