Obsessive compulsive disorders are very common in our population. Some of the examples of OCD include people, who will not go to public places because they are afraid that they will have intolerable sexual thoughts or they will falsely accuse someone of committing a crime. In addition, there are women who will plug and unplug electrical appliances 20 times or more, check door locks several times before leaving the house for the fear that they may have left it unlocked, and there are people who cover everything with a paper towel first for the fear of contaminating germs. People suffering from OCD, will wash hands up to the elbow 30- 60 times a day until the elbows are scabbed. There are young men who spend an hour a day washing hands, showering and dressing due to suffering from OCD. Additionally, there are women who will organize their closets color wise, and constantly check to see that furniture and other items are in exactly in the “right” places. Some people have the obsession of wall pictures to be accurately aligned or it will give them tension.
The American Psychiatric Association defines the disorder as a set of recurrent obsessional ideas or compulsive actions that take up more than an hour a day or cause serious distress or impairment. The most common subject matter of obsessions is cleanliness (dirt and germs), followed by aggressive and sexual impulses, health, safety, symmetry or order. The obsession may take the form of a doubt, a fear, an image, or an impulse. Although obsessional ideas can be bizarre, they are rarely delusional. But sometimes their obsessions can take the form of conviction and transform into overvalued ideas.
Compulsive acts are performed to attain a sense of ease and comfort destroyed by obsessions. People with obsessional thoughts need repetition for reassurance. They suppress the thoughts either by overt actions such as checking and cleaning or by mental rehearsals, silent prayers, counting or repetitions of single words. The person tends to relieve anxiety or tension by compulsive acts and eventually he or she is no longer fully conscious of the tension because the rituals have become automatic and take the form of habits. Compulsive behavior is time consuming in itself and the lives of the OCD people are further complicated by avoidance of situations that provoke the symptoms. This leads to depression marked with isolation and withdrawal.
The prevalence of OCD is about the same in both sexes, but the symptoms appear an average of five years earlier in men. OCD usually begins in adolescence but can develop as early as the age of three. OCD is also genetic. Studies have found that identical twins are much more susceptible for the disorder than fraternal twins.
OCD should be distinguished from obsessive compulsive personality. The symptoms of OCD are not character traits, and people with the disorder are not necessarily, orderly, morally rigid, indecisive or perfectionist in a self defeating way.
Obsessions and compulsions are linked together but they don’t always go together. Obsessions are repetitive thoughts for example thoughts of violence, contamination and doubt. Compulsions are repetitive actions, for example hand washing, counting, checking and touching.
The distinctive quality of obsessions and compulsions is that they do not give pleasure and are not actively sought out. They are repetitive, meaningless, trivial and ritualistic thoughts or actions that reduce anxiety. Neurotic obsessions tend to deplete energy and destroy mental functioning. For example a person who is obsessed with thoughts of anger and hostility directed towards his boss, might not be able to be productive at work. When a person has neurotic compulsion, the behavior is experienced as being against one’s will. For example, the person may be aware that his behavior is bizarre but he will still be compelled to perform the ritual like washing hands twenty times before going to work. Thus the person shows the awareness of the problem but is embarrassed to talk about it. Obsessive compulsive disorders can be debilitating and it is important to seek professional help. Unlike addictions, the person is usually conscious of how unpleasant and dysfunctional his obsessions are and is likely to seek help. People with addiction are usually in denial and tend to hesitate to seek professional help.
Psychological Implications of OCD:
Psychodynamic theory implies that the disorder is caused when the person represses unacceptable wishes and desires. To defend themselves against the knowledge of these wishes, people with OCD tend to isolate and undo. Isolation separates an idea or image from the feeling associated with it and drives the feeling out from awareness. The energy of the repressed emotion gives the idea its compelling obsessional attribute. When isolation is about to fail, the secondary defense of undoing produces compulsive acts. This is the psychodynamic explanation of OCD.
Behavioral psychologists disagree with the concept of repression but agree with the theory of tension and anxiety. They contend that some people have unusually intense biological responses to stress or have been conditioned early in life to regard some thoughts as unclean, immoral, or dangerous. As the thought recurs, it becomes a source of conditioned anxiety. Compulsive rituals reduce the anxiety and provide control over obsessive thoughts. This becomes rewarding and thus reinforces the compulsive rituals which tend to alleviate anxiety, at least, temporarily.
