Obsessive-Compulsive Behaviors Essay, Research Paper
Obsessive-Compulsive Behaviors
“Compulsive” and “obsessive” have become everyday words. “I’m
compulsive” is how some people describe their need for neatness, punctuality,
and shoes lined up in the closets. “He’s so compulsive is shorthand for calling
someone uptight, controlling, and not much fun. “She’s obsessed with him” is a
way of saying your friend is hopelessly lovesick. That is not how these words
are used to describe Obsessive-Compulsive Disorder or OCD, a strange and
fascinating sickness of ritual and doubts run wild. OCD can begin suddenly and
is usually seen as a problem as soon as it starts.
Compulsives (a term for patients who mostly ritualize) and obsessives
(those who think of something over and over again) rarely have rituals or
thoughts about nuetral questions or behaviors. What are their rituals about?
There are several possible ways to list symptoms of OCD. All sources agree that
the most common preoccupations are dirt (washing, germs, touching), checking for
safety or closed spaces (closets, doors, drawers, appliances, light switches),
and thoughts, often thoughts about unacceptable violent, sexual, or crude
behavior.
When the thoughts and rituals of OCD are intense, the victim’s work and
home life disintigrate. Obsessions are persistant, senseless, worrisome, and
often times, embarrassing, or frightening thoughts that repeat over and over in
the mind in an endless loop. The automatic nature of these recurant thoughts
makes them difficult for the person to ignore or restrain successfully.
The essence of a Compulsive Personality Disorder is normally found in a
restricted person, who is a perfectionist to a degree that demands that others
to submit to hiser way of doing things. A compulsive personality is also often
indecisive and excessively devoted to work to the exclusion of pleasure. When
pleasure is considered, it is something to be planned and worked for.
Pleasurable activities are usually postponed and sometimes never even enjoyed.
With severe compulsions, endless rituals dominate each day. Compulsions are
incredibly repetitive and seemingly purposeful acts that result from the
obsessions. The person performs certain acts according to certain rules or in a
stereotypical way in order to prevent or avoid unsympathetic consequences.
People with compulsive personalities tend to be excessively moralistic, and
judgmental of themselves and others.
Senseless thoughts that recur over and over again appearing out of the
blue; certain “magical” acts are repeated over and over. For some the thoughts
are meaningless like numbers, one number or several, for others they are highly
charged ideas-for example, “I have just killed someone.” The intrusion into
conscious everyday thinking of such intense, repetitive, and to the victim
disgusting and alien thoughts is a dramatic and remarkable experience. You
can’t put them out of your mind, that’s the nature of the obsessions.
Some patients are “checkers,” they check lights, doors, locks-ten,
twenty or a hundred times. Others spend hours producing unimportant symmetry.
Shoