Category: Obsessive Compulsive Disorder

Mental disorders affect the health and well-being of individuals. They alter their behavior so that individuals have difficulty in performing mundane tasks. It is made worse by the stigma attached to people who seek medical attention regarding mental health and its associated disorders. Studies have shown that it is essential for people to have more in-depth knowledge and understanding of mental disorders. This paper draws attention to obsessive-compulsive behavior and highlights its symptoms and treatment. The findings from the literature review on obsessive-compulsive disorder indicate that the disorder has a range of symptoms that can be treated and managed. Additionally, the paper provides recommendations for further research to be conducted on mental disorders to expand on the body of knowledge.

Mental disorders are the behavioral changes that alter the pattern and behavior of individuals, so the extent that their functioning is impaired (Bolton, 2008). These patterns of behavior result in significant discomfort and distress, affecting the regular operation of an individual. While some of these altered behavior patterns are minimal, others can be quite severe, even resulting in death if not properly managed. Nonetheless, patterns of behavior vary from disorder to disorder, and they are categorized according to the symptoms they manifest. It is also important to note that these altered patterns of behavior occur at different intervals. This essay is going to highlight on obsessive-compulsive disorder (OCD), its symptoms, and treatment. Furthermore, it will provide the reader with an in-depth analysis of OCD so that they can have a more profound understanding of the subject matter and lay the ground for further research on the same.

The diagnosis of mental disorders is based on the patterns of behavior that work to alter how one reasons and perceives feelings. Furthermore, social, cultural, and religious norms have a hand in mental disorders, and as such, these considerations are customarily factored in during diagnosis (American Psychiatric Association, 2013). It is from this determination that the patients get access to proper treatment to control and manage their conditions. Medical practitioners and other relevant stakeholders use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to establish standard procedures for diagnosis, treatment, and other activities related to mental health (Kendell and Jablensky, 2003).

Obsessive-compulsive disorder (OCD), just like other mental disorders, manifests itself by altering the behavior of the individual. With OCD, this changed behavior demonstrates itself with an increase in routines that are repeated over some time. Such forms of practice are known as compulsions, where the individual feels inclined to perform specific tasks over and over again (Storch et al., 2008). In addition to compulsions, individuals also have thoughts that repeatedly occur over given subject areas. Such manifestations of OCD are referred to as obsessions (Markarian, 2010).

According to Conelea et al. (2014), compulsive patterns of behavior occur in a significant number of the population where people are accustomed to performing specific tasks based on the explanation that they have to. The involuntary actions find themselves dominating the individual’s behaviors to such an extent that failure to perform such tasks repeatedly would result in severe irritation. Compulsive behaviors are also explained as ways of reconciling other dreaded results individuals feels will surely happen if they fail to act accordingly (Boyd, 2007). Individuals will be drawn towards certain behaviorism because they think that deviating from that will have catastrophic consequences for them and those around them. For example, people will arrange napkins in public restaurants because they believe that it only through such actions that their food will be served right. When one is prevented from arranging napkins in a particular pattern, they might take extreme activities that are not limited to aggressive or violent behavior. Additionally, compulsive behaviors thoroughly inhibit the productivity of such individuals in different roles.

Recurring thoughts under obsessions occur over and occur even after the individuals try to ignore them (Markarian, 2010). These thoughts are thus involuntary and tend to happen when the individual is confronted or finds themselves in situations that stimulate and inhibit such ideas. A trip to the mortuary may trigger thoughts about death that are obsessive. Just like with compulsions, obsessive thoughts are also ways of dealing with anxiety. Intrusive thoughts tend to occur when presented with certain conditions (Osgood-Hynes, 2006). For example, people with obsessive sexual thoughts will be more inclined towards such behavior when they see or come into contact with people that trigger the feelings. OCD makes these patterns of thought bear more significance that they cannot be ignored. Obsessive thoughts usually are distressing because they distort perceptions of reality, they have great ability to interfere with the well-being of the individual, thus affecting how they even relate with those next to them (Doron, 2013).

Signs and symptoms of OCD vary in that they can manifest themselves as groups while others are unique to individuals. According to Strorch et al. (2010), Yale-Brown Obsessive-Compulsive Scale is used to assess the nature of symptoms before arriving at a diagnosis. The symptoms are divided into four, depending on how they manifest in the individual pattern of behavior. Symmetry factor encompasses all those signs and symptoms that relate to behavior that connects to uniformity, balance, and consistency. The forbidden thoughts factor is associated with upsetting thoughts and behavior on a wide range of subjects such as religion, explicit, intimacy, among others. The hoarding factor involves the difficulty in disposing of items brought about by a strong need to save and hold onto them, which then results in the accumulation of objects. When the individual faces the task of discarding his or her things, they exhibit great distress that their behavior (Bloch et al., 2008). Cleaning factor symptoms are related to hygiene and contamination where individuals resort to repetitive behavior such as washing, brushing, checking body parts as well as avoiding body contact as a way of preventing contact with contamination. From these signs and symptoms, medical practitioners are best positioned to arrive at a diagnosis, which further aids in treatment. According to McKay et al. (2004), the response to treatment differs in the symptom factors so that while some are more responsive to treatment, others take a longer time to respond.

