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PTIMA
| Specialty Hospital |
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Obsessive-Compulsive Disorder (OCD)
SYMPTOMS
Obsessive-compulsive disorder is characterized by either obsessions or
compulsions:
Obsessions as defined by:
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 his or her own mind (not imposed from without as in thought
insertion.)
Compulsions as defined by:
Repetitive behaviors (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 behaviors or mental acts are aimed at preventing or reducing distress or
preventing some dreaded event or situation; however, these behaviors or
mental acts either are not connected in a realistic way with what they are
designed to neutralize or prevent or are clearly excessive.
At some point during the course of the disorder, the adult has recognized that
the obsessions or compulsions are excessive or unreasonable (not applicable
to children).
The obsessions or compulsions cause marked distress, are time consuming
(take more than 1 hour a day), or significantly interfere with the person's
normal routine, occupational (or academic) functioning, or usual social
activities or relationships.
If another disorder is present, the content of the obsessions or compulsions is
not restricted to it. The disturbance is not due to the direct physiological
effects of a substance.
Obsessive-Compulsive Disorder is one of the most difficult to understand of all
psychiatric illnesses. Persons who have this condition find themselves
repeating certain behaviors or thoughts again and again and again and again.
They know the repetition is unnecessary, but are unable to stop themselves.
Common forms of this are checking locks, stoves, and lights, or recurrent
intrusive thoughts of hurting oneself or one's children.
Afflicted individuals usually experience severe anxiety if unable to complete
their rituals, though many therapies work by helping the individual learn that
no catastrophe occurs when the behaviors do cease.
Research has shown that one of the most difficult problems in OCD is in
getting family members to understand that the patient is unable to simply stop
the behavior. Many times relatives become angry and upset when they are
forced to deal with the time-consuming and unrealistic repetitive behaviors.
With this background, it is no wonder that many patients do not volunteer their
symptoms, and instead complain only of anxiety or depression.
Psychotherapy
For many years, OCD was seen as a purely psychological disorder, related to
a desire to control one's environment or to undo some perceived wrong
action. Insight oriented psychotherapy has been singularly unsuccessful in
treating this group of disorders, however. Behavior therapies have had much
more success, especially those with specific small steps geared to the exact
obsessions.compulsions involved in the individual case.
Behavior therapy has a lot to offer individuals with this disorder. Two common
and popular techniques are systematic desensitization and flooding.
Systematic desensitization techniques involve gradually exposing the client to
ever-increasing anxiety-provoking stimuli. It is important to note here, though,
that such a technique should not be attempted until the client has successfully
learned relaxation skills and can demonstrate their use to the therapist.
Exposing a patient to either of these techniques without increased coping
skills can result in relapse and possible harm to the client. Relaxation
techniques may include imagery, breathing skills, and muscle relaxation. It is
important for the client to find a relaxation technique which works best for
them, before attempting something like systematic desensitization or flooding.
Flooding allows the patient to face the most anxiety-provoking situation, while
using the relaxation skills learned.
Additional behavior and cognitive-behavioral techniques which may have
some effectiveness for people who suffer from this disorder include saturation
and thought-stopping. Through saturation, the client is directed to do nothing
but think of one obsessional thought which they have complained about. After
a period of time of concentration on this one thought (e.g., 10-15 minutes at a
time) over a number of days (3-5 days), the obsession can lose some of its
strength. Through thought-stopping, the individual learns how to halt
obsessive thoughts through proper identification of the obsessional thoughts,
and then averting it by doing an opposite, incompatible response. A common
incompatible response to an obsessive thought is simply by yelling the word
"Stop!" loudly. The client can be encouraged to practice this in therapy (with
the clinician's help and modeling, if necessary), and then encouraged to
transplant this behavior to the privacy of their home. They can also often use
other incompatible stimuli, such as tweaking a rubber-band which is around
their wrist whenever they have a thought. The latter technique would be more
effective in public, for example.
Medications
In the last 25 years, medications have been found to be fairly successful in the
treatment of OCD. First was the tricyclic antidepressant clomipramine
(Anafranil). This has been followed by several of the newer SSRI class
anti-depressants that act selectively on the re-uptake of serotonin, a
neurotransmitter. In the last few years, neuro-imaging studies have begun to
disclose the underlying pathophysiology of OCD. The area of the brain that
functions abnormally is directly next to those areas that relate to tick disorders
such as Tourette's Syndrome and to Attention Deficit Disorder. It now seems
that variable amounts of dysfunction produce clinical symptoms that may be
virtually all in one of these areas, or may be overlapping. Many people with
ADD also have tics, as do many people with OCD. Most unexpected is the
finding that children who have Rheumatic Fever and develop Sydinham's
Chorea have a significantly increased risk of OCD. Therefore treatment with
antibiotics early in an infectious illness may reduce the chances of future
obsessive thinking.
Summary
Imaging studies have also demonstrated that both medications and behavior
therapy alter brain metabolism in the direction of normalcy. This then is one of
the few areas in all of mental health where clear proof exists for the efficacy of
multiple types of treatment.
With medications, generally the dose used to treat depression is not enough
to control OCD symptoms. Patients often will take 2-4 times the usual amount.
Behavioral therapy with medications seems to offer the best long term
improvement. Virtually no treatment is curative for OCD. Most treatment can
be expected to reduce symptoms by 50-80% or more, however. The illness is
cyclic, and worsens when the individual is under stress.
