OCD Disease It was 9:30 a.m., and Nancy, a 36-year-old attorney, had arrived late for work again. Nancy knew she needed to catch up on her legal assignments, but a familiar worry nagged at her. No matter how hard she tried, Nancy could not dislodge the thought that she had left a pot burning on the stove. The image of her home engulfed in flames was so vivid she could almost smell the smoke. Nancy tried to shut the thought out of her mind, reassuring herself that she had turned the gas jet off.
But even remembering her hand touching the cool stove burner-a precaution she took whenever she left the house-still left her wondering whether she had checked carefully enough. The pot and stove were not all that had been on Nancys mind that morning. For Nancy, leaving the house entailed a time-consuming routine designed to ensure that no major or minor disaster-such as a fire, burglary, or household flood-would strike while she was away. Like a pilot preparing for take-off, she would spend more than an hour checking and rechecking that all appliances were turned off, all water faucets shut, all windows closed, and the doors to the house securely locked. Except for necessities such as work, Nancy avoided going out because it meant performing this arduous routine.
But even these measures were not enough to keep her from worrying. A few weeks earlier, Nancy had hit on the idea of documenting that everything was safe before she left home. Now, sitting at her desk, she pulled a completed checklist from her purse and reviewed it to see if the “stove and oven” item and been marked off. At first, she felt relieved to see that it was. But then a new thought struck: What if this wasnt todays checklist? Panic overtook reason.
Nancy dialed the local fire department and asked that truck be sent to investigate a fire at her house. (Goodman, 1994, pp 103, 104) The first modern description of OCD was provided in 1838 by Jean-Etienne Dominique Esquirol, a French psychiatrist. Esquirol called the disorder the folie de doute, or doubting madness, and suspected it was rooted in a physical problem in the brain. During much of the 1900s, psychoanalytic theories dominated the study of OCD. Many psychoanalytic theorists believed OCD originated from conflicts early in a childs development over such issues as toilet training. (Goldman, 1994, p.104) Researchers theorize that an antibody may actually cause OCD.
The antibody called D8/17, is produced to fight streptococcus bacterium that causes rheumatic fever. However D8/17 may attack healthy cells in the brains basal ganglia region, which helps control basic movement sequences, such as walking or eating. (Klobuchar, 1998, p.266) The obsessions or compulsions must cause marked distress, be time consuming (take more than 1 hour per day), or significantly interfere with the individual’s normal routine, occupational functioning, or usual social activities or relationships with others. Obsessions or compulsions can displace useful and satisfying behavior and can be highly disruptive to overall functioning. Because obsessive intrusions can be distracting, they frequently result in inefficient performance of cognitive tasks that require concentration, such as reading or computation. In addition, many individuals avoid objects or situations that provoke obsessions or compulsions.
Such avoidance can become extensive and can severely restrict general functioning. (Diagnostic and Statistical Manual of Mental Disorders, 1994). Symptoms of OCD include repetitive, ritualized behavior, such as counting, hoarding objects, or handwashing; obsessive fear of threats, such as germs; or a fear of committing violent acts. (Klobuchar 266) The American Psychiatric Association classifies OCD as an anxiety disorder. People with OCD suffer from persistent and disturbing thoughts, images, or impulses, called obsessions.
They relieve the anxiety caused by their obsessions through compulsions-repeated behaviors that they feel driven to perform. (Goodman, 1994, p.104) The DSM-IV defines obsessions as recurrent thoughts, images, or impulses that are anxiety-provoking and are perceived as intrusive or senseless. (Gragg & Francis, 1996, p.1) The intrusive and inappropriate quality of the obsessions has been referred to as “ego-dystonic.” This refers to the individual’s sense that the content of the obsession is alien, not within his or her own control, and not the kind of thought that he or she would expect to have. However, the individual is able to recognize that the obsessions are the product of his or her own mind and are not imposed form without (as in thought insertion). (Diagnostic and Statistical Manual of Mental Disorders, 1994). Obsessions typically fall within seven major categories.
i.e. Contamination obsessions, which typically involve excessive concerns about germs, disease, and cleanliness. Somatic obsessions, which are persistent, repetitive thoughts about physical concerns. Children may experience intrusive thoughts that they have a tumor or that they are developing sensory impairments. Sexual/Aggressive obsessions typically involve recurrent thoughts or images that one has committed an unacceptable sexual or aggressive thought or act in the past or is likely to do so in the future. Hoarding obsessions are worries that things should not be thrown away just in case they might be needed later. Doubting obsessions are incessant worrying that one will be responsible for a terrible consequence resulting from ones failure to fulfill an obligation or complete a task correctly.
