Obsessive Compulsive Disorder: Diagnosis and Treatment

Obsessive Compulsive Disorder is an anxiety-related condition whereby a person experiences involuntary or out-of-control thoughts that keep repeating themselves in such a person’s brain hence causing great anxiety. As a result, many such people resort to compulsive behaviors aimed at countering the anxious thoughts and thus inhibiting the anxiety (Hewlett, 2008, p. 298). Unfortunately however, OCD triggers a positive-feedback mechanism, kind of similar to that witnessed during labor contractions. Consequently, the more the anxiety, the greater the intensity and frequency of the compulsive reaction, and the greater the frequency of the compulsive behavior, the greater the anxiety felt by such a person.

It is interesting to note that such a person is often aware of his or her irrational obsessions and compulsions, but he she is incapable of regaining control of thoughts or thought processes that are autonomous while in such a condition. As a result, people with OCD often feel embarrassed and try to hide their condition until eventually it spins out of control affecting their employment and other relationships. The onset of Obsessive Compulsive Disorder is at adolescence or early adulthood.

It is rarer among children but not impossible to find (Chabane, Delorme, Millet, Mouren, Lebover, & Pauls, 2004, p. 884). Where present in a child, it is co-morbid with other psychological conditions such as autism, hence difficult to detect and diagnose. It is even less common in adults past the age of 35. Signs and symptoms of OCD include obsessive thoughts and compulsive habits. Fear, which results in anxiety is a common feature in these obsessive thoughts.

Such a person often drifts off and zeroes in on a particular thought. Psychologists have narrowed down obsessive thoughts into various categories, hence a person may obsess over: contamination, harming others, sexually explicit or violent thoughts, religion or morality, order and symmetry, superstitions, or loss of precious items or people. This person then manifests such an obsession by repetitively acting in a particular manner to ward off the fear or obsession.

Consequently, he or she develops a compulsive behavior to manage the obsessive thoughts. For instance, if a person’s obsession is contamination, he / she adopts excessive cleaning habits and falls under the category of ‘washers’. In some extreme cases, due to the fear of contamination by germs and dirt, which sometimes such a person directs at others, as in he / she fears to contaminate others, the patient may scrub their hands until they are raw and bleeding! (Sadwick, 2010, p. 45) Those with the fear of losing precious possessions and loved ones develop a habit of checking on these loved ones or items to ensure their safety.

Obsessions with order and symmetry drive a patient into persistently arranging things ‘just-so’ into a perfect format. They form the bulk of ‘checkers and arrangers’ and often have superstition about particular numbers, hence they avoid its occurrence within their perceived ‘order’. ‘Doubters’ have a habit of double-checking everything to ensure it is in place. For instance, they may keep checking the stove to see if they switched it off, or keep checking a switch or maybe a lock.

This stems from the fear of causing harm to themselves and others. Some have repeatedly driving around after hitting a bump to make sure they did in reality not hit a person. ‘Sinners’ obsess about religion and other moral codes. Consequently, they live in perpetual fear of being punished for what they conceive are mortal sins and so regularly engage in prayer activities or other religious habits aimed at paying penance for their sins such as flagellation and excessive fasting. ‘Hoarders’ live in fear of repercussions for throwing away things. Consequently, they store a lot of junk such as old newspapers, clothes, and containers among other things.

The exact cause of OCD is not known, but studies point to a variety of possible biological and psychological sources including: genetics, infections, tumors in the brain, head trauma, lesions in specific brain parts, oversensitivity or the malfunction of various brain pathways, side effect of taking some drugs, aggression or sexual deviation often resulting from strict parenting, and anxiety. Biological treatments include the administration of antidepressants including Selective Serotonin Reuptake Inhibitors (SSRI’s), which increases the amount of neurochemical serotonin in the brain (Geller, Biederman, Stewart, et al., 2003, p. 1919).