After the diagnosis, the next step is treatment, where the patients are put through a wide range of treatment procedures based on the diagnosis to manage their condition better. Therapy is one method of treatment where patients are taken through routines that they can incorporate in their habits to best deal with those scenarios that trigger them to behave otherwise. Medical practitioners argue that through exposure to such situations, patients can develop responsive mechanisms geared towards preventing the occurrence of compulsions and obsessions. The goal of therapy is to develop long-term responses through which the patient develops refrain from any obsessive and compulsive behavior (Abramowitz et al., 2011).

Medication is another method of treatment where patients are prescribed drugs that they take under clear and specific instructions. The prescriptions depend on the nature and scale of the OCD on the patients so that stronger doses are recommended for patients that have severe instances of OCD. Furthermore, children and adults have different dosage requirements, either for short-term or long-term treatment (Grant 2014). Due to the nature of side effects associated with medication, patients are under constant review to ensure they do not develop other psychiatric issues.

Conclusion

Developments in the study of OCD have facilitated the availability of knowledge useful in the diagnosis, treatment, and understanding of the disorder. Previously, OCD diagnosis was viewed as life sentences that people could not recover. However, the condition is now manageable to the extent that people can actively participate in other areas of life without interference. Moreover, conducting further studies on mental disorders is a crucial step in understanding the nature of such ailments, thus eliminates instances of stigma. The limitations of such a research undertaking would be the reluctant participants unwilling to share information due to stigma. By accepting that mental disorders are typical and can affect anyone, then it will be possible to gather much-needed information. Pharmaceutical companies need to spend time on research to develop drugs that have little or no side effects.

References

1. Abramowitz, Jonathan. Deacon, Brett. Whiteside, Stephen. (2011).Exposure Therapy for Anxiety: Principles and Practice. Guilford Press.
2. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Pp.101–05.
3. Bloch, Michael. Landeros-Weisenberger, Angeli. Rosario Maria. Pittenger, Christopher. Leckman, James. (2008). A meta-analysis of the symptom structure of obsessive compulsive disorder. The American Journal of Psychiatry. 165 (12), pp1532–42.
4. Bolton, Derek (2008). What is a Mental Disorder? : An Essay in Philosophy, Science, and Values. OUP Oxford. p. 6.
5. Boyd. M. (2007). Psychiatric Nursing: Issues in Mental Health Nursing. Lippincott Williams & Wilkins. pp. 13–26.
6. Conelea, Christine. Walther, Michael. Freeman, Jennifer. Garcia, Abbe. Sapyta, Jeffrey. Khanna, Muniya. Franklin, Martin. (2014). Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II. Journal of the American Academy of Child & Adolescent Psychiatry. 53 (12), pp1308–1316.
7. Doron, G. Szepsenwol, O. Karp, E. Gal, N. (2013). Obsessing About Intimate- Relationships: Testing the Double Relationship-Vulnerability Hypothesis. Journal of Behavior Therapy and Experimental Psychiatry. 44 (4), pp433–440.
8. Grant, J. (2014). Clinical practice: Obsessive-compulsive disorder. The New England Journal of Medicine. 371 (7), pp646–53.
9. Kendell, R. Jablensky, A (2003). Distinguishing Between the Validity and Utility of Psychiatric Diagnoses. American Journal of Psychiatry. 160 (1): 4–12.
10. Markarian, Y. Larson, M. Aldea, M. Baldwin, S. Good, D. Berkeljon, A. Murphy, T. Storch, E. McKay, D. (2010). Multiple pathways to functional impairment in obsessive-compulsive disorder. Clinical Psychology Review. 30 (1), pp78–88.
11. McKay, Dean. Abramowitz, Jonathan. Calamari, John. Kyrios, Michael. Radomsky, Adam. Sookman, Debbie. Taylor, Steven. Wilhelm, Sabine. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: symptoms versus mechanisms. Clinical Psychological Review. 24 (3), pp283–313.
12. Osgood-Hynes, Deborah. (2006). Thinking Bad Thoughts. Belmont, Massachusetts: MGH/McLean OCD Institute.
13. Storch, E. Larson, M. Goodman, W. Rasmussen, S. Price, L. Murphy, T. (2010). Development and Psychometric Evaluation of the Yale-Brown Obsessive Compulsivee Scale—Second Edition. Psychological Assessment. 22 (2), pp223– 232.
14. Storch, Eric. Marien, Wendi. Goodman, Wayne. Murphy, Tanya. Geffken, Gary. (2008). Obsessive-compulsive disorder in youth with and without a chronic disorder. Depression and Anxiety. 25 (9), pp761–767.

