Obsessive Compulsive Disorder
by Casey Edgington
Obsessive Compulsive disorder is a psychological disorder that involves compulsions, which are observable behaviors, and obsessions which are usually mental thoughts and ideas that constantly torment the sufferer. Obsessive compulsive disorder is something that someone must suffer for a minimum of six months to be diagnosed (Barlow & Durand, 2005, p.159) “[and] anyone who needs hospitalization because of an anxiety disorder most likely suffers from OCD” (Barlow & Durand, 2005, p.159). OCD can be a very serious disease that can prevent someone from functioning in their job, within their family lives, or even functioning at all if the obsessions and compulsions get too out of hand. Obsessive compulsive disorder is not limited to thoughts and simply organizing objects, but can be manifested in other ways too such as: Trichotillomania (hair pulling), nail biting, body dysmorphic disorder, depersonalization disorder, somatization disorder, delusional disorder, posttraumatic stress disorder, and eating disorders in addition to these conditions, typical compulsions that would be normal for people, and actual impulse control disorders such as compulsive drinking smoking, gambling, eating, shopping, or stealing (kleptomania) can be hard to discern (Greist & Jefferson, 1995, p. 42). There are so many different symptoms to this disorder, and so many have been documented and examined by psychologists for years, it is almost a spectacular disease that can be a subject of great interest because of its variance in symptoms and the reason people act and think in these compulsive and obsessive ways. The disorder is made to be somewhat humorous on the popular television show Monk. The character on the show named Adrian Monk is represented as a detective in the series; Monk suffers from both mental anxieties and compulsions that require he attend therapy to try and reduce the frequency of his problems. The show Monk most likely represents an increased awareness of the condition for the general population. Obsessive compulsive disorder comes in many forms and degrees of severity, sometimes it can seriously impede a person’s life; other times it can be worked with, and a person can lead a relatively normal life even in the presence of the disorder. While reading about many different cases and how different patients and doctor’s deal with this illness I would say Obsessive compulsive disorder must be one of the most intriguing disorders in the abnormal psyche.
OCD may be broken down to Obsessions which are as defined by the DSM-4 criteria as: recurrent and persistent ideas, thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate, and cause marked anxiety” (Steketee, 1993 p. 6). Obsessions are intrusive and mostly nonsensical thoughts or images, or urges that the individual tries to resist or eliminate. Compulsions are the thoughts or actions used to suppress the obsessions and provide relief. Some people can do simple things like shaking a leg, counting or twitching to placate themselves, but some cannot. Compulsions can be behavioral such as washing hands, like our good friend Monk who carries around wipes to wipe his hands after shaking someone else’s hand or touching something ‘unclean’, or “they can be mental like counting, praying, or thinking of certain words in specific order etc.”( Barlow & Durand, 2005, p.159). These coping mechanisms may relieve some anxiety but in the end only succeed in strengthening the cycle of obsessive and compulsive behaviors.
While OCD can be commercialized in a somewhat humorous tone in the show Monk it is a very serious condition that in some cases can cause a tremendous amount of suffering. Not only do the thoughts that can sometimes be extremely disturbing cause the sufferer mental anxiety, there are cases where symptoms also include tic disorders which are can be defined as: “[a] disorder [that] involves quick, uncontrollable movements or vocal outbursts (but not both)” (Jasmin, 2008). One such case that is a prime example of how destructive and harmful this symptom can be, involves a man named Kurt who is hospitalized because of his “…extremely debilitating compulsive behaviors, which include repeatedly putting his fingers in his mouth and pressing or pulling at his gum, lips, and jaw” (Greist and Jefferson, 1995 p. 5). Kurt continuously harms himself because of his OCD. Kurt is an inpatient in a hospital, and has lost all of his teeth because of his compulsions and after destroying his teeth he started pressing on his eyes as Greist and Jefferson document “to a point where staff members [were] worried about damage to his eyes” (1995 p. 5). Greist and Jefferson believe Kurt’s case is “an excellent example of the link between OCD and tic disorders (1995 p. 7). This is an example of how serious and even physically harmful this illness can be.
