FREE ESSAY ON OBSESSIVE-COMPULSIVE DISORDER

OBSESSIVE-COMPULSIVE DISORDER

Obsessive-Compulsive Disorder
OCD stands for obsessive-compulsive disorder. An individual with OCD tends to worry about
many different things. One out of fifty adults currently suffer from this disorder, and
twice that many have had it at some point in their lives. When worries, doubts, or
superstitious beliefs become excessive then a diagnosis of OCD is made. With OCD it is
thought that the brain gets stuck on a particular thought or urge and just can't let go.
Most often people with OCD describe the symptoms as a case of mental hiccups that won't
go away. This causes problems in information processing. OCD was generally thought as
untreatable until the arrival of modern medications and cognitive behavior therapy. Most
people continue to suffer even though they had years of ineffective psychotherapy. Today
treatments tend to help most people with OCD. OCD is not completely curable but is
somewhat treatable.
OCD is a potentially disabling condition that may persist throughout a person's life and
get worse without treatment. An individual with OCD becomes trapped in a pattern of
repetitive thoughts and behaviors that are senseless and distressing but are extremely
powerful and hard to overcome. OCD can occur in cases from mild to severe, but if left
untreated can destroy a persons life and capacity to function at work, school, and even
at home. Some of the worries and rituals can get out of control. An individual life
becomes dominated by thoughts and behaviors they know make absolutely no sense but they
are powerless to control. People with OCD tend to fear uncertainty; These people are
plagued by persistent and recurring thoughts or "obsessions" that they find very
disturbing. These thoughts usually reflect exaggerated anxiety or fears that have no
basis on reality.
A person who suffers from OCD has constant doubts about their behaviors and constantly
seeks assurance from other people. Many people who suffer from this disorder feel
compelled to perform certain rituals or routines to help relieve the anxiety caused by
their "obsessions", however the relief is only temporary. Some rituals or "obsessions"
include cleaning, checking, repeating, slowness, and hoarding.
Usually an individual has both obsessions and compulsions, though sometimes they have
only one or the other. A person with OCD usually wants everything around them to be
perfect. {What is 1}?
Compulsions are intrusive thoughts, impulses, and images that feel out of control and
occur over and over again. A sufferer does not want to have these ideas and knows that
they don't make any sense but find them intrusive and disturbing. A person with OCD may
be obsessed with the idea they are contaminated or may contaminate someone else and worry
excessively about dirt and germs. This person could also have an intense fear that they
harmed someone else although they usually know it is not realistic. {What 3}
Uncomfortable feelings such as fear, disgust, doubt, or a sensation that things have to
be "just so" usually accompany obsessions. A person tries to make their obsessions go
away by performing certain compulsive rituals. These compulsions are acts that an
individual may perform repeatedly, often according to certain "rules". OCD symptoms do
not give a person pleasure but a sense of temporary relief for a short period of time.
The relief is only temporary and the discomfort always comes back. These relieve make up
a lot of time and interfere with a person's social life and relationships. 
Most people recognize at some point that their obsessions are not just worries about real
problems but are coming from their minds. Compulsions are excessive or unreasonable but
the sufferer has to perform them. OCD poor insight is an individual that not recognize
that their beliefs and actions are unreasonable and unreal. Extreme severe distress tends
to happen when the symptoms wax and ware over time. 
OCD symptoms can start at any age from as early as preschool too as late as adulthood.
1/3 of 1/2 of adult sufferers said that their symptoms started during their childhood. On
an average people spend 9 years seeking a diagnosis and see up to 3 to 4 doctors. Studies
also show that it takes an average 17 years from the time OCD begins for an individual to
find appropriate treatment. {What 3} 
OCD may be under diagnosed and untreated for a number of reasons. People with OCD may be
secretive about their symptoms or lack insight on the illness. Many healthcare providers
are not familiar with the symptoms and are not trained to provide treatment. Some people
may also not have access to treatment resources. This is unfortunate since early
diagnoses and proper treatment can help an individual. 
Research suggests genes do play a role in development of the disorder yet no specific
genes have been found for OCD. Childhood onset tends to run in the family. An increasing
risk for a child getting OCD is if the parent has it. When OCD runs in families it seems
to be inherited but not the specific symptoms. One example is if a child has checking
rituals his mother might wash excessively. 