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder. As the name provides, it has two components: obsessiveness or repeated thoughts and compulsiveness or repeated behavior. These two components seem to work together to form this disorder; obsessiveness may stem from high anxiety levels and to reduce this type of stress, repetitive behavior or action is done to reduce the anxiety and reduce the obsessiveness (Sun, et al., 2019). This disorder is known to possibly be genetic, as some evidence shows that people with first degree OCD relatives have a higher risk of contriving OCD themselves (“Obsessive-Compulsive Disorder. (n.d.)”). Like many other disorders, OCD can be subdivided into different types: contamination and washing; doubts about accidental harm and checking; symmetry, arranging, and counting; and unacceptable taboo thoughts and mental rituals (“Symptoms of OCD”. (n.d.). Because there are so many types of different OCDs, the underlying neurological reasons are not clear but there are some theories regarding the general neurological abnormalities that might be the root of this disorder. In this paper, mechanistic theories and neurological abrasions/ abnormality patterns, will be discussed, some experiments based on this order will be discussed and finally, some possible medications that may alleviate the symptoms of OCD will be discussed.

Much of the noninvasive neurological imaging of people with OCD show abnormal patterns in the CSTC loops or corticostriatal-thalamocortical (CSTC) loops. These circuits including the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), ventral striatum, and mediodorsal (MD) thalamus. First, let’s discuss the OFC. The orbitofrontal cortex (OFC) is located in the prefrontal cortex of the frontal lobe. The (OFC) seems to control cognitive behavior, meaning, the ability to combine emotions, thoughts and motor responses to create a goal-motivated action (Torregrossa, et al.,2008). Lesions to the OFC are known to cause a reversal-learning deficit, meaning, it causes learning from experiences to happen slowly, and cause repetitive behaviors or habits even when there is no reward from them (Torregrossa, et al., 2008). The Anterior cingulate cortex (ACC) lies near the front of the corpus callosum. It connections the prefrontal cortex to the limbic system, in other words, the cognitive information with the emotional information. There are three major portions of ACC: the emotional or limbic component, cognitive component, and motor component. This might explain why people with OCD may also have been triggered due to trauma thus this emotional factor is showcased through behavior or actions (Yücel, et al. 2003.). The ventral striatum connects the frontal orbital region to the basal ganglia. In people without OCD, the OFC and ACC give input and control striatal activity by a balance of excitatory input and inhibitory input. Medium spiny neurons (MSNs) are excitatory and (PV)-positive interneurons keep them inhibited and controlled. In people with OCD, when their striatum has some deficit, both ACC, OFC and striatal regions are hyperactive. This may be because of the decrease in the number or function of PV interneurons that usually inhibit these Medium spiny neurons from excitation, and because it is a loop from ACC and OFC to the striatum to the thalamus and back, activity is heightened in all regions (Burguière, et al., 2015). Some experiments have been done that show that SAPAP3 is a gene located at the postsynaptic density or PDS at the excited synapses (Ting & Feng, 2011). It was found that this gene was the only family member gene strongly shown in the striatum. The study found that deleting this genetic allele in mice has them develop behavioral problems due to heightened anxiety which caused them to repetitive groom themselves to the point of facial hair loss and skin abrasions around those over groomed areas. These mice without the SAPAP3 gene were also, evidently, were found to have problems with glutamate transmission at cortico-striatal synapses or where the OFC/ACC meet the striatum in the loop (Ting & Feng, 2011). This specific problem regarding the neurotransmission of glutamate was solved when this gene was put in specifically back to the striatum. This shows how sensitive this entire circuitry is structured. The other problem, the overgrooming problem and high anxiety were alleviated with repeated administration of fluoxetine, a common SSRI (Selective Serotonin Re-uptake Inhibitor) (Ting & Feng, 2011). How this works will be discussed later in the paper. The mediodorsal (MD) thalamus seems to be involved with memory and the limbic system which includes the amygdala. The medial, lateral prefrontal and orbitofrontal (OFC) cortices, gives information to the MD and the MD gives information back to the medial prefrontal cortex (Mitchell, et al., 2013).

In summary, possible problems to the corticostriatal-thalamocortical (CSTC) circuits that can cause OCD or OCD like behaviors include the imbalance of serotonin, dopamine, and glutamate. A person without OCD would have their corticostriatal-thalamocortical (CSTC) circuits follow in the following order. First, glutamate is transmitted from the cortex area which consists of the OFC and ACC to the striatum which has the medium spiny neurons (MSNs) and (PV)-positive interneurons. Second, GABA affects the basal ganglia and then information is projected to thalamic regions. Finally, glutamate is projected back to the thalamus which goes back to the back to the cortex (Ahmari, et al., 2015). However, people with OCD showcase problems in any area of this pathway. Although much evidence supports that problems to the corticostriatal-thalamocortical (CSTC) circuits cause OCD, new evidence shows something more specific. Human OCD imaging findings show that some early models of basal ganglia circuitry may propose that the high activity of the orbitofrontal-subcortical loops, may be caused by a disruption in the balance of activity through these opposing ganglia pathways (Ting & Feng, 2011).