SYMPTOMS
Obsessive-compulsive disorder is characterized by either obsessions or
compulsions:
Obsessions as defined by:
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 his or her own mind (not imposed from without as in thought
insertion.)
Compulsions as defined by:
Repetitive behaviors (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 behaviors or mental acts are aimed at preventing or reducing distress or
preventing some dreaded event or situation; however, these behaviors or
mental acts either are not connected in a realistic way with what they are
designed to neutralize or prevent or are clearly excessive.
At some point during the course of the disorder, the adult has recognized that
the obsessions or compulsions are excessive or unreasonable (not applicable
to children).
The obsessions or compulsions cause marked distress, are time consuming
(take more than 1 hour a day), or significantly interfere with the person's
normal routine, occupational (or academic) functioning, or usual social
activities or relationships.
If another disorder is present, the content of the obsessions or compulsions is
not restricted to it. The disturbance is not due to the direct physiological
effects of a substance.
Obsessive-Compulsive Disorder is one of the most difficult to understand of all
psychiatric illnesses. Persons who have this condition find themselves
repeating certain behaviors or thoughts again and again and again and again.
They know the repetition is unnecessary, but are unable to stop themselves.
Common forms of this are checking locks, stoves, and lights, or recurrent
intrusive thoughts of hurting oneself or one's children.
Afflicted individuals usually experience severe anxiety if unable to complete
their rituals, though many therapies work by helping the individual learn that
no catastrophe occurs when the behaviors do cease.
Research has shown that one of the most difficult problems in OCD is in
getting family members to understand that the patient is unable to simply stop
the behavior. Many times relatives become angry and upset when they are
forced to deal with the time-consuming and unrealistic repetitive behaviors.
With this background, it is no wonder that many patients do not volunteer their
symptoms, and instead complain only of anxiety or depression.
Psychotherapy
For many years, OCD was seen as a purely psychological disorder, related to
a desire to control one's environment or to undo some perceived wrong
action. Insight oriented psychotherapy has been singularly unsuccessful in
treating this group of disorders, however. Behavior therapies have had much
more success, especially those with specific small steps geared to the exact
obsessions.compulsions involved in the individual case.
Behavior therapy has a lot to offer individuals with this disorder. Two common
and popular techniques are systematic desensitization and flooding.
Systematic desensitization techniques involve gradually exposing the client to
ever-increasing anxiety-provoking stimuli. It is important to note here, though,
that such a technique should not be attempted until the client has successfully
learned relaxation skills and can demonstrate their use to the therapist.
Exposing a patient to either of these techniques without increased coping
skills can result in relapse and possible harm to the client. Relaxation
techniques may include imagery, breathing skills, and muscle relaxation. It is
important for the client to find a relaxation technique which works best for
them, before attempting something like systematic desensitization or flooding.
Flooding allows the patient to face the most anxiety-provoking situation, while
using the relaxation skills learned.
Additional behavior and cognitive-behavioral techniques which may have
some effectiveness for people who suffer from this disorder include saturation
and thought-stopping. Through saturation, the client is directed to do nothing
but think of one obsessional thought which they have complained about. After
a period of time of concentration on this one thought (e.g., 10-15 minutes at a
time) over a number of days (3-5 days), the obsession can lose some of its
strength. Through thought-stopping, the individual learns how to halt
obsessive thoughts through proper identification of the obsessional thoughts,
and then averting it by doing an opposite, incompatible response. A common
incompatible response to an obsessive thought is simply by yelling the word
"Stop!" loudly. The client can be encouraged to practice this in therapy (with
the clinician's help and modeling, if necessary), and then encouraged to
transplant this behavior to the privacy of their home. They can also often use
other incompatible stimuli, such as tweaking a rubber-band which is around
their wrist whenever they have a thought. The latter technique would be more
effective in public, for example.
Medications
In the last 25 years, medications have been found to be fairly successful in the
treatment of OCD. First was the tricyclic antidepressant clomipramine
(Anafranil). This has been followed by several of the newer SSRI class
anti-depressants that act selectively on the re-uptake of serotonin, a
neurotransmitter. In the last few years, neuro-imaging studies have begun to
disclose the underlying pathophysiology of OCD. The area of the brain that
functions abnormally is directly next to those areas that relate to tick disorders
such as Tourette's Syndrome and to Attention Deficit Disorder. It now seems
that variable amounts of dysfunction produce clinical symptoms that may be
virtually all in one of these areas, or may be overlapping. Many people with
ADD also have tics, as do many people with OCD. Most unexpected is the
finding that children who have Rheumatic Fever and develop Sydinham's
Chorea have a significantly increased risk of OCD. Therefore treatment with
antibiotics early in an infectious illness may reduce the chances of future
obsessive thinking.
Summary
Imaging studies have also demonstrated that both medications and behavior
therapy alter brain metabolism in the direction of normalcy. This then is one of
the few areas in all of mental health where clear proof exists for the efficacy of
multiple types of treatment.
With medications, generally the dose used to treat depression is not enough
to control OCD symptoms. Patients often will take 2-4 times the usual amount.
Behavioral therapy with medications seems to offer the best long term
improvement. Virtually no treatment is curative for OCD. Most treatment can
be expected to reduce symptoms by 50-80% or more, however. The illness is
cyclic, and worsens when the individual is under stress.
| THE MOST COMMON MENTAL AND EMOTIONAL DISORDERS |
| The information provided on these pages are intended as a educational public service. New diagnose and treat these illnesses and direct contact with the appropriate, licensed mental health professional prior to treatment is always reccomended. |