There is no single proven cause for OCD. Research suggests that OCD could involve
problems in communication between the brain and deeper structures although this is not
proven. {what 4} 
For many years only a small minority of healthcare professionals patients had OCD there
for it was thought to be rare. OCD went unrecognized often because many of those
afflicted with it kept their repetitive thoughts a secret and failed to seek treatment.
This led to the underestimate of the number of people with the illness. {obsessions 1} 
Most common symptoms of OCD go along with a certain compulsion for instance: A need to
tell, ask, or confess goes along with praying. A need to have things "just so" goes along
with hoarding or saving. Forbidden thoughts equals arranging. Excessive religious or
moral doubt = counting. Intrusive sexual thoughts or urges = touching. Imagining losing
control or aggressive urges = checking. Imagining having harmed ones self or others =
repeating. Fear of contamination or germs = washing. 
Obsessive symptoms occur in people of all ages. Not all of the compulsive behaviors
represent an illness. Some rituals like bedtime songs and religious practices are a
welcoming part of life. Normal worries like contamination fears may increase during times
of high stress. Only when persisting symptoms occur that make no sense, cause much
distress or interfere with functioning do they need clinical attention. 
{what 2}
The less common form of OCD is hoarding which is the excessive saving of typically
worthless items. A most commonly thought form of OCD is contamination. This is the
awareness of germs, disease, or the presence of dirt that evokes a sense of threat and an
incredible inspiration to reduce the presence of contamination. The compulsion of
contamination involves a cleaning response such as hand washing and chronic cleaning.
{Steven1} Another common form of OCD is checking. Checking involves door locks, lights,
switches, faucets, stoves, or items left unchecked that might pose a threat to ones well
being or the well being of others. It is not uncommon for people to check items between
10 to 100 times a day. The impulse to recheck can remain until the person experiences a
reduction in tension despite the realization that the item is secure. One other less
common form of OCD is ordering in which a person feels compelled to place items in a
designated spot in order. 
In approximately 80% of all cases, people performing the rituals are painfully aware that
their behavior is unreasonable and irrational. OCD is an anxiety disorder the thought
associated with OCD is bizarre. The thoughts associated with OCD are recurrent obsessions
that create an awareness of alarm or threat. Obsessions can take form of a threat or
physical alarm to oneself or others. People typically engage in some avoidance or escape
response in reaction to the obsessive threat. There are three main branches of OCD. The
most common and well-known branch of OCD is known as OC where the undoing response
generally involves some overt behavior. The next branch of OCD is purely obsess ional
this involves the escape or avoidence of noxious and unwanted thoughts.
There are a number of treatment strategies which are specific to obsessive problems. For
example motivations neutralizing behavior and other counter-productive strategies,
increasing selective attention and increased negative mood. These serve to maintain the
negative beliefs and therefore the obsessive-compulsive problem. 
Most recently developments in cognitive therapy suggest that the key to understanding
obsession problems lies in the way the intrusive thoughts, images, impulses and doubts
are interpreted. The general and specific aspects of cognitive-behavioral treatment are
described. The important negative interpretations usually include the idea that a persons
actions can result in harm to onset to others. This responsibility interpretation has
several consequences.{ steven 1}
OCD can change and effect a persons life in many ways sometimes alienating them from
their friends and family. Many sufferers with OCD are never diagnosed because they are so
secretive about their symptoms. They are afraid to let people know and are even
embarrassed about their compulsive reactions.
Some of the most common obsessions of OCD in children are extreme concern with order,
concern that a task or assignment has been done poorly or incorrectly, concern with
certain sounds or images, fear that a disaster will occur, there is also the fear of
AIDS, fear of getting dirty, fear of losing important things, recurring thoughts, and a
fear of saying something wrong.
It is a fact that approximately one million children and adolescents in the United States
alone suffer from OCD. This means that 3 to 5 children in an average elementary school
and 20 teenagers in a large high school are currently suffering.
OCD effects adolescents during an important time of social development. School work,
homework, and friendships are affected most often. Most children are to young to realize
that there obsessions and compulsions are unusual. Adolescents are embarrassed because
they don't want to be different from other people and they worry uncontrollably about
their behavior. These adolescents usually hide their rituals in front of friends at
school or at home and become mentally exhausted and strained. 
Children and adolescents that suffer from OCD are different from adults because they
express their disorder in special ways. Young children often say their rituals are
silly.
Young children's OCD is never really recognized by their parents until they are about 3
or 4 sometimes even older. To get a proper diagnoses the child should be brought to a
doctor or psychiatrist. 
