Obsessive-compulsive disorder (OCD), is characterized repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome.
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Compulsive handwashing is one way OCD manifests itself.
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Obsessions involve persistent and recurrent intrusive thoughts, images or impulses that are experienced as disturbing and inappropriate.
Compulsions can involve over repetitive behavior, or more covert mental acts. This is often in response to an obsession and it is behavior that is often times rigid as to how it should be performed. The goal can be preventing or reducing distress or preventing some dreaded event or situation.
NIMH Definition of Obsessive Compulsive Disorder
"An anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called 'rituals,' however, provides only temporary relief, and not performing them markedly increases
anxiety".
http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
Characteristics of Obsessive Compulsive Disorder OCD
Cognitive: Obsessions, Ruminations, Cognitive
Obsessions are defined as recurrent, persistent ideas, thoughts, images or impulses involuntarily coming to awareness. (Recurrent, persistent ideas, thoughts or images, impulses involuntarily coming to one's consciousness.)
Ruminations are forced preoccupation with thoughts about a particular topic, associated with brooding, doubting, and inconclusive speculation. (Several hours a day worried if a former lover will establish contact.)
Cognitive rituals are often elaborate series of mental acts that one feels compelled to complete. Ending performance of the ritual can only take place, for those with OCD, if the ritual is properly performed or carried out completely. (Elaborate mental acts that one feels compelled to complete.)
Motor: Compulsive, Avoidances
Compulsive motor rituals can be elaborate, time-consuming activities that are often associated with common, every day activities such as eating, washing, toileting, grooming, dressing and sexual activity. (repetitive hand washing, compulsive counting or "checking" of objects.)
Compulsive avoidances involve substitute actions performed instead of appropriate anxiety causing behavior. (e.g. Distracting oneself before exams with elaborate avoidance activities, so as to avoid having to study for the test, an action with potential anxiety.)
Signs and Symptoms of Obsessive Compulsive Disorders
The Medical Director of the New York State Office of Mental Health, Lloyd Sederer, MD, explains the difference between signs and symptoms when diagnosing mental health disorders, using Obsessive Compulsive Disorder as an example. Obsessions are considered to be symptoms, involving thoughts or impulses, whereas compulsions are signs, involving visible actions.
"Obsessions are symptoms, such as thoughts or impulses, which gnaw away at someone's mind, even though the sufferer knows that the thoughts are unreasonable. Obsessions are more than just worries like: Did I remember to leave a note for friend who is staying at my apartment? Another symptom of the condition is anxiety, manifest as anxious thoughts, such as: Did I turn off the stove (after checking it 25 times)? Will I be exposed to infection if I touch any surface in the classroom?
Compulsions are signs: they are visible, repetitive actions by a person in response to a particular anxiety provoking idea (despite knowing that these are irrational and foolish behaviors). Some examples of compulsions are: I will count to forty, forty times and only then I can leave the house safely; If I touch my index and thumb fingers while saying the Lord's Prayer, then nothing bad will happen to my children; or I must wash my hands just one more time (after ten minutes of scrubbing red hands that are chapped from previous washings), then I can return to work." (Sederer, L., Erlich, M., 2012)
Who is Affected with Obsessive Compulsive Disorder (OCD)
OCD can range from mild to severe. One reference says that OCD
effects 2% or persons in the US. Divorced or separated persons, or unemployed people are somewhat overrepresented. There seems to be little gender difference in OCD, markedly different than that of
depression and other
anxiety disorders.
It is stated that 67% of those with OCD may also experience
major depression at some time in their life and there can be other comorbid personality problems or disorders. According to A.D.A.M. Medical Encyclopedia, most who develop OCD do so by the age of 30 .
Psychodynamics of OCD - Overcoming Perfectionist Thinking
There are different schools of thought with regards to OCD and its causes. From a psychodynamic viewpoint displacement, substituting one activity for another activity can be a causal factor, a person who has thoughts of hurting a child, displaces those thoughts with other compulsive behavior. A person might be seeking
forgiveness for some real or imagined transgression, and try to find that in a "formula" of compulsive behavior, in an endeavor to "undo" such thoughts or past actions.
In this aspect of OCD, helping a person past an "all or nothing" viewpoint of life, to realize that we are acceptable despite our imperfections and that perfection is not expected or demanded, can be important psychological and spiritual lessons to learn, both acknowledging such, and making it a part of one's psyche.
Some religions teach a very strict view of sin, fundamentalist religions that might stress obedience through fear. Others might have been raised by overly demanding parents, or parents who were abusive, or who never gave approval. These thought patterns are not easy to erase. This type of thinking, then can contribute to the thought patterns that contribute to obsessive thoughts.
From the role of a psychologist or that of a pastor or other
counselor, a person needs to be helped to realize that perfection is not expected of them, that God does not expect perfection, and also that God is forgiving, especially if a person continues to make efforts in a positive direction. Accepting mercy for oneself and realize that each one has worth can be something of value in changing the thinking that can lead to obsessive thoughts.