Religious obsessions typically involve thoughts about committing or having committed an immoral act or sin. And lastly, a need for symmetry and exactness. These obsessions are characterized by excessive concern about putting objects in a specific position, scheduling events in a certain order, doing and undoing motor acts in an exact fashion, or making sure that things are precisely symmetrical. (Gragg & Francis, 1996, pp.2,3) The individual with obsessions usually attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action (i.e., a compulsion). For example, an individual plagued by doubts about having turned off the stove attempts to neutralize them by repeatedly checking to ensure that it is off.
(Diagnostic and Statistical Manual of Mental Disorders, 1994). The DSM-IV defines compulsions as repeated behaviors or mental acts that a person feels compelled or driven to perform, either in response to an obsessions or according to a self-imposed, rigidly applied rule. (Gragg & Francis, 1996, p.4) There are six major types of compulsions. The most common compulsion is washing, bathing, or cleaning to relieve an obsessive fear of contamination from germs, dirt, or some imagined source. Washers may scrub their homes or bathe until their skin is raw before they feel safe from the imagined danger. Checkers may find themselves repeatedly driving back over a stretch of road to confirm that they havent accidentally hit a pedestrian.
(Goodman, 1994, p.107) Washing and cleaning compulsions typically involves excessive washing and cleaning of oneself and ones surroundings, as well as active avoidance of objects, places, or persons considered to be unclean. Checking compulsions typically consists of an overwhelming urge to check and recheck objects and/or actions. Repeating compulsions involve redoing physical or mental acts a certain number of times or until it feels just right. Counting compulsions include rituals that include having special or lucky numbers that dictate the number of times they must do, say, or think things. Ordering compulsions are typically associated with the obsessions involving the need for symmetry and exactness. Hoarding compulsions are rituals that often occur in response to hoarding obsessions, that involve the inability to throw things away or the need to collect useless objects.
(Gragg & Francis, 1996, pp.4-6) OCD was once thought to be rare. It is now estimated that up to 3 percent of the U.S. population may suffer from OCD at some point in their lives (about 5 million people). The disorder usually begins in adolescence or early adulthood, but it may also occur in childhood. (AMI/FAMI). By definition, adults with Obsessive-Compulsive Disorder have at some point recognized that the obsessions or compulsions are excessive or unreasonable.
This requirement does not apply to children because they may lack sufficient cognitive awareness to make this judgment. (Diagnostic and Statistical Manual of Mental Disorders, 1994) The exact causes of OCD are still unknown. However, researchers strongly suspect that a biochemical imbalance is involved. Alterations in one or more brain chemical systems that regulate repetitive behaviors may be related to the cause of OCD. These imbalances may be inherited. Psychological factors and stress may heighten symptoms. (AMI/FAMI).
We do not know why OCD bothers each person in a different way. It does seem that it is almost as if OCD ‘knows’ what would bother you the most and hones in on that. For example, if you are a particularly religious person you might be plagued by repugnant religious OCD thoughts that are a lot more upsetting to you than they would be to a person with below average concern about religion. (National Anxiety Association). It has been hypothesized that there is a relationship between OCD and the neurotransmitter serotonin. Support for this theory is based primarily on evidence that OCD symptoms decrease in response to treatment with medications that affect serotonin levels.
(Gragg & Francis, 1996, p.8) In the 1960s and 1970s, psychiatrist announced that a drug called clomipramine (trade name Anafranil) was effective in treating OCD. After a nerve cells releases serotonin, it reabsorbs any serotonin not captured by an adjoining nerve cell. This process, known as serotonin reuptake, acts to recycle serotonin, making it available for later use. Clomipramine and related drugs block the reuptake of serotonin, preventing its return to its home nerve cell. (Goodman, 1994, p.112) In March 1997, the FDA approved the use of the drug fluvoxamine maleate, or Luvox, previously approved to treat adults, prevents the neurotransmitter serotonin from being reabsorbed into neurons. An inadequate level of serotonin in the synapses between neurons has been linked to several mental illnesses including OCD. (Klobuchar, 1998, p.266) Overall, my personal experience with OCD in my family has really opened my eyes to many issues.
Although many people laugh about it, and consider OCD sufferers “crazy,” it is a very serious and ailing disease. It has the potential to ruin a marriage or a family if not treated accurately and quickly. I think that it would be an incredibly benefit for people to take interest in this disease and other related disease, to better aware themselves of worldly issues, that may, at one time or another, have potential to affect their life. Bibliography Diagnostic and Statistical Manual of Mental Disorders. (4th ed.).
(1994). American Psychiatric Association. Francis, G., & Gragg, R. A. (1996). Childhood obsessive compulsive disorder.
London: Sage Publications. 1-6, 8 Goodman, W. K. (1994). The World book health and medical annual 1994. Chicago: World Book. 103-104, 107 Jaffe, D.
J. (1998). All about obsessive disorders (OCD) and mental illness. New York: AMI/FAMI Klobuchar, L. (1998). The World book health and medical annual 1998. Chicago: World Book.
266 National Anxiety Association. (1992-1999). Obsessive-Compulsive Disorder. Kentucky: National Anxiety Association.