While a child is at school they usually erase and redo their assignments which usually
results in late school work. Classroom concentration is usually limited because a child
is obsessing about their fears and rituals. Parents should tell a child's teacher about
the OCD and may ask for occasional progress reports .
OCD is not contagious and parents are often blamed for the disorder they are said to have
parental perfections, inappropriate toilet training, or even under parenting. The cause
for OCD is neurobiological. Although life events can also aid in the onset of OCD.
Children's OCD is often said to be started by a death of a loved one, a divorce, moving
to a new location, or unhappiness with changes in school.
Checking compulsions are rituals that are precipitated by fear of harm to oneself or
others and this includes the checking of doors, locks, heaters, alarms, faucets,
switches, and other objects that could be a threat. This can create problems for the
learning of a child. For example while getting ready for school a child may check his or
her books several times to make sure they are all there even to the point where the child
is late for school. Once the child is in school they may call to return home and check
their books once more. These rituals may also interfere with the completion of homework.
This could make a child work late at night to complete an assignment that could have
taken ten minutes to complete.
Repeating compulsions are rituals in which some one repeats a certain action over and
over again. These rituals can in some cases be anxiety driven and in other cases have to
be done "just so". For instance a person might walk backward and forward or get up and
down from a chair many times until the ritual is performed "just right". These rituals
are also connected with counting rituals. In children the rituals can assume many forms
in the classroom. This could lead to many repeated questions because the child may need
to remember or know something. On written assignments the student could endlessly cross
out, trace, or rewrite letters or words. Lockers can also cause a problem because the
combination may need to repeated several times till it feels right. Note taking is most
likely impossible because the student is compelled to take every word down. Computer
scored tests are a nightmare because the student has to fill in the circles perfectly.
Approximately 80 percent of children and adolescents with OCD at some point during their
illness will develop a washing or cleaning ritual. The most common compulsion is hand
washing. An individual may feel compelled to wash their hands extensively and according
to a self-prescribed manner for minutes or hours at a time. Other individuals may be less
thorough about washing or cleaning but may engage in the act a number of times a day
sometimes even hundreds.
During school these rituals may manifest themselves in the school setting as subtle
behaviors not obviously or immediately related to washing or cleaning. The students
teacher should be alert if the student frequently excuses themselves from the classroom
under voiding or guise. This child could actually be seeking a private area in which to
carry out the cleaning rituals. Another sign is the presence of dry, red, chapped,
cracked, or even bleeding hands. Bleeding hands are a result of washing with strong
cleaning agents such as "Mr. Clean" to free themselves of "contaminants".
Although contamination fears frequently lead to excessive washing they can also have the
opposite affect, shoes may be untied, teeth unbrushed, clothing may be slovenly and hair
may be dirty. In these cases, fear of contamination of personal objects or body parts
leads to the individuals refusal to touch them. A combination of excessive hand washing
and sloppiness in other areas of grooming had even been reported.
Obsessions revolving around a need for symmetry may result in compulsive arranging.
Children who engage in symmetry-related rituals may also feel compelled to have both
sides of their bodies identical. For instance a child my spend an inordinate amount of
time tying and retying shoelaces so that each side of the bow is perfectly even or
"balanced". Symmetry rituals may consist of taking steps that are identical in length or
speaking with equal stress on each syllable. In a classroom, symmetry rituals may be seen
in the student's compelling need for order. Books on a shelf, items on a desk, or
problems on a page must be arranged in a precise manner so that they can appear
symmetrical to the student.
OCD sufferers usually experience obsessional thoughts that lead to compulsive avoidance
in these cases, individuals may go to great lengths to avoid objects, substances, or
situations that are capable of triggering fear or discomfort. For example, fear of
contamination may result in the avoiding of objects usually found in the classroom,
things like paint, glue, paste, clay, tape, and ink. A child may even inappropriately
cover their hands with clothing or gloves or may use facial tissue, shirts, or shirt
cuffs to open doors or turn on faucets. A student with an obsessive fear of harm may
avoid using scissors or other sharp tools in the classroom. A child may even circumvent
the use of a certain doorway because a passage through that entry may trigger a repeating
ritual.
Children and adolescents with OCD may also engage in compulsive reassurance-seeking. In
the school setting, they may continually ask teachers or other school personnel for
reassurance that there for example are no germs on the drinking fountain or that they
have not made any errors on a page. Although reassurance may serve to allay the anxiety
or discomfort that frequently accompanies their fears the relief is often short lived,
different situations typically arise in the classroom that pose new fears or discomfort
for the student.