Most people with OCD are prescribed with SSRIs or Selective serotonin reuptake inhibitors as their first line of medication alongside with Cognitive Behavioural Therapy (CBT). This medication, in simple terms, increases the effectiveness of natural serotonin by blocking reuptake from occurring at the presynaptic neuron head. There are different types of SSRIs but the one most used on humans with OCD is called Fluoxetine (Prozac). SSRI are usually used for people with anxiety, depression and panic disorders. This may be the first line of medication for OCD patients as it can reduce the anxiety component of the disorder which stems from mainly the limbic system. Unfortunately, SSRIs do not have a high success rate as only 40-60% of patients respond poorly to this treatment. This may be due to the fact that there are various types of OCDs and that also may play a part in how impactful this treatment might be the specific OCD patient. However, the future for OCD treatment is not bleak, some evidence shows some promising results regarding glutamate neurotransmission within the CSTC pathways. The drawback here is that there is not enough specific evidence on where exactly the glutamate transmission problem area is located. Knowing this could help scientists find a way to reduce compulsive actions or behaviors (Pittenger & Bloch, 2014). Some new evidence was found regarding glutamic neuronal transition which suggests that the amygdala, specifically the basolateral amygdala (BLA), might be the place to focus on in order to reduce especially compulsive or repetitive behaviors. Data from this specific study claims that the BLA consists of about 90% of glutamatergic neurons. Thus, this might be the next area to focus on to reduce the compulsive component of OCD (Sun, et al. 2019).

Overall, obsessive-compulsive disorder (OCD) seems to have two overbearing components: obsessiveness, which is more emotion and anxiety based and compulsiveness, which are the repetitive motor/behavioral actions done to alleviate the anxiety. For the Obsessive component, SSRIs along with CBT seems to work best with the knowledge existing about OCD, for the compulsive component however; glutamate transmission seems to be the more promising answer for that component. Further studies on OCD can pave the path to more treatments with higher success rates. The key to this may be to target not one but both of these components.

References

1. Ahmari, S. E., & Dougherty, D. D. (2015, August). DISSECTING OCD CIRCUITS: FROM ANIMAL MODELS TO TARGETED TREATMENTS. Retrieved November 25, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515165/.
2. Burguière, E., Monteiro, P., Mallet, L., Feng, G., & Graybiel, A. M. (2015, February). Striatal circuits, habits, and implications for obsessive-compulsive disorder. Retrieved November 25, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293232/.
3. Mitchell, A., S, A., Chakraborty, A., & Subhojit, A. (2013, July 17). What does the mediodorsal thalamus do? Retrieved November 25, 2019, from https://www.frontiersin.org/articles/10.3389/fnsys.2013.00037/full.
4. Obsessive-Compulsive Disorder. (n.d.). Retrieved November 25, 2019, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml.
5. Pittenger, C., & Bloch, M. H. (2014, September). Pharmacological treatment of obsessive-compulsive disorder. Retrieved November 25, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143776/.
6. Sun, T., Song, Z., Tian, Y., Tian, W., Zhu, C., Ji, G., … Zhang, Z. (2019, February 26). Basolateral amygdala input to the medial prefrontal cortex controls obsessive-compulsive disorder-like checking behavior. Retrieved November 25, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397577/.
7. Symptoms of OCD. (n.d.). Retrieved November 25, 2019, from https://www.ocdtypes.com/ocd-symptoms.php.
8. Ting, J. T., & Feng, G. (2011, December). Neurobiology of obsessive-compulsive disorder: insights into neural circuitry dysfunction through mouse genetics. Retrieved November 25, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192923/.
9. Torregrossa, M. M., Quinn, J. J., & Taylor, J. R. (2008, February 1). Impulsivity, compulsivity, and habit: the role of orbitofrontal cortex revisited. Retrieved November 25, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265211/.
10. Yücel, M., Wood, S. J., Fornito, A., Riffkin, J., Velakoulis, D., & Pantelis, C. (2003, September). Anterior cingulate dysfunction: implications for psychiatric disorders? Retrieved November 25, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC193981/.

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.

