Obsessive-Compulsive Disorder, commonly known as, “OCD” is an anxiety disorder defined as involving unwanted, persistent, intrusive thoughts and impulses, as well as repetitive actions intended to suppress them. There are two parts to Obsessive Compulsive Disorder, (1) obsessions; intrusive and nonsensical images or urges that the individual tries to resist or eliminate, and (2) compulsions; thoughts or actions used to suppress the obsessions and provide relief (Burger, J. M. 2019). Individuals who experience symptoms of OCD will have the consistent presence of obsessions or compulsions or both. Types of obsessions can be; contamination, lack of order, fear of harm, and forbidden thoughts. Types of compulsions can be; checking, cleaning, rearranging, and repeating (Team, G.T. 2019). OCD contains an age range that can start in childhood through late adulthood. The male peak onset is ages thirteen to fifteen years of age, and female peak onset is ages twenty to twenty-four years of age. According to the DSM-5, (The Diagnostic and Statistical Manual of Mental Disorders), explains obsessions as recurrent, persistent thoughts and/or feelings, or urges experienced, followed by attempting to ignore and suppress such thoughts, impulses, or images. Compulsions are defined by repetitive behaviors or mental acts in which the individual feels driven to respond to these behaviors followed by the belief that the individual is preventing a negative event or situation (American Psychological Association, n.d). According to demographic prevalence among adults in the United States, The National Institute on Mental Health (NIMH) found that about 1.2% of United
States adults had OCD in the past year. Past year prevalence shows OCD is commonly diagnosed higher in women than men by 1.8%. Among impairments, approximately 50.6% of American adults had a serious impairment, while 34.6% of adults had moderate impairment and 14.6% had mild impairment. (NIMH, 2017) Mental health professionals diagnose Obsessive-Compulsive Disorder by the use of physical examination, laboratory tests, psychological evaluation, and diagnostic criteria of OCD (DSM-5). Physical examination is used to examine the patient and address any physical issues that may be causing the patient’s symptoms. Laboratory tests include a screening for complete blood count (CBC) and thyroid function. Psychological evaluation entails discussing thoughts and feelings in a clinical setting and the mental professional may reference the DSM-5 to complete the diagnosis of the disorder (Burger, J. M. 2019). In this section, I addressed the definition, symptoms, demographics, and how the disorder is diagnosed. Next, I will explain the Psychoanalytic Approach in Personality.
Psychoanalytic Approach in Personality
The Psychoanalytic Approach is well-known for its Freudian approach in Psychology. Sigmund Freud is a well-known figure and part of the intellectual movement of the development of Psychology for the expansion and creation of Psychoanalysis. Freud believed strongly in the unconscious mind, that is, the part of the psychic makeup that is outside the awareness of the individual, in which we have no immediate access to. Freud believed that most adults in our culture freely accept the idea of being sometimes influenced by the unconscious part of the mind and wondered if dreams reveal our fears and desires that we are unable to express (Barlow, D. H., Durand, V. M., & Hofmann, S. G. 2018). Freud emphasized the three levels of awareness; id, ego, and superego. The id is that pleasure principle- a source of strong sexual and aggressive feelings, the ego is the reality principle- in which ensures we act and have realistic expectations. Lastly, the superego- being our inner conscience that abides by the moral principles instilled by our parents and society. Another well-known idea Freud emphasized was defense mechanisms. Defense mechanisms defined by the textbook are unconscious protective processes that keep primitive emotions associated with conflicts in check so that the ego can continue coordinating function (Burger, J. M. 2019). The defense mechanisms I will be addressing are displacement, reaction formation, and intellectualization. Displacement involves channeling our impulses to non-threatening objects. Reaction formation focuses on hiding from threatening unconscious ideas or urges by acting in a manner opposite to our unconscious desires. Lastly, Intellectualization is considering something in a strictly intellectual, unemotional manner (Burger, J. M. 2019). Freud also introduced the psychosexual stages of development as a cornerstone of our beliefs of psychoanalysis. The psychosexual stages of development are oral, anal, phallic, latency, and genital. The stage I will be focusing on is the anal stage- which occurs at about eighteen months of life. In this section of the Psychoanalytic Approach in Personality, I have addressed the unconscious mind, the levels of awareness, defense mechanisms, and the psychosexual stages of development.
