OBSESSIVE-COMPULSIVE DISORDER

Obsessive-Compulsive Disorder is an anxiety disorder in which the mind is invaded by persistent and uncontrollable thoughts or in which a person is driven irresistibly to continuously repeat certain actions or behaviour. This leads to a considerable form of psychological distress and significant interference in day-to-day living and activities. Obsessive-Compulsive Disorder afflicts 2 - 3% of the American population and it occurs more frequently in women than in men (Karno and Golding, 1991). In any given year it has been calculated that about 2.3% of the northern American population aged 18 to 54 (approximately 3.3 million people) has OCD, which affects men and women equally. The condition typically begins during adolescence or in early childhood, and at least one-third of the cases of adult OCD began during childhood.

OCD normally appears at the beginning of adulthood, often following some stressful event such as a pregnancy, childbirth, a family conflict or occupational difficulties (Kringlen, 1970). An early onset is more common amongst men and is associated with control compulsions (see glossary), i.e., the repetition of gestures and behaviour which have the function of constantly keeping the surrounding environment under control. A late appearance of the disorder is more frequent amongst women and is associated with cleaning compulsions such as frequently washing one’s hands, taking many showers during the day or incessant housework. Occasionally the disorder is preceded by an episode of depression, while in other cases the disorder itself will occur prior to depression (Rachman and Hodgson, 1980). Obsessive-Compulsive Disorder may be associated with other anxiety disorders, and in particular with Panic Disorder, the Phobias and also various Personality Disorders.

Obsessions are undesired invasive and repetitive thoughts, impulses or images that are generated in the mind and appear as irrational and uncontrollable to the individual who experiences the phenomena. While it is observed that many people have fleeting moments when they experience obsessive thoughts, in those individuals who truly experience an obsession the phenomena can be of an intensity and frequency capable of seriously disrupting the person’s normal life and social functioning. From the clinical point of view, the most frequent obsessions are fears of contamination, which appear to reflect a sexual or aggressive impulse (see glossary) or hypochondriacal fears of a physical impairment (Jenike, Baer and Minichiello, 1986). Obsessions may also present as an extreme form of doubt, indecision and procrastination.

A compulsion is a repetitive behaviour or mental act which an individual feels forced to perform in order to reduce the malaise caused by obsessive thoughts or to avoid the occurrence of a particular disaster. The action has no realistic link with its apparent aim, or it is found to be obviously excessive. Often, individuals suffering from this disorder continue to repeat the same act over and over again because they are afraid that if they failed to do so, they would undoubtedly suffer terrible consequences. The frequency with which a compulsive action is repeated can be extremely high.

The most common compulsions are related to cleaning or keeping things in order and under control: goals that are reached only at the cost of performing complicated rituals that can take many hours to complete or even most of the day. In some cases there is the avoidance of certain objects, such as keeping away from any brown object, or repetitive and protective actions to which the subject may attribute some magical value, such as counting, pronouncing certain numbers, touching a talisman or a certain part of the body. In other cases, we may find some form of continuous control such as returning a dozen times to check whether a certain task or action has been properly carried out (for example, checking to see whether the gas and electricity have been turned off or making sure the water taps have been closed, that the windows have been safely shut and that the door of the house has been locked).

There are compulsive gamblers and compulsive eaters and drinkers. However, although these individuals refer that they feel an irresistible drive to gamble or eat or drink, in clinical terms their behaviour cannot be considered a compulsion as it is often a source of pleasure. A true compulsion is often experienced by the person as being an experience that has nothing to do with his/her personality. Two researchers, Stern and Cobb (1978), found that 78% of a certain sample population formed by compulsive subjects considered their rituals <<rather stupid>> or <<absurd>> despite the fact they were incapable of putting a stop to them.

A frequent consequence of Obsessive-Compulsive Disorder can be found in the negative effects which the disorder has on an individual’s interpersonal relations and especially relationships within the subject’s own family. There is indeed a good chance that a person incapable of controlling an irresistible need to wash his hands every ten minutes or touch every doorknob he comes across or count all of the tiles on the bathroom floor will provoke a certain degree of concern and even resentment in his wife, children, friends or work colleagues. It may happen that these antagonistic feelings generated in significant others and perceived by the individual presenting the symptoms in question will eventually result in a depression and generalized anxiety, thereby creating the conditions for a further deterioration of the person’s interpersonal relations.

>>> (Post-Traumatic Stress Disorder)


Bibliographical references:

Jenike, M.A., Baer, L., & Minichiello, W.E. (1986). Obsessive-compulsive disorders: Theory and management. Littleton, MA: PSG Publishing.

Karno, M., & Golding, J.M. (1991). Obsessive-compulsive disorder. In L.N. Robinson & D.A. Regier (Eds.), Psychiatric disorders in America. New York: Free Press.

Kringlen, E. (1970). Nutural history of obsessional neurosis. Seminars in Psychiatry, 2, 403-419.

Rachman, S.J., & Hodgson, R.J. (1980). Obsessions and compulsions. Englewood Cliffs, NJ: Prentice-Hall.

Stern, R.S., & Cobb, J.P. (1978). Phenomenology of obsessive-compulsive neurosis. British Journal of Psychiatry, 132, 233-234.

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