The articles No evidence of attentional bias toward angry faces in patients with obsessive-compulsive disorder by Skinazi et al and The Narcissistic Function in Obsessive-Compulsive Neurosis by Martin Burgy are scholarly, peer-reviewed journals from American Journal of Psychotherapy and Brazilian Journal of Psychiatry. The Narcissistic Function in Obsessive-Compulsive Neurosis is a psychotherapy study with a political and social view with a background of advocating a separated idea of over-the-top habitual mental issues of obsessive-compulsive disorder. The next journal No evidence of attentional bias toward angry faces in patients with obsessive-compulsive disorder by Skinazi et al (2019), is a mental disorder and psychiatric study and journal from qualified authors to demonstrate a study with comparison of obsessive-compulsive disorder and psychiatric symptoms in patients. The objective was to observe the symptoms from obsessive-compulsive disorder in patients dealing with an aggressive reaction from attentional bias while dealing with a biased view. In relation to both articles, the information given made a purpose, content, stance, authority, type of information, and audience for information dealing with obsessive-compulsive disorder.

The journal by Skinazi et al (2019) and by Martin Burgy, served a purpose in informing, while the organization and content with both articles had a clear organization, grammar issues were not present, and the links were worthwhile due to the clear and concise language. The journal by Skinazi et al (2019) informs the audience to show whether patients with OCD could give a relationship attentional predisposition and make an irate face, if consideration inclination is identified with the side effects or if the AB scores are related with explicit OCD indications. While The Narcissistic Function in Obsessive-Compulsive Neurosis by Martin Burgy shows a purpose with signifying an intrapersonal idea of the translation of fanatical impulsive anxiety as a basic inner self shortfall. The journal emphasized people experiencing over-the-top enthusiastic hypochondria coming up short on the self-evaluation factor to show that it needs someone else as their very own feature self-image who acknowledges and underpins them in their conduct. The organization and content of both journals organization and content had descriptive headers and subtitles while relating to the main idea of psychotherapy and psychiatric in relation with obsessive-compulsive disorder. The purpose, organization, and content were a significant contribution to the details of obsessive-compulsive disorder.

For the stance of political, religious, something, someone, and the authority, each article had a different viewpoint. No evidence of attentional bias toward angry faces in patients with obsessive-compulsive disorder by Skinazi et al (2019) had an issue stance while The Narcissistic Function in Obsessive-Compulsive Neurosis by Martin Burgy was associated with a political and social stance. The Brazilian Journal of Psychiatry/ Brazilian Psychiatric Association was affiliated and responsible for the methods, information, and the visual aspect and authority for No evidence of attentional bias toward angry faces in patients with obsessive-compulsive disorder by Skinazi et al (2019). The Narcissistic Function in Obsessive-Compulsive Neurosis by Martin Burgy implemented authority by stating American Journal of Psychotherapy as the source. For the author of No evidence of attentional bias toward angry faces in patients with obsessive-compulsive disorder, the author Michele Skinazi left contact information through email while the other authors’ contact information wasn’t presented along with the author of The Narcissistic Function in Obsessive-Compulsive Neurosis. Every author of both articles was qualified scholar to give information relating to obsessive-compulsive disorder through psychotherapy and psychiatry. The stance and authority implemented a clear target and viewpoint for both journals as both have different bias stances and initiation of authorities.

For the type of article and audience, each journal was presented as published psychiatric or psychotherapy journal. That is a periodical production that is grant identifying with a specific scholastic control that is distributed as a straightforward gathering for the introduction, examination, and talk of research in a scientific manner relating to data in mental conditions with similar audiences. The Narcissistic Function in Obsessive-Compulsive Neurosis is a peer-reviewed essay journal article to inform an audience of professionals, general readers, researchers, and scholars. No evidence of attentional bias toward angry faces in patients with obsessive-compulsive disorder by Skinazi et al (2019) is a peer-reviewed psychiatric journal article formatted as a study with an audience towards general readers, researchers, and professionals. Each article presented a similar article type of entry as each was associated with a professional journal association and specific audience.

In conclusion, obsessive-compulsive disorder is presented in a variety of ways to signify the disorder can be represented in a psychotherapeutic and psychiatric manner, as seen by Skinazi et al., and Burgy’s research. Through evaluating these two peer-reviewed articles, it is evident that obsessive-compulsive disorder is a typical, constant, and dependable issue in which an individual has wild, reoccurring musings (fixations) and behaviors (impulses) that the person in question wants to rehash again and again. Individuals with OCD are not ‘frantic’ or perilous. Most people with OCD realize that their considerations are over the top or nonsensical yet the tension they feel makes the contemplations hard to disregard. Overall, the purpose, audience, content, bias, and authority were a critical evaluator for information regarding OCD and for the global issues that surround this mental disorder.

Section I: Intake and Social History

Alexis is a 19-year-old Hispanic American who was referred to A Greater Grace Counseling service by her mother, Amy who believes that her daughter has Obsessive Compulsive Disorder. She has gotten progressively worse with the need for cleanliness. She yelled at her mother for leaving footprints on her freshly vacuumed carpet. Alexis states that dirt and germs make her nervous and anxious. Amy came with her to the counseling center because she worries that Alexis washes too much, noting that Alexis takes several showers a day. Additionally, Amy feels that her daughter hates her. Alexis feels that her mother is overbearing and asks too many questions. This is Alexis’s first time in therapy.