With obsessive compulsive disorder, one suffers from anxiety and may become unable to focus on anything but the obsessive thought that is running through their mind continuously. In adults it can be experienced as chronic worry, worrying about everything, and when they are not worried they are worried about not worrying! In children they mostly suffer from insecurities around social situations and embarrassing themselves with poor performance. The elderly with this disorder may constantly worry about health. Most people suffering from this disorder will have trouble sleeping, or insomnia. The worry they suffer is unstoppable and trying to stop it almost always has the opposite effect. Some people eventually withdraw and become completely consumed–take Richard for example: a nineteen year of freshman in college who withdrew from school because of incapacitating ritualistic behavior. “He had to abandon hygiene all together because the rituals were so time confusing that he had no time to do anything else”(Durland & Barlow, p.159). Obviously he can be diagnosed with OCD considering because of his rituals he could no longer attend school, which, fits in with the category of interfering with his life to a great extent. Another case of exaggerated worry is Neil who was a certified accountant, but was sent to treatment for what Greist and Jefferson describe “as an overwhelming anxiety with a phobia that he had cancer of the nose and throat. Neil would spend hours clearing his throat and vomiting to see if he could find any blood in his throat. Neil had excessive thoughts about having cancer and would constantly ask his doctors if he had cancer. Even though doctors assured him he did not have cancer this did nothing to stop Neil from thinking he had cancer. Even after attending therapy an unfortunate incident took place according to Griest and Jefferson:
Neil’s condition took a turn for the worse as a result of the following incident: One night while he was having dinner in a restaurant, Neil went to the men’s room. Upon finding that there were no more fresh towels on which to dry his hands, he used a towel that was in the wastebasket. On the way out of the restaurant, he began to wonder whether the person who had used the towel before him had acquired immunodeficiency syndrome (AIDS). He then developed an obsessional fear of AIDS that utterly overwhelmed his previous fears of cancer (1995 pg. 28).
Neil was admitted to a psychiatric hospital because he could no longer function normally in the world because of this terrible affliction. Unlike Richard and Neil, Jean a woman in her late forties is not so unlucky. Jean counts everything, and expresses distress with her unusual behavior, but as Greist and Jefferson state:
Perhaps the most amazing feature of this case is the interference that Jean has had in life because of OCD. In spite of her rituals, Jean carries a greater percentage of the workload in her office than do her co-workers and is totally reliable, thorough, punctual, and very well organized (1995, p.41).
While punctuality and being reliable is consistently a problem for many patients with OCD Jean does not seem to have a problem with either. Although, Jean experiences distress and anxiety because of her OCD she is not completely incapable of going through her daily life. Unfortunately, for Richard and many other people with OCD that is just not the case.
People with OCD do not deal with stress very well, in most cases, a dramatic change in a person with this disorders life may cause an increased occurrence of their behaviors. For example, in the show Monk the main character that suffers from this disease, Adrian Monk is a germaphobe, a symptom someone with this disorder would suffer. He also has phobias including heights, crowds, boats, and milk. The story behind Adrian Monk’s eccentricity is that he was not always as intensely OCD as he is presently portrayed. In actuality, he was pushed to the edge of insanity when his wife Trudy was murdered. Before Trudy’s murder he was only mildly OCD and not completely obsessed with order and cleanliness. Monk was a very organized man before his wife’s murder. Captain Stottlemeyer of the police force in the show mentions that when Monk was his partner before, he used to organize the glove box. He was not afraid to shake hands, and he did not need everything perfectly in place. He was always somewhat…eccentric but he was not as explosive about it. Monks reaction to his wife’s death is not completely unrealistic; like Monk a real case involving a man named Anthony, who had some minor rituals “[His family] remembers his touching the door in a particular way while closing it and engaging in bathroom rituals involving tooth brushing and showering. These compulsive behaviors, however, were not of such magnitude that they significantly interfered with his functioning” (Greist & Jefferson, 1995, p. 25). These behaviors along with an attempt to lose weight never cause him significant disruption in his life, but when Anthony’s father died “[he] became very rigorous in his pursuit at weight loss” (Greist & Jefferson, 1995, p. 25). He succeeded in losing all the extra weight by following an extremely well put together routine; not only that but other rituals increased considerably since his father’s death; dressing washing and cleaning became extremely strict and unchangeable. Anthony had become obsessed with his physical well-being and will constantly check his appearance in the mirror, and all this was following the passing of his father. So, while Anthony was somewhat of an obsessive fellow, after his father’s death he became quite extreme. Anthony is not the only case to develop such behavior after a death in the family; take fifty seven year old Louise who after a death in her family suffered a panic attack, manifested by a racing heart, trembling sweating, lightheadedness, and feelings of being in another world…” (Greist & Jefferson, 1995, p. 29). It is not only a death of a family member that can cause and increased frequency in OCD behavior but multiple occurrences that may cause the affected person stress. According to Turner and Beidel “a number of different types of stressors have been associated with the onset of OCD, and these include medical illness, childbirth, and various forms of interpersonal and occupational stress” (1988, p. 6). A tragic occurrence in a person’s life, who is obsessive, or any event that can be considered stressful to them, obviously can have a great influence in those persons already obsessive behavior and symptoms.