Treatment of Obsessive Compulsive Disorder
People who suffer from this kind of disorder will benefit from Cognitive Behavior Therapy, which focuses on making the individual become aware of their irrationality of thoughts and replacing dysfunctional thought patterns with more rational thoughts. Therapist tries to teach them techniques like thought stopping, visualization with guided imagery, use of affirmations, challenging thought patterns with the help of Socratic questions and disputing irrational beliefs. These techniques have been described in detail in other blogs written by the writer. Please refer to the blogs written by the writer on Decreasing Emotional Distress with the help of RET and Panic Disorder. Individual therapy helps the person gain an insight into his problem and he then tries to implement what has been offered in therapy. Group therapy also focuses on teaching skills and educating the person about the inappropriateness of the obsessive thoughts and compulsions and giving them reassurance that compulsive rituals need not be performed to relieve anxiety.
Exposure techniques are generally used to treat OCD. In exposure therapy, the person is exposed to the objects or situations that trigger obsessions and prevent them from performing the usual rituals until he or she becomes accustomed to the obsessions and begins to disregard them. Situations are ranked by degree of anxiety, and exposure proceeds in an ascending order on the scale. Patients are asked to imagine vividly the dreaded consequences of going without the rituals also called Imagery Desensitization. To supplement the exposure therapy, sometimes therapist also gives training in progressive muscle relaxation, deep breathing, and visualization with guided imagery. Patients are also advised to practice exposure at home. Sometimes family members are also involved in treatment to provide supervision and encouragement to the patients.
Response prevention is a technique that helps the person delay and prevent the compulsive act. For example, deliberately trying not to wash hand several times, or checking locks and light switches repeatedly in the presence of the therapist. The person is suggested that he or she will consciously instruct himself or herself not to engage in these compulsive acts. After practicing it for several times, the person begins to think before act and stop the compulsive behavior. The treatment of cleaning rituals involve putting the patient in direct contact with a dirty object and prevented to clean up for hours afterwards. The therapist generally demonstrates the action first, holding the dirty object or touching the floor to show the patient that it is safe to do so. The procedures are lengthy and detailed. Compulsions that involve checking, hoarding and orderly arrangement are more difficult to treat behaviorally, partly because many people perform these rituals only in privacy. In these cases, the therapist may have to accompany the patient to the place where the ritual is performed.
Thought stopping technique is used to address obsessional thoughts and cognitive rituals like silent counting, and repetition of words. In these situations, the Behavioral Therapy is modified because there is no action to be prevented. The person is asked to say the word “STOP” when the obsession occurs in mind and snap a rubber band on the wrist simultaneously to interrupt the thought pattern. Sometimes it is accompanied by an aversive experience like mild shock. They are asked to replace obsessive thoughts with calming and reassuring statements like,” I can handle this”, “I do not need to repeat these words or count”.
The opposite approach is Saturation in which the patient is asked to concentrate intensely on the obsessive thought to the point that it becomes meaningless and loses its compelling attribute. Stimulus control entails that the patient schedules a worry time and is not allowed to indulge in obsessive thoughts any other time of the day. Assertiveness training and relaxation training tend to help reduce anger, anxiety, and guilt that lead to obsessional thinking. A rare form of OCD is known as primary obsessional slowness in which people do everything with excessive deliberation and attention to detail. They take hours to perform simple acts like dressing and eating. Modeling, prompting and shaping are used as behavioral interventions for this type of OCD. The therapist models the action, tells the patient to perform it within a preset time while the therapist counts aloud and praises the patient repeatedly for his effort to approximate the desired time.
Group and individual treatments are equally effective to treat OCD. Studies of Behavior Therapy for OCD have found a 70% to 80 % improvement in symptoms of OCD.
Pharmacotherapy also helps reduce the symptoms of OCD significantly. Many SSRI drugs like Luvox, Zoloft, Paxil, Prozac are prescribed to treat OCD but they do have side effects like agitation, insomnia, and sometimes loss of libido or the capacity for orgasm. As a last resort, brain surgery is also used to treat OCD but the most severe side effect of surgery is seizure and impairment in the capacity for judgment and planning.
OCD can ruin marital and family life. It is very important to seek professional help if you have symptoms of OCD.
Hypnosis can also help reducing symptoms of OCD. Please visit our Blossom Hypnotherapy page to learn how hypnosis can help reduce symptoms of Anxiety disorders.