Alexis presents with obsessive behaviors, such as frequent washing and excessive housecleaning. She has repetitive and intrusive thoughts that the house is dirty or that she needs to shower. Alexis states that she cannot go into stores because they are very disorganized, and she gets anxious and needs to go home and shower. These rituals are causing anxiety, which is affecting her temperament and causing physical and emotional tension. The obsessions have been present for 3 years and the anxiety has presented within the last 8 months. Alexis does not think that she has Obsessive Compulsive Disorder but agrees that she has anxiety-related symptoms.

Amy states that Alexis has always been a clean child. After she turned 16, she became obsessively clean. Alexis would often stay with friends during high school because Amy did not like to clean house. Amy provides for Alexis financially and has agreed to continue while Alexis is in treatment. Alexis appears very neat but looks fatigued as evidenced by the circles under her eyes. She is well-mannered and well-spoken; however, she seems guarded and irritable in front of her mother.

Alexis is half Caucasian, and half Latino. She speaks English and some Spanish. She states that English was the primary language spoken in the home, although her father could also speak Spanish fluently. She has never been a victim of race discrimination and has many Caucasian friends. She identifies as white and Latina.

Her father, Joe, and mother, Amy have been married for 27 years. She has an older brother who has been in the military since Alexis was 16. They were very close growing up. Alexis moved out of her family home when she graduated high school and turned 17 because she believed that the home was filthy. Her mother still supports her financially. Her father is a recovering alcoholic. Her mother has a history of depression and her brother suffers from PTSD, resulting from his last deployment to Afghanistan. He is still enlisted in the military.

Amy still financially supports Alexis; however, the father is unaware of it. Amy is the only person who is aware of Alexis’s state of mind and presenting issues. Amy feels that Alexis is going “crazy”. Alexis admits that she cannot stand to live in filth and her family should understand that since their house is always dirty. She has recently been at odds with her mother, as evidenced by the yelling and no longer allowing Amy into her apartment.

Alexis has a high school diploma and has no current desire to attend college. She admits that the thought of going to school causes anxiety. Alexis is unemployed but is supported by her mother. Alexis has an apartment in mid-town that her mother paid for. Currently, her utilities and daily expenses are covered by her mother. Alexis worries about her brother, who is still enlisted in the military. He was shot in Afghanistan during his last deployment.

Alexis was raised in the church and identifies as Catholic. Until 8 months ago, Alexis actively attended church with a group of friends and was active in the choir. She stopped attending after she had a dinner party with her congregation at her apartment, and someone spilled coffee on the floor.

Alexis appears clean and intelligent. She has no financial concerns, nor does her immediate family. Alexis has three close friends from high school that she still stays in contact with, but she has not been in contact with any of the members of her church. She relies heavily on her mother for financial support but does not confide in her about anything.

Alexis was born healthy, with no illness or accidents occurring, is not on medications currently, has no genetic illness other than a predisposition to depression and alcoholism, and has no physical limitations. Alexis has no history of substance use but drinks wine occasionally on Christmas and Easter. She denies previous mental health issues. She presents with Obsessive Compulsive Disorder and Generalized Anxiety Disorder.

Section II: Models of Intervention

Cognitive-behavioral therapy (CBT) is a widely used method that has been proven effective in the treatment of anxiety-related behaviors (Marom & Hermesh, 2003). Additionally, the practice of cognitive restructuring can help mediate somatology associated with obsessive-compulsive disorder when utilized with exposure therapy (Marom & Hermesh, 2003; Marom, Hermash, & Gilboa-Schechetman, 2009)). Examined is a session where both cognitive restructuring (CR) and exposure therapy (ET) are applied.