Patients with OCD can have a symptom that is called ‘checking’. Yes, our good friend Adrian Monk displays this very well in the television series Monk. Monk constantly encounters obstacles that lead to extreme stress and virtually disable him from continuing on with his daily life because of this symptom. Monk has an extreme paranoia about safety. Adrian Monks checking as a result of his serious obsession with order; that goes so far as to impede him to the point that it makes him appear self-centered and even callous at times, for instance, in one particular episode he is offended by a man rushing into his house to call 911 for a fire because it was interrupting his routine check the thirty-two fire alarms. Not only does it make him appear uncaring, but sometimes it is painfully obvious that he cannot control his urges to straighten objects and count them. Not only does this suit the Rogers theory that Monk has a self-concept that hinders him in life and causes him to be extremely maladjusted, but this behavior as Passer describes is detrimental for the very fact that is indeed a mental disorder alone because these obsessive behaviors can be described as “Repetitive and unwelcome thoughts images, or impulses that invade consciousness, are often abhorrent to the person, and are very difficult to dismiss” (p. 549). Monk constantly complains that he cannot resist his urges to perfect everything. He cannot stop his mental obsessions even when the result is the endangerment of his very life in episode twenty-six of the first season Monk is being chased by someone in a vehicle intent on killing him because they are afraid he will solve the murder that they committed. While being chased by the car Monk stops to touch every light post even though it slows him down from escaping. This makes his disorder abnormal because it impedes him in daily life from performing to the best of his ability. A certain real life case follows closely to the episode where Monk checks his fire alarms by a patient of Greist and Jefferson who is named Leon, a 27-year-old single man “whose checking rituals consist primarily of repeatedly verifying that the doors and windows of his house are locked” (p. 44). Leon according to Greist and Jefferson even has his sleep interrupted by obsessive thoughts that he is not safe, he can only alleviate his fears by checking all the doors and windows locks. Sometimes he even returns to his house during the day to check the locks. Checking is a very distressing part of this disorder to many patients that find it interferes with their daily activity, and is just disruptive and just plain annoying to them in general.
Obsessive Compulsive disorder was not always considered to be very common. According to Turner and Beidel, “patients suffering from obsessions and compulsions were once thought to be rather rare. However, the most recent epidemiological data suggest that the prevalence of the disorder in the general population is about 2%” (1988, p. ). This data means that there are about “490,000 obsessional patients in the United States, and it also means there are at least as many obsessional patients as there are schizophrenics” (Turner and Beidel 1988, p.1).
