This brief paper explores the symptoms, etiology, treatment, and prognosis of Obsessive-Compulsive Disorder (OCD).
Obsessive-Compulsive Disorder (OCD) is classified by The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) as a chronic mental illness. In order to be diagnosed with OCD, a person must have obsessions and compulsions. Obsessions are defined as persistent thoughts urges and images and attempts to suppress them with a thought or action. Those thoughts and actions are the compulsions (American Psychiatric Association, 2013). Compulsions are repetitive behaviors or mental acts such as handwashing, counting, repeating phrases, checking, and praying. The acts, both mental and physical, are intended to prevent or mitigate anxiety and stress or to prevent a calamitous event or situation but they do not actually do so. Further, they impact daily life in a negative way.
I have personally experienced a number of the symptoms of Obsessive-Compulsive Disorder in my life. During my adolescent years, my fear of loss of a loved one (specifically my parents) led me to perform a number of rituals in an attempt to ward off the “bad things” I feared. It started with prayers, but the prayers morphed into counting to the number ten. Counting to the number 10 out loud if I was alone, or silently in my mind, if I feared someone would hear me, was a way to focus on something besides my imaginings that some calamity had befallen my parents. The need to count to ten would, at times, be all-consuming. Eventually, I added the need to draw or trace a 10-sided figure on my body as way to ward off the bad thoughts and the calamity itself. Intellectually, though I was a child, I understood that the simple act of counting to 10 would not actually prevent my parents from being dying. Nevertheless, I felt compelled to do so, because, I had to. I experienced this for years, with flair-ups from time to time. But even my calmest moments, I would find myself tracing the ten-sided figure. It was the early 1980s and I had no access to a mental health professional through school and I did not feel I could bring this concern to our family doctor. So, I suffered through it in silence and eventually, it became so minimal and wholly unobtrusive to my life. From time to time the compulsions come back, as I frustrate my spouse by checking a third time that I have locked our car or on occasion when I have to assure myself that I have not left an appliance on. (My wife, who lost her mother at the age of 7, reports that she and her sister developed elaborate rituals in the aftermath of their family tragedy that appears to fit the classification of obsessions and compulsions. These involved lining up the bedroom door just so and placing treasured toys in particular spots.) In retrospect, I can identify my octogenarian grandfather's concern that there had been a horrible accident anytime my parents were late coming home from an event to a heightened worry for their safety myself. If only we had cell phones back then, those worries could have been alleviated simply with technology.
Obsessional thoughts and experiences are a key symptom of OCD, with the obsessive quality of the phenomena overriding any rational thought or resistance that the person can offer. (Toates, F., & Coschug-Toates, O. 2002). Common obsessions are contamination fears, (i.e. avoiding germs and “dirty things”) concerns about safety checks (“did I unplug the toaster?”), the need for symmetry at all times (“is everything in its right place?”) worries about particular body parts and bodily functions, and recurring disturbing thoughts of a violent or sexual nature such as hurting someone or committing incest (Aboujaoude, E. 2008).
The compulsions performed by the individual who suffers from OCD are intended to provide relief from the obsessions. Common compulsions include frequent checking, that doors or windows are locked; that electrical appliances are off or unplugged; constant washing of hands or cleaning of body parts, desk, room, or house; hoarding of unneeded items, or mental acts such as counting, praying or repeating of phrases in a particular order (Aboujaoude, E. 2008). The compulsions become so overbearing as to interfere with the ability to function in daily life (O'Connor, K., & Aardema, F. 2011).
50 million people in the world suffer from some form of OCD (Toates, F., & Coschug-Toates, O. 2002). The most common form of compulsion is excessive checking, seen in more than 60% of those with OCD (Aboujaoude, E. 2008). The scenarios often begin to take up more and more time and that leads to seeking treatment.
There is no consensus on the cause or causes of OCD. For most who suffer from OCD, it is a chronic problem. (Toates, F., & Coschug-Toates, O. 2002). It may have a genetic component, and it may be hereditary. Neurological research indicates that OCD may be a brain problem where neurotransmitters are not functioning properly. Evidence for this is demonstrated in studies that show that increasing the levels of serotonin in the brain may alleviate some of the symptoms of OCD (Aboujaoude, E. 2008). OCD does not fit the Freudian model of neurosis (Toates, F., & Coschug-Toates, O. 2002).
Obsessive-Compulsive Disorder is a chronic condition for most who suffer from it. Diagnosis and treatment may lead to a lessening of the severity of the symptoms and provide the client with further coping mechanisms. Treatment options include behavior therapy, cognitive therapy, and intervention with drugs (Toates, F., & Coschug-Toates, O. 2002). The first two methods seek to adjust the behavior via an approach such as exposure (“keep your hands dirty for a set period of time”) or cognitive therapy wherein the therapist seeks to logically restructure the client’s thoughts (Toates, F., & Coschug-Toates, O. 2002).
Inference-based Therapy (IBT) presents an interesting approach to treating OCD as detailed in the Clinician's Handbook for Obsessive-Compulsive Disorder: Inference-Based Therapy O'Connor, K., & Aardema, F. (2011). IBT focuses on the client’s acceptance of the imaginary nature of the problem, then transitions to alternatives for thinking and behavior.
OCD is a fascinating brain disorder. Given the complexity of the brain, it does not seem out of order to accept that, in such a complex system, something can go ary to cause such a “malfunction” (Toates, F., & Coschug-Toates, O. 2002). Many people can experience variations of “obsessional” issues, and in the vast majority of individuals, it is not diagnosable as OCD. Those that do suffer the symptoms of OCD appear to suffer from previously “normal” levels of concern about the world around us to something far more severe and disruptive to daily life. Perhaps future brain research will identify a more specific cause of OCD. Genetic research may pinpoint the cause in greater detail. For the time being, those who suffer from OCD must turn to practical methods of treatment to reduce the severity of the impact of OCD on their day-to-day functioning (Hershfield, J., & Corboy, T. 2013). Those with the most severe cases, such as individuals who cannot leave the house, or those whose OCD-based hoarding is literally burying them will need the aid of prescription medication in conjunction with therapeutic techniques.
References
American Psychiatric Association., & American Psychiatric Association. DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association.
Steketee, G., & Frost, R. O. (2006). Compulsive Hoarding and Acquiring. Cary, US: Oxford University Press, Incorporated. Retrieved from http://www.ebrary.com
Aboujaoude, E. (2008). Compulsive Acts. Berkeley, US: University of California Press. Retrieved from http://www.ebrary.com
Hershfield, J., & Corboy, T. (2013). The mindfulness workbook for OCD: A guide to overcoming obsessions and compulsions using mindfulness and cognitive behavioral therapy. Oakland: New Harbinger Publications.
Toates, F., & Coschug-Toates, O. (2002). Obsessive-Compulsive Disorder. London, GBR: Class Publishing. Retrieved from http://www.ebrary.com
O'Connor, K., & Aardema, F. (2011). Clinician's Handbook for Obsessive-Compulsive Disorder: Inference-Based Therapy (1). Hoboken, GB: Wiley. Retrieved from http://www.ebrary.com