Alexis and I sat together to discuss her obsessive behaviors and the anxiety that is associated with them. She revealed to me that ever since she moved away from her childhood home, she felt relief from the “mess”. She stated, “My mother is a pig! She never washed a single dish in her life. It was so embarrassing when people came over because there was never a place for them to sit. There was trash and laundry piled everywhere!” I asked, “What is it about the mess that upsets you?” She replied, “It’s just disgusting!” As she said this, she reached into her purse and pulled out a bottle of hand sanitizer and began to rub her hands vigorously. It is time to restructure her thoughts… “Alexis, do you think my office is dirty?” She replied, “No.” I ask, “Then what’s with the sanitizer?” Alexis, “Oh, I didn’t even realize I did that (As she holds up the bottle).” In cognitive restructuring, we identify cognitive distortions that produce abnormal behaviors and identify means to assess the current situation prior to acting upon it (Marom & Hermesh, 2003; Marom et al., 2009). “Alexis, I want you to hold this bear.” She takes the bear and notices that it has been worn. I ask, “Do you like him?” She replies, “I’m not sure, he looks a little dirty (scrunches her nose).” As she goes to set the beardown, I stop her. I told her, “I want you to hold him for five minutes.” This is exposure therapy. The bear, while worn, is not dirty; but to Alexis, it is filthy. By holding him in brief intervals throughout our sessions, she will make the connection between dirt and safety (Marom & Hermesh, 2003; Marom et al., 2009). I allow her to set the bear down as we talk without the use of sanitizer (ET). Every 5 minutes, she must pick him up again. The expectation is that she slowly begins to realize that a little dirt is not a terrible thing (Marom & Hermesh, 2003; Marom et al., 2009). The more she recognizes this, the less anxiety the bear will evoke. I assign her homework and ask her to take the bear home and hold him each time she feels obsessed to take shower (ET) (Marom & Hermesh, 2003; Marom et al., 2009). One shower per day is the maximum (CR). She will take notes on how often she feels compelled to hold the bear (CR and ET).

The next session, Alexis came in the office with the bear under her arm. She was smiling and seemed less fidgety than on our first visit. We reviewed her notes and assessed her current state of mind. She stated, “I feel a little better. I had a lot more free time because I was only allowed to shower once a day. I still think this bear could use a shower (laughing).” I noted her lightheartedness and humor. I asked, “Did you bring hand sanitizer with you?” She admitted that she did, so I asked her to place it on the table beside the bear. I said, “At any time during our meeting, you may hold the bear, but I want you to try to refrain from using the sanitizer, ok?” She agreed, and we began to discuss her plans. I asked, “Are you interested in school?” Alexis said, “I really enjoyed high school, but I found that most places are filled with germs and I get really anxious about that.” I saw her looking at the sanitizer as she said this, but she quickly looked away. “Alexis, do you think that my office has a lot of germs?” She looked around and said, “Probably, but I can’t tell.” I assured her that my office was not perfect (CR) and that although it looks clean, there are a few germs there that are unavoidable (CR) (Marom & Hermesh, 2003; Marom et al., 2009). She looked at her sanitizer on the table as I spoke. I asked her, “Do you believe that my office is as dirty as your mother’s house?” She stated, “No.” I asked, “Then why would you think that working in an office or going to school would be so bad?” (CR) (Marom & Hermesh, 2003; Marom et al., 2009). She agreed that it would not be as bad as going to her mother’s house and looked a little bit relieved. “Alexis, if there was something that you could do that does not involve cleaning, what would it be?” Alexis stated that she enjoyed writing and researching about people. I explained to her that she could go to school online until we were able to work through some of her anxieties and compulsions (ET) (Marom & Hermesh, 2003; Marom et al., 2009). I strongly believe that preoccupying Alexis with healthier choices is naturally a good idea (CR); however, I do not think that she is ready to be thrown into social situations that would interfere with the progress she and I are making. I noted a comment that Alexis made about her current situation: I don’t really need to work or school, mom takes care of everything. I sent her home with the bear and chuckled after she closed the door because she left the sanitizer behind. Her homework was to research schools and find one that best suits her. Additionally, I asked that she bring her mother to the next visit.

Walsh (2015) describes systems theory as the combination of elements, both social and environmental, that have a cause-and-effect reaction the components of the system. Each element is influenced by the other and in families, the parallel strongly exists (Walsh, 2015). According to current research, parental influence on healthy lifestyles, social behavior, and education after adolescence carries over into adulthood (Walsh, 2015). The range of support a parent provides can impact the perception that growing adolescents have on the world. Bowen’s family systems theory suggests that human behavior assumes a family unit as emotional and that each member’s feelings, emotions, behaviors, and actions affect each element, or family member (Walsh, 2015). Emotional interdependence is increased as family members change behaviors or disrupt the cohesiveness of the family unit (Walsh, 2015). If Alexis’s behavior toward her mother is related to childhood events, it should surface during session (Walsh, 2015); however, Amy’s overcompensation to appease Alexis could be the trigger for Alexis’s abnormal behavior (Walsh, 2015). Taking a structural family systems approach, I will utilize role-play between Alexis and her mother to evaluate the structure of their relationship (Marom & Hermesh, 2003; Marom et al., 2009).

Alexis and her mother came in together but neither of them appeared interested in talking to one another. It was already made clear that Amy believed that Alexis was crazy, and Alexis had little respect for Amy. As such, I placed them in chairs facing each other and forced a conversation (Marom & Hermesh, 2003; Marom et al., 2009). I asked Amy to tell Alexis how she was feeling. Amy stated, “I worry about you. You are too clean, and you won’t go to work or go school. If you put as much effort into life as you do cleaning, you might be a successful person”. Alexis replies, “I’m clean, yes! I am disgusted by filth. And why should I do anything? You have all the money and you can pay the bills.”