Not only does OCD occur in adults but it has been known to affect children. Even though it is only recently that children are seen to have the ability to develop psychological problems; due to the care free visual one usually has of children, OCD itself can be seen as less serious because children are seen as having strange quirks that they will soon grow out of. But “OCD children and adolescents constitute only a small percentage of patients on a worldwide basis who are referred to child and adolescent psychiatric wards” (Thomsen 1999 p. 33). According to Sheslow, in the United states it is estimated that about 1% of children experience OCD and that just like with adults it is an illness that “is characterized by a pattern of rituals and obsessive thinking that generally lasts more than an hour each day, causes a child distress, or interferes with daily activities…kids [are] usually diagnosed between the ages of 7 and 12” (Sheslow 2008). Just like many adults, children experience OCD as a result of anxiety. Unlike many adults who can explain some reasoning behind their bizarre behavior children may justify their behavior with a “just because” response (Sheslow 2008). For children it can be very frightening to experience OCD behaviors. Sheslow states that “Most kids with OCD realize that they really don’t have to repeat the behaviors over and over again, but the anxiety can be so great that they feel that repetition is “required” to neutralize the uncomfortable feeling”(2008). While giving in to the urge to carry out rituals may temporarily ease the anxiety an adolescent feels, in the long run in only increases the severity of the OCD (Sheslow, 2008). Serotonin might actually be the chemical of choice here, and there is significant evidence that because a person experiences low levels of serotonin that are blocked the brain sends a false alarm of danger and “instead of filtering out unnecessary thoughts the mind dwells on them—and the person experiences unrealistic fear and doubt” (Sheslow 2008). Being an adult and experiencing unrealistic fears would be scary enough and cause a person to think they must be crazy, but as a child it must be even more so because a child cannot truly know that their constant thoughts of fear are completely unreasonable and that can make it even more terrifying. As Sheslow points out:
Evidence is strong that OCD tends to run in families. Many people with OCD have one or more family members who also have it or other anxiety disorders influenced by the brain’s serotonin levels. Because of this, scientists have come to believe that the tendency (or predisposition) for someone to develop the serotonin imbalance that causes OCD can be inherited through a person’s genes (2008).
Like with most psychological disorders and medical conditions it is not always your families fault. Biological evidence usually only means someone is more susceptible to psychological problems and medical problems that run in their families; like if a parent smokes or drinks they have an addictive personality, which, made them more likely to do drugs. But just because they may have passed that addictive personality onto their children that does not mean that their children will end up addicted to any sort of drug. Like Sheslow states “having the genetic tendency for OCD doesn’t mean people will develop OCD, but it means there is a stronger chance they might (2008). Children with OCD may also start to exhibit signs of anxiety and depression. While it is the most prevalent illness among children it is unfortunate that many children are too embarrassed to reveal their problem to anyone and keep it hidden from their friends and families (Sheslow 2008). Like always, children feel a pressure to fit in with their peers and having some weird desire to wash your hands after touching another person’s hand would not exactly be seen as inoffensive to another child, or not wanting to share your pencil because of some strange compulsive habit would probably make a kid a social outcast. Not only would the compulsions be somewhat of an embarrassment but the insecurities and distress that would develop because of indecent or strange thoughts can be equally crushing and give a child even more of a reason to close themselves off and hide their problem. It should be pointed out that a child cannot help their problem anymore than a child with asthma or diabetes can help that they have symptoms (Sheslow 2008). Children may not only participate in rituals, but try to get other family members to join them as Sheslow says:
It’s common for kids to ask a parent to join in the ritualistic behavior: First the child has to do something and then the parent has to do something else. If a child says, “I didn’t touch something with germs, did I?” the parent might have to respond, “No, you’re OK,” and the ritual will begin again for a certain number of times (2008).
I do not think any parent would want to believe that their child has anything wrong with them and would pass this behavior off as ‘a phase’ or just a quirk that could be considered ‘cute’. Children can also have tantrums and constantly express worry of things that may seem bizarre. Children can also suffer from tic disorders which a are defined by the AACAP as:
[When] a part of the body moves repeatedly, quickly, suddenly and uncontrollably. Tics can occur in any body part, such as the face, shoulders, hands or legs. They can be stopped voluntarily for brief periods. Sounds that are made involuntarily (such as throat clearing) are called vocal tics. Most tics are mild and hardly noticeable. However, in some cases they are frequent and severe, and can affect many areas of a child’s life (Tic Disorders, 2004).
According to Sheslow “the most successful treatments for kids with OCD are behavioral therapy and medication…also known as cognitive-behavioral psychotherapy” helps kids learn to change thoughts and feelings by first changing behavior. (2008). As Sheslow goes on to explain in involves desensitization to what the child may fear, like if they are afraid of being contaminated by dirt they would be exposed to dirt and be made unable to wash excessively. This would give the child the feeling that they have a little more control and can beat OCD (2008). Just like in adults, OCD can cause a major problem for children who have the illness and it should be treated by a well educated professional.
