OBSESSIVE-COMPULSIVE DISORDER
Obsessive-compulsive disorder (OCD) is a psychiatric
disorder; more specifically, it is an anxiety disorder. OCD is manifested
in a variety of forms, but it is most commonly characterized by
a subject’s obsessive, distressing, intrusive thoughts and related
compulsions (tasks or rituals) which attempt to neutralize the obsessions.
The phrase “obsessive-compulsive” has worked its way into common
use in English, and is often used in an offhand manner to describe
someone who is meticulous or absorbed in a cause. Such casual references
should not be confused with obsessive-compulsive disorder which
is a specific and well-defined condition.
Obsessive-compulsive disorder can be a common
comorbid condition with autism and Aspergers syndrome because of
the tendency to become fixated and obsessive over certain ideas,
objects and activities. As a rough rule of thumb, a child or adult
may be diagnosed when life is seriously disrupted by obsessive thoughts
and/or compulsions.
Diagnosis of Obsessive-compulsive Disorder
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 as recurrent and persistent
thoughts, impulses, 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.
Compulsions are defined as 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 that
of depression.
Examples of OCD include:
Repeated hand-washing.
Arranging or counting objects in patterns
Having to “cancel out” bad thoughts with good thoughts
A fear of contamination by germs
A need for both sides of the body to feel even
Obsessions about getting hurt or hurting others.
Most 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.]
Causes of Obsessive-compulsive Disorder
The community of scientists studying obsessive-compulsive
disorder has been split into two factions — psychological causes
and biological causes. The former group believes that OCD is caused
when people believe that they are personally responsible for the
obsessional thoughts they experience. This exaggerated sense of
responsibility makes sufferers more anxious, keeping the distressing
thought in their mind. They try to avoid this feeling of responsibility
by performing compulsions.
The latter group includes 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. 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 neurotransmitter serotonin, among
other possible psychological or biological abnormalities; however,
it is possible that this activity is the brain’s response to OCD,
and not its cause. Recent research has revealed a possible genetic
mutation that could be the cause of OCD.
Treatment of Obsessive-compulsive Disorder
OCD can be treated with Behavioral therapy, Cognitive
therapy medications, or any combination of the three. Psychotherapy
can also help in some cases, while not being one of the leading
treatments. The specific technique used in Cognitive
Behavioral Therapies is called Exposure and Ritual Prevention.
This involves gradually learning to tolerate the
anxiety associated with not performing the ritual behavior. At first,
for example, someone might touch something only very mildly “contaminated”
(such as a tissue that has been touched by another tissue that has
been touched by the end of a toothpick that has touched a book that
came from a “contaminated” location, such as a school.) That is
the “exposure.” The “ritual prevention” is not washing.
Medications used to treat OCD include selective serotonin reuptake
inhibitors (SSRIs) as well as tricyclic antidepressants.
SSRIs seem to be the most effective drug treatments for OCD, and
help about 60% of OCD patients, but do not “cure” OCD. While parents
of children diagnosed with OCD will understandably be reluctant
to consider medication, it can have good results, particularly if
cognitive therapies have had limited or no success.
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