Number obsessions are typically common among young boys. Only certain numbers are "safe"
other numbers are "bad". An obsession with a particular number may result in a child's
having to repeat an action a given number of times or having to repeatedly count to a
particular number.
Some children with strong religious ties have an obsessive fear that they are doing
something evil. This symptom of OCD is called "scrupulosity" and causes an individual to
tell themselves that they constantly commit sins, and they must pray constantly or find
ways to condone their imagined sins. Members of the catholic religion who suffer from
this may go to confession many times a week. Some individuals create elaborate systems to
avoid certain thoughts, memories, or actions, or to replace or equalize "sinful" thoughts
with pure good ones.
One of the most reported obsession in youth with OCD is a fear of contamination. This
fear may center around a concern with germs, dirt, ink, paint, excrement, body
secretions, blood, chemicals, and other substances. Recently, an increase in obsessions
with AIDS had also been witnessed. Preoccupation with contamination may lead to the
avoidance of suspected contaminants orConstant findings in studies such as testing the
effectiveness of different therapies, strongly suggest that it is the working alliance or
bond between therapist and patient which is paramount to therapeutic success.
Interpersonal aspects of treatment such as 1. comfort 2. confidence and 3. a true
commitment from both patient and therapist make a great deal of difference in fostering
an atmosphere of collaboration. To be successful both the patient and the therapist need
to bring their fullest devotion to the explicit and implicit contract of therapy. By
saying this it means that at the end of each session both parties need to come to an
agreement of the next week's challenges. The patient must except the responsibility and
be willing to participate in his or her challenges. Clients can choose to share the
challenges of this therapy with an experienced partner or they can choose to decline. The
principles of this therapy focus on fostering a sense of therapeutic independence on the
part of the client. 
Equally important to training, knowledge, experience, and credentials are understanding,
compassion and warmth. Most often the cognitive-behaviorist believes that self-disclosure
is a healthy part of any relationship, including a therapeutic one. Therefore when a
client answers questions about themselves it is considered a natural and healthy part of
the therapeutic exchange. {steven phillipson 1}
The basic premise of this therapy is based on the belief that at the heart of depression
exist distorted and irrational thinking patterns. Such patterns revolve around our
automatic reactions toward life circumstances which create upsetting emotional
consequences. CBT was developed to assist patients to respond rationally to automatic
irrational thoughts. Here automatic thoughts are said to be mental reflexive reactions to
upsetting events. Typically, the approach teaches people to learn to identify our
reflexive reactions or "beliefs" that occur as a consequence to upsetting events, that
are responsible for the periodic upset we experience. Traditional therapist that
specialize in CBT focus on teaching clients to substitute rational thinking for automatic
irrational thinking. {steven phillipson 2}
Basic CBT believes that within all of us exist irrational ideas. This therapeutic
intervention is based on therapists' faith in our ability to learn how to sort out the
difference between being rational and irrational. 
At the heart of learning is the belief that we learn from society, family, and religion
how to think in dysfunctional and irrational ways. Traditional CBT for patients suffering
with OCD is therefore likely to be counter productive toward achieving a beneficial
therapeutic outcome. This approach assumes that persons are reacting irrationally to a
rationally safe situation. The problem is that the majority of OCD patients are aware
that what they are doing is bizarre and irrational. Most can even predict that the risk
of danger is infinitesimal. Yet they feel overwhelmingly compelled to act out some escape
response. Therefore using traditional CBT: activating event, automatic thought, emotional
reaction, and rational response would be futile. 
Traditional CBT was developed as a treatment for depression. The two basic components
entail, 1. the behind the scenes strategizing and 2. the front line conflict. It is very
important not to mix up the appropriate application of these two separate strategies when
dealing with OCD. The manner in which one conceptualizes a battle and the behavior
exerted in fighting it, are very different. {steven phillipson 3}
Cognitive therapy for OCD predominantly focuses on the two mentioned aspects of this
disorder. The first aspect initially involves having sufferers develop a healthy and
informed understanding of how the mechanisms of OCD operate. This focus will be referred
to as cognitive conceptualization. Cognitive conceptualization includes having the
sufferer separate themselves from the emotional or moral implications of what the
disorder seems to represent. Many people who suffer from the purely obsessional form of
this condition and responsibility experience tremendous amounts of guilt and shame for
having these thoughts or being responsible for the wellbeing of others. 
