Obsessive compulsive disorder
Obsessive-compulsive disorder is characterized by the presence of recurrent, unwanted, intrusive ideas, images, or impulses that seem silly,weird, nasty,or horrible (obsessions) and an urge or compulsion to do something that will relieve the discomfort caused by an obsession.The pervading obsession theme is harm, risk, or danger.Common obsessions include concerns about contamination, doubt, loss, and aggressiveness.Typically,people with obsessive-compulsive disorder feel compelled to perform rituals—repetitive, purposeful, intentional acts.Rituals used to control an obsession include washing or cleaning to be rid of contamination, checking to allay doubt, hoarding to prevent loss, and avoiding the people who might become objects of aggression.Most rituals, such as excessive hand washing or repeated checking to make sure a door has been locked, can be observed. Other rituals are mental, such as repetitive counting or making statements intended to diminish danger.
Obsessive-compulsive disorder affects about 2.3 percent of adults and occurs about equally in men and women. Because people with this disorder are afraid they’ll be embarrassed or stigmatized, they often perform their rituals secretly, even though the rituals may occupy several hours each day.About one third of the people with obsessive compulsive disorder are depressed at the time the disorder is diagnosed.Altogether, two thirds become depressed at some point.
Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress the thoughts, impulses, or images are not simply excessive worries about real-life problems the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action the person recognizes that the obsessional thoughts, impulses, or images are a product of her/his own mind (not imposed from without as in thought insertion) .
Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly the behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviours or mental acts either are not connected in a realistic way with what they are designed to neutralize or preventor are clearly excessive At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.
A model based on the psychological concept of conditioning has also been used to understand the development of obsessions and compulsions.Compulsions,whether mental or observable,usually decrease the anxiety en gendered by obsessional thoughts.
Thus, if a person is preoccupied with fears of contamination from germs, repetitive hand washing usually decreases the anxiety caused by these fears. The compulsion becomes a conditioned response to anxiety.Because of the tension-reducing aspect of the compulsion, this learned behaviour becomes reinforced and eventually fixed.
Compulsions, in turn, actually reinforce anxiety because they prevent habituation from occurring; that is, by performing a compulsion, contact with the fear-evoking stimulus (e.g., dirt) is not maintained, and habituation (a decrease in fear associated with the stimulus) does not occur.Thus, the vicious circle linking obsessions and compulsions is maintained.
Sigmund Freud found obsessions and phobias to be psycho kinetically related. Isolation of affect: By this defence mechanism, ego removes the affect (isolates the affect) from the anxiety causing idea.The idea is thus weakened, but remains still in the consciousness. The affect however becomes free and attaches itself to other neutral ideas by symbolic associations. Thus, these neutral ideas become anxiety provoking and turn into obsessions.
This happens only when isolation of affect is not fully successful (incomplete isolation of affect). When it is fully successful, both the idea and affect are repressed and there are no obsessions
Undoing: This defense mechanism leads to compulsions,which prevent or undo the feared consequences of obsessions
Reaction formation: results in the formation of obsessive compulsive personality traits rather than contributing to obsessive compulsive symptoms while displacement leads to formation of phobic symptoms. Thus, the psycho dynamic theory explains OCD by a defensive regression to anal sadistic phase of development with the use of isolation, undoing and displacement to produce obsessive compulsive symptoms Treatment
Exposure therapy, a type of behaviour therapy, often helps people with obsessive compulsive disorder. In this type of therapy, the person is exposed to the situations or people that trigger obsessions, rituals, or discomfort. The person’s is comfort or anxiety will gradually diminish if s/he prevents her/himself from performing the ritual during repeated exposure to the provocative stimulus. In this way, the person learns that the ritual is not needed to decrease discomfort.The improvement usually persists for years, probably because those who have mastered this self-help approach continue to practice it as away of life without much effort after formal treatment has ended. Psychotherapy, with a view toward gaining insight and understanding of underlying conflicts,has generally not been effective for people with obsessive-compulsive disorder. Ordinarily, a combination of drugs and behaviour therapy is the best treatment.Drugs can also help many people with obsessive-compulsive disorder.