OCD patients have many different quirks about them. The different obsessions that OCD sufferers can experience can be categorized according to Steketee as follows:
1. Risk/harm—overestimation of risk or harm, high negative valence associated with harm, risk aversion. 2. Doubt/uncertainty/decision making—doubting perceptions and memory, a need for certainty, difficulty making decisions or trusting them, difficulty categorizing and discriminating. 3. Perfectionism—perfectionistic attitudes. 4. Guilt/responsibility/shame—excessive feelings of responsibility, guilt or shame about thoughts or behaviors. 5. Rigidity/morality—moralistic attitudes, rigid rules (1993 pg 40).
Michael for example would be a prime example for category one. According to Greist and Jefferson “Michael is frustrated by his inability to drive his new sports car beyond his neighborhood. The mere thought of driving alone on the highway terrifies him…He does not use public transportation and avoids riding in elevators” (1995 pg. 62). Obviously, Michael fits the criteria for OCD because of his excessive fear of harm. He also has a great concern for safety according to Greist and Jefferson, “Michael also reports excessive concern about safety, which leads to extensive checking routines” (1995 p.62). Adrian Monk mirrors this concern for safety because he constantly carries around hand wipes to wipe his hands after he has shaken hands with somebody else. He cannot touch anything that has been touched by somebody else. He fears public transportation because of germs and the close proximity of other people that may give him an illness. Steketee explains this excessively worrisome behavior exhibited by Monk here by pointing out that people with OCD “…often appear to exaggerate the probability or seriousness of ordinary concerns about health, safety, death, others’ welfare, sex, morality, religious matters, and scrutiny by others” (1993 pg. 40). This particular case here would be an example of germophobia, or a sometimes excessive fear of germs. People with OCD are not good at making decisions it may take a patient of OCD forever to complete math problems because they must check the problems over and over and still may be uncertain if the answers are correct. A person with this disorder may also just have trouble making a simple decision on what to order for lunch or wear to work. They may exhibit forms of perfectionism, nothing is to their satisfaction and things must be a certain way. Because of obsessive thoughts they may consider inappropriate people with OCD may experience excessive guilt over their thoughts and behaviors. They may also so rigid morals to an excessive extent some with the justification of religion.
Although OCD, in some cases, like Jean, allows the sufferer of the condition to maintain a productive life; but unfortunately, this is not true for everyone, like in the case of Kurt who actually caused himself bodily harm, or Richard who had to withdraw from school because of his obsessive behavior. In both of these cases the patients are not so lucky to have manageable compulsions and obsessions and their lives were greatly disrupted if not completely destroyed. People suffering from OCD, will more than likely, not recover without any treatment because they tend to get worse as they go through life as Neil did. This is evident because the person suffering from OCD will often be unaware that the compulsions harm them more than help them. They need someone outside of themselves to help them refrain from the compulsions. Since OCD is a cyclical disease. It falls onto itself continually.
It is best that treatment be found in a psychiatrist or someone who understands the illness and can perform the treatment properly. One treatment involves an “Exposure and response prevention involves repeated exposure to the source of your obsession. Then you are asked to refrain from the compulsive behavior you’d usually perform to reduce your anxiety.” (Obsessive-Compulsive Disorder (OCD), 2008). This is supposed to help the sufferer realize that acting on their compulsions does not really reduce their anxiety, thus reducing the desire to do as such, possibly eliminating the desire to act upon the desires and compulsions at all if the treatment is successful. Another treatment is called “the cognitive therapy component for obsessive-compulsive disorder (OCD) focuses on the catastrophic thoughts and exaggerated sense of responsibility the patient experiences. A big part of cognitive therapy for OCD is teaching the patient healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior (Obsessive-Compulsive Disorder (OCD), 2008). This treatment is obviously trying to distract the patient from obsessive thoughts and concentrate on something else, to channel anxiety into something else less destructive and more productive. Obsessive Compulsive Disorder is a very complex disorder and for psychologist can be quite the challenge, especially the destructive patients like Kurt. It seems leaps and bounds are being made in this century for human health, and hopefully research for OCD continues and makes more and more breakthroughs for treatment.
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