Also involved with the first aspect is having clients appreciate that giving in to a
ritual or embracing the risk of the obsession, requires making a series of genuine
choices and are not pre-programmed reflexive reactions. 
Critical aspects of this focus involve reshaping one's response set to the risk. This
involves concentrating on one's relationship with their condition as that of making
choices in the matter of giving in the ritual, or not. This viewpoint is in difference to
perceiving the reaction to cognitive threats as obligatory or as having no choice in the
matter. In practice this translates into having patients reframe their disposition from,
"I had to" to "I chose to". 
Research has clearly showed that acknowledging our choice in the matter of facing
difficult life challenges increases one's tolerance to adversity. Consistently studies
have demonstrated that our ability to tolerate pain is greatly increased as we
acknowledge our choice in relation to the decision to seek relief or to tolerate the
discomfort. As our perceptible sense of control increases so does our willingness to
tolerate discomfort. 
A minor but crucial aspect of cognitive-conceptualization involves educating people about
the actual risks pertaining to their specific concerns. Unfortunately medical science
doesn't offer total certainty. Therefore telling someone that the chances of getting AIDS
from a door knob is slim at best, does little to take away the general concern. Some
people claim to have been guided by their disorder for so long that they have forgotten
their real instincts. In addition, becoming informed that people who spike about being a
danger to others rarely actually do damaging things or that person with anxiety disorders
almost by no means develop schizophrenia might educate, but rarely provides lasting
relief. {Steven Phillipson 4}
Cognitive-management is the second goal of CT, this involves teaching individuals to
respond to obsessive threats in a way that there is little to no debate in response to
being spiked. The main goal is to reduce conflict or mental escape in formulating a
response to the upsetting thought. The end product is referred to as habituation.
Principles are also included in cognitive-management. These principles enhance greater
levels of tolerance toward the physical discomfort, generated by the anxiety. The
principles include making space for the discomfort and looking upon it as something to be
managed effectively, rather that just achieving a period of relief. 
The search to eliminate the spike is more than likely the greatest cognitive
misconceptualization that people bring to the therapeutic process. Eventually the goal of
CT for OCD is to manage he spike effectively, not to focus on its existence or
disappearance. The same thing could be said about the experience of anxiety. Tolerating
anxiety focuses on developing room for the experience. Developing room for its presence
enables the brain to focus on other information. 
Cognitive conceptualization focuses on helping take out a sense of culpability, guilt and
shame, which is pervasive among obsessive-compulsive sufferers. To access the ideas and
philosophy of cognitive-conceptualization in the midst of the challenge would be
unadvised because it would tend to be reassurance oriented. The goal for later on in the
treatment is instructive in aiding a persons respond effectively to the cognitive prompt
of the danger with the least resistance which thereby allows habituation. 
Creating an aggressive disposition toward a challenge is tremendously advantageous toward
a successful recovery. Aggressiveness is defined as actively looking for anxiety
provoking challenges. Paradoxically, when a person seeks an anxiety provoking challenge
there tends to be a greater likelihood that experiencing reduced levels of anxiety is
achieved. This comes out due to changing the condition's momentum from endless escape to
approach. "As we seek challenges there is less likelihood of finding them". 
Cognitive therapy for OCD has two main applications 1. to help people understand the
guidelines of anxiety disorders overall plan 2. to provide specific suggestions in
response to the moment of being challenged by an awareness that there is some imminent
danger. Cognitive principles to assist sufferers develop a healthy disposition in the
direction of their anxiety is 
The statement "within the question lies the answer" proposes that when confronted with a
seemingly sincere risk, relying on the consciousness that there is doubt and therefore
making the strength of mind to receive the possibility will get rid of a enormous
quantity of difficulty solving. {steven phillipson 6}
The ultimate aspect of cognitive management entails deliberately creating the
consciousness and nature of the chance while engaging in the uncovering exercise. This
strategy suggests that the impact of an uncovering exercise is enhanced by combining the
behavior a compulsive act with a self talk. Making the choice to put up with the risk
tends to close down the brain's natural propensity to alert its host, through physical
uneasiness and cognitive warnings, that you should feel unpleasant until the danger is
removed.
Overall CT involves providing a sufferer with specific responses to the spikes and
educating them about the distinction between having these concerns and separating one's
identity from the topics of the condition and highlighting general strategies which
facilitate anxiety management. This goes to say that providing reassurances and
attempting to educate the sufferer about the truly limited risks involved in the spikes
is counterproductive and alienating. {steven phillipson 7} lead to excessive washing.
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