Amy looked at me and stated, “See? This is what I am talking about!” I respond, “I have an idea, are you ladies willing to hear it?” Such questions evoke a healthy working relationship and help clients become more receptive to ideas and suggestions (Walsh, 2015) “Alexis has already started making changes toward a healthier lifestyle. What if, you reward her for progress rather than enable her to stay stuck in the same place?” Alexis looked at me inquisitively and then looked at her mother. Amy said, “How do I do that?” Facilitating change in family systems requires all parties to invent a goal, work cohesively to achieve that goal, and reward each other when goals are met. My theory suggests that Alexis is given a budget and must adhere to that budget until she can work and care for herself. As Alexis makes progress toward her recovery, Amy can reward her with extras like lunch out together or a girl’s shopping expedition. Often family members will concede to another member’s irrational or abnormal behaviors thinking that they are helping when the enabling is making the problems worse (Marom & Hermesh, 2003; Marom et al., 2009). By nudging the notion of self-reliance, Alexis will learn that she cannot take advantage of her mother’s kindness. Moreover, Amy will recognize that Alexis is much stronger than she has previously given her credit for.

Section III: Critical Critique

Cognitive-behavioral therapy and family systems therapy are both beneficial when working with clients presented with the disturbances noted in the case study (Marom & Hermesh, 2003; Marom et al., 2009). Although it is not typical to have such quick and all-positive results as I have presented with this case, the approaches applied over time could produce similar outcomes (Marom & Hermesh, 2003; Marom et al., 2009). Both approaches have strengths and limitations but when introduced appropriately, can serve to benefit individuals like Alexis in the long term.

The cognitive-behavioral approach to obsessive-compulsive disorder and the symptoms of anxiety associated with it is best suited in this situation because Alexis is frozen by her symptoms (Marom & Hermesh, 2003; Marom et al., 2009). She is incapable of attending school or going to work because her fear of germs outweighs her desire for independence. She needs to change her patterns of thinking. The family systems approach seeks to benefit Alexis and her mother by teaching them that enabling is holding Alexis back (Marom & Hermesh, 2003; Marom et al., 2009). The ‘nothing changes if nothing changes’ approach will greatly benefit Alexis by urging her to seek independence because the reality is, she has no choice.

Although Bowen suggests a multigenerational perspective when applying family systems theory, I did not see the benefit because the family history that Alexis presented did not warrant such an investigation (Walsh, 2015). Had her father been aware of the financial support that Amy was providing her daughter, I would have felt compelled to include him in the session. I could convey this to Amy in future sessions, but the primary focus of this therapeutic intervention was to get Alexis well. As such, I suggest that cognitive-behavioral treatment is the best option for treating Alexis until her symptoms are well under control, as highlighted by the treatment goal and its objectives.

Treatment goal: Have Alexis gain her independence

• Alexis can gain her independence by changing cognitive distortions associated with obsessive-compulsive disorder. To do this, I have incorporated a gently used bear to help Alexis identify that “dirty” is not such a terrible concept if taken retrospectively
• Help Alexis refrain from the overuse of hand sanitizer and over-bathing. Taking notes and replacing the urge to shower with holding the bear will help her redirect her focus onto more healthy behaviors
• Have Alexis begin school. An interest in writing and research will serve her well in her search for independence. Additionally, it will help her redirect negative thoughts associated with her surroundings by putting her focus onto more promising things.

Since Alexis’s case is complex, I would like to meet with her regularly to track her progress. Additionally, her situation is very connected to her mother’s enabling, therefore, it is important to include her in the process. The main issue that I could predict as a barrier would be Amy. Without her assistance in creating a budget and providing Alexis an allowance, the likelihood that Alexis will stay dependent on her mother is increased exponentially.

References

1. Marom, S., Aderka, I. M., Hermesh, H., Gilboa-Schechtman, E. (2009). Social Phobia: Maintenance Models and Main Components of CBT. Israel Journal of Psychiatry and Related Sciences, 46(4).
2. Marom, S. & Hermesh, H. (2003). Cognitive Behavior Therapy in Anxiety Disorders. The Israel Journal of Psychiatry and Related Sciences, 40(2).
3. Walsh, J. (2015). Theories for direct social work practice (3rd ed.). Belmont, CA: Brooks/Cole Cengage.

Abstract

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

1. 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.
2. Steketee, G., & Frost, R. O. (2006). Compulsive Hoarding and Acquiring. Cary, US: Oxford University Press, Incorporated. Retrieved from http://www.ebrary.com
3. Aboujaoude, E. (2008). Compulsive Acts. Berkeley, US: University of California Press. Retrieved from http://www.ebrary.com
4. 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.
5. Toates, F., & Coschug-Toates, O. (2002). Obsessive-Compulsive Disorder. London, GBR: Class Publishing. Retrieved from http://www.ebrary.com
6. 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