Psychoanalytic Approach and Obsessive-Compulsive Disorder
A mental health professional that uses the Psychoanalytic Approach in Personality to describe Obsessive Compulsive Disorder would describe the levels of awareness (id, ego, and superego), defense mechanisms (repression and sublimation), and the psychosexual stages of development (anal stage) as underlying reasoning of the diagnosis of OCD. The Psychoanalytic Approach itself focuses on the unconscious mind as behavior can be defined and determined by experiences from your past that are lodged in your unconscious (Ackerman, C. 2018, May 7). As the Psychoanalytic Approach can help deal with resolved conflicts in your childhood which can impact overall development, it can also improve psychological health and behavior. The levels of awareness contribute to OCD as the id satisfies the need to fulfill the obsessions and compulsions. The ego helps mediate between the id and superego as it develops an “obedience” in order to solve conflicts between the two levels of awareness. As the superego represents society’s moral standards and social norms, the behavior of the obsessions and compulsions places a restriction and conscience on ourselves to realize that the behavior is incorrect. Defense mechanisms also play a key role in OCD because the ego forms several techniques to deal with unwanted thoughts. Displacement can be caused if the individual is unable to perform the obsessions and compulsions, the individual may channel his or her emotions on an object and/or destroy them. Reaction formation is included because an individual may unconsciously develop negative attitudes and behaviors opposite of unacceptable repressed impulses, even desires. The psychosexual stages of development, specifically the anal stage is very important to address in the development of OCD. Freud believed and theorized that OCD symptoms were caused by wrong and firm toilet-training practices in early childhood development. This traumatic toilet training experience can result in a fixation, called anal personality. As stated in the textbook, an adult that has an anal personality is described as “orderly and rigid” (Burger, J. M. 2019). Having an anal personality can cause major dysfunction in the adult stages. In this section, I have addressed the levels of awareness (id, ego, superego), defense mechanisms (displacement, reaction formation, and intellectualization), and psychosexual stage of development (anal stage), in order to explain in further detail the influence these have on obsessive-compulsive disorder. Next, I will explain treatment options for OCD using the Psychoanalytic approach.
Treatment Options for Obsessive-Compulsive Disorder
A mental health professional that follows Freud’s Psychoanalytic Approach may use several treatment options in order for the patient to significantly improve from the psychological disorder. In this case, several Psychoanalytic treatment options will help for Obsessive Compulsive Disorder, such as hypnosis, free association, and dream analysis. The primary goal of psychoanalysis is to bring crucial unconscious material into consciousness where it can be examined in a rational manner (Burger, J. M. 2019). Hypnosis allows the ego to be placed in a hypnotic trance, and allows, the hypnotist to bypass the ego and get to unconscious material. When treating OCD, the mental health professional will use hypnosis as a deep relaxation technique in order for the patient to have the ability to identify their thoughts and urges and to examine and evaluate the reasoning behind the obsessions and compulsions, (e.g. childhood traumas, childhood dysfunctions, etc.). The next technique is the use of free association, that is, the ability to say any thoughts that come to mind. The patient can either write or verbalize their thoughts during therapy (Team, G.T. 2019). Free association allows the patient to be able to have complete freedom to address their thoughts and help reveal repressed thoughts and memories. Lastly, dream analysis is a psychoanalytic technique used to identify dream contents and examine their symbolic meaning. Freud called dream analysis the “royal road to the unconscious” (Burger, J. M. 2019). Dream analysis in therapy would be used to represent wish fulfillment, unconscious desires, and conflicts. In therapy, the patient will describe the dream (manifest content) and the mental health professional will examine the underlying symbolic meaning of the dream (latent content). In this section, I have addressed the most common treatment options using the Psychoanalytic Approach.
In conclusion, the diagnosis of Obsessive-Compulsive Disorder is very common in Western cultures and it is important to raise awareness on the topic. Using the Psychoanalytic Approach in Personality allows the diagnosis of OCD to be addressed, examined, and treated in order to improve the daily life and functioning of the diagnosed patient.