SSRIs are better than clomipramine, an older drug, in terms of side effects (Foa, Liebowitz, Kozak, et al., 2007, p. 374). The side effects of SSRI’s only include nausea, diarrhea, agitation, insomnia, and headaches. Another option is surgery involving the removal of part of the brain. Depending on what part the surgeon removes, it may be a “cingulotomy, subcaudate tractotomy, limbic leucotomy, or a capsulotomy” (Sessa, 2005, p. 458).

Side effects include epileptic seizures, infections, bleeding, and weight-gain. Psychological treatments are milder and generally more effective than medical treatments because not only do they treat the symptoms but they also identify the source of the fear or anxiety and help to eradicate the disorder my applying a paradigm shift on a person’s perspective of a certain phenomenon (Kobak, Greist, & Jefferson, et al. , 2004, p. 467).

The most common psychotherapeutic treatment is Cognitive Behavioral therapy, which just as the name suggests, has two elements: behavioral and cognitive therapy. Behavioral therapy involves exposure and response prevention whereas cognitive therapy deals with a person’s exaggerated sense of responsibility and obsessive thoughts (Stein, 2009, p. 665). Behavioral therapy involves repetitive exposure to the source of one’s obsessions. For instance, where a person’s obsession is contamination, the therapist may decide to make him or her touch a toilet seat and then not to wash his or her hands (Heyman, Mataix-Cols, & Fineber, 2006, p. 428).

The longer such a person resists the urge to wash, the more he/she gets in control of his/her thoughts and actions. Eventually, the therapist may suggest that such a person adopt a different coping mechanism to deal with his stress or anxiety, and to change this mechanism regularly so that the anxiety is in check. Cognitive therapy involves thought processes. The therapist assists the person to recognize the source of his or her fears by administering a self-test diagnosis so that the patient answers questions about his or her fears and they determine the possible source of the anxiety (Ward, et al, 2010, p. 346).

Consequently, the therapist assists the person to change his or her dimension of thought. For instance, the irrational fear of having knocked down a person can be overcome by the therapist suggesting that the driver who suffers from OCD slow down a confirm that it is a bump that he wants to drive over before jumping it so that he has no doubt in his mind about what he just did.

Reference List

Chabane, N.Delorme, R., Millet, B., Mouren, M., Lebover, M., & Pauls, D.,. (2004). Early-Onset Obsessive-Compulsive Disorder: A Subgroup With a Specific Clinical and Familial Pattern. Journal of Child Psychology and Psychiatry , 881-887.

Foa, E., Liebowitz, R., Kozak, M., et al. (2007). Randomized, Placebo-Controlled Trial of Exposure and Ritual Prevention, Clomipramine and Their Combination in the Treatment of Obsessive-Compulsive Disorder. Focus 5 , 368-380.

Geller, A., Biederman, J., Stewart, E., et al. (2003). Which SSRI? A Meta-Analysis of Pharmacotherapy Trials in Pediatric Obsessive-Compulsive Disorder. American Journal of Psychiatry 160 , 1919-1928.

Hewlett, W. A.,. (2008). Obsessive-compulsive disorder. In M. H. Ebert, Current Diagnosis & Treatment: Psychiatry. 2nd ed. McGraw Hill Companies, Inc, New York.

Heyman, I., Mataix-Cols, D., & Fineber, N. (2006). Obsessive-Compulsive Disorder. British Medical Journal 333, 424-429.

Kobak, K., Greist, J., & Jefferson, J., et al.. (2004). Behavioral Versus Pharmacological Treatments of Obsessive Compulsive Disorder. Focus 2 , 462-474.

Sadwick, L. F.,. (2010). Obsessive-Compulsive Disorder. In Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR,4th ed, American Psychiatric Association, Arlington, VA.

Sessa, B.,. (2005). Can Psychedelics Have a Role in Psychiatry Once Again? The British Journal of Psychiatry 186 , 457- 458. Web.

Stein, D.J., et al. (2009). Obsessive-Compulsive Disorder: Diagnostic and Treatment Issues. Psychiatric Clinics of North America , 32:665.

Ward, H. E., et al. (2010). Update on deep brain stimulation for neuropsychiatric disorders. Neurobiology of Disease , 38:346.