The Behavioral Model for OCD is said to be very helpful for many who experience such compulsions. In the therapy involved, a person would be exposed to a situation that leads to obsessive-compulsive behavior and helped through the situation. Repeated success in controlling the compulsion or overcoming unreasonable fears, helps a person gain mastery of the situation and confidence.
Antidepressant Use in Treating OCD
Antidepressants are the most common form of treating OCD, despite the fact that relief from symptoms is usually temporary, short-term, and lasts only as long as the drug is taken. There is some anecdotal evidence that there is some benefit to antidepressants as an adjunctive, rather than primary therapy. As far as clinical evidence goes, there seems to be only two short-term clinical studies measuring the effectiveness of antidepressants for OCD, which provide some support for modest improvement in symptoms (reduction of symptoms by approximately one-third) of OCD with antidepressant use.
Why, then, has prescribing antidepressants become the most common way of treating OCD, despite the fact that there are more effective treatments? The answer lies in the fact that prescribing an antidepressant is simple and convenient. Also, antidepressant use has become an accepted part of treatment for depression, and depression accompanies signs and symptoms of OCD in the majority of sufferers (over 70%, according to some studies).
In researching clinical studies which support antidepressant treatment for OCD, it cannot be determined the origin of those studies, who sponsored or conducted the studies. This indicates that the studies were most likely sponsored by the pharmaceutical company who manufacturers the antidepressants used in treatment. Because of the lack of objectivity that is likely with studies sponsored by the manufacturers of the drug being tested, it seems that more testing would be necessary before one could conclude that antidepressants are effective treatment, albeit, in most cases conjunctive, for OCD. In others words, we can be a little skeptical about clinical studies sponsored by the manufacturers of the drug being tested. There can be bias in the way the study is designed, conducted and interpreted, in view of the fact that the doctors performing the studies are being paid on a regular basis, to conduct clinical studies testing pharmaceutical, and it is a lucrative source of income for doctors.
Additionally, while it is possible that there may be some short-term benefit for use of antidepressants, it has also been concluded that there is a higher-than-usual relapse rate for OCD treated with pharmaceuticals, in the long-term.
"Once a person stops taking [antidepressants for OCD], in most cases the OCD symptoms return." (Grohl, M., PSYD, June 27, 2012).
Bradley C. Riemann, PhD states in Psychiatric Times, "While medications can reduce symptoms of OCD by about one third, this is seldom sufficient to adequately control the disorder."
Dr. Riemann continues,
"Patients with OCD generally respond best to cognitive-behavioral therapy (CBT)."
For this and other reasons,
Cognitive Behavioral Therapy, then, is a preferred method of treatment for OCD that addresses, not only the symptoms, but also the thought patterns associated with the behavior.
Psychosurgery and OCD
For approximately ten-percent of those with OCD, the disorder seems to be intractable. For some of these who find no relief from symptoms through various non-invasive therapies,
neurosurgery techniques have been suggested. This site does not recommend neurosurgery.)
Before anyone resorts, though, to
neurosurgery, in addition to behavioral and cognitive therapies, one might consider also some of the other suggestions found on this site, on the
16 Keys to good mental health
which can assist one to overcome problems associated with OCD, in addition to whatever cognitive behavioral therapy.
Films and Television - Violence and Disturbing Content - Psychological Affect
---Prevention and Possible Media Influences
Obsessive Compulsive Disorder is considered to be a form of anxiety disorder. As such, it is reasonable to conclude, that avoiding external stimuli that contributes to unnecessary anxiety can be one area of prevention in self-help for OCD.
Because watching fast-paced television and movies can contribute to higher anxiety levels, it is possible that watching certain types of television and films on a regular basis, may contribute to an increase in symptoms of OCD in some.
Excessive time with television and devotion to watching movies as a form of recreation can have the effect of locking the mind in a passive mode, that is being constantly directed by external sources. The mind can become weak and open to suggestion. Certain types of films and TV programs, such as suspenseful thrillers, can contribute to the type of thinking that is evident in OCD. These type of films and TV programs, on a regular basis, can contribute to irrational fears, contributing to the thought processes involved with OCD. As this thinking is reinforced over time, symptoms of OCD can be reinforced.
In one study of 237 adults conducted in Israel, television clips of terrorism and political violence reported higher levels of anxiety. (Hamblen, J., Ph.D.) Watching television, including the news and sensational news programs, then, can increase levels of stress and anxiety for some people. Watching television as a way of life, hours a day, does affect one's thinking, and for some, can contribute to "circular thinking," a way of thinking that can contribute towards obsessions and compulsions.
The same might be said for many
films that might have feature violence or distressing situations. Viewing films with macabre themes, or scenes or themes with deep emotions, on a somewhat regular basis, can also put some persons in a disturbed emotional state, which can contribute to, along with other factors, thinking that can contribute to symptoms of OCD.
Persons with OCD might consider doing without television and
movies, films, or cutting back on the number of intense films that one might watch in a given week or month.
Television Habits and Sports Obsessions
Similarly,
watching sports on television such as baseball and basketball, can become something of an obsession for some, the statistics and numbers involved with baseball can lend itself well, for some persons, to the type of thinking that is associated with OCD. Not to say that playing sports might lead to such thinking, but the passive obsession of following teams and statistics, might be one factor for some people, that contributes to the mental patterns that lead to OCD and the way of thinking associated with it.
Baseball is known for being amongst the sports where superstitious thinking is most common among players and coaches, as well as fans, and it is that type or pattern of thinking that for a few, might also lead to obsessions and compulsions. (Stadler, M., 2006).
Music
There may be certain types of music which reinforce mental patterns contributing to thought patterns involved with OCD. Overindulgence in intense music may contribute to mental health difficulties. Self-examination in this area can be beneficial and switching from intense and powerful music, to music which is less taxing on the mind might benefit some.
Cognitive Behavioral Therapy for OCD
Behavioral and cognitive therapy are effective because the results are more enduring and new skills are learned and reinforced; new ways of thinking are developed.
For the people who benefit from CBT, they usually see their OCD symptoms reduced by 60-80%. (International OCD Foundation) The International OCD Foundation states that one of the most effective types of Cognitive Behavioral Therapies used for OCD is one that is called Exposure and Response Prevention, or ERP. "Exposure" in ERP refers to confronting the thoughts, images, objects and situations that make a person with OCD anxious.
"Response Prevention" refers to making a deliberate choice not to perform a certain compulsive behavior after coming into contact with the things that trigger a compulsive response.
Both actions and thought patterns need to be changed with OCD. The compulsive way of thinking can develop in certain mental environments. Cognitive Behavioral Therapy can be effective because it addresses both actions and changing though patterns.
Solutions and Self-help for OCD
Art is an excellent therapy for OCD, both art as a hobby and as a
professional therapy. Art can calm and soothe the mind. The temporary mental retreat of creating art, the satisfaction of creating something new, as well as the soothing nature of creating artwork, can make obsessions and rituals less compelling, and can assist individuals with OCD to break free from them.
Reading the news rather than watching it on television can also be of benefit for some. The news for some, might contribute to fears that can lead to irrational obsessions. Reading the news is more gentle, and it requires more deliberate choice in what articles one will read. It requires more mental energy and strength to read the news rather than to watch it, and if reading becomes a way of life, it can serve the purpose of strengthening the mind. This in turn can help some to gain ground on certain types of mental health disorders.
Finding quiet time with nature, green therapy, is also of value as a therapeutic activity for OCD. Prayer is of value, attention to spiritual needs, as well as the avoidance of any type of pornography, which can set up patterns of thinking of obsessions, compulsions and guilt.
There is much that can be done through self-help, and non-pharmaceutical professional therapy to overcome the thought processes that lead to obsessive compulsive disorder and it need not be a lifetime difficulty.
Many can overcome the symptoms associated with obsessive compulsive disorder through self-help methods, lifestyle adjustments and professional non-pharmaceutical therapy.
Natural Therapies for OCD - (on-site links)
Cognitive Behavioral Therapy
Art Therapy
Attention to
Spiritual Needs
Green Therapy
Relaxing and
Soothing Music (rather than intense music).
References for Obsessive Compulsive Disorder (OCD) - Signs, Symptoms and Treatment Options
1. Cognitive Behavior Therapy (CBT). 2010.
International OCD Foundation.
http://www.ocfoundation.org/CBT.aspx
2. Grohl, M., (Jun3 27, 2012).
OCD Is Most Often Treated with Antidepressants.
PsychCentral. http://psychcentral.com/blog/archives/2012/04/07/ocd-is-most-often-treated-with-antidepressants/
3. Hamblen, J., Ph.D.
The Effects of Media Coverage of Terrorist Attacks on Viewers.
National Center for PTSD Fact Sheet. (Retrieved July 28, 2012). http://www.au.af.mil/au/awc/awcgate/va/fs_media_disaster.htm
4. Obsessive-compulsive disorder - Obsessive-compulsive neurosis; OCD, (March 7, 2012).
A.D.A.M. Medical Encyclopedia. PubMed Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001926/
5. Riemann, B. C., PhD, (August 1, 2006). Cognitive Behavioral Treatment for Obsessive-Compulsive Disorder.
Psychiatric Times. http://www.psychiatrictimes.com/ocd/content/article/10168/51891
6. Sederer, L., Erlich, M., 2012.
How Thoughts Become a Psychiatric Diagnosis.
The Atlantic http://www.theatlantic.com/health/archive/2012/07/how-thoughts-become-a-psychiatric-diagnosis/260012/
Stadler, M., (2008). The Psychology of Baseball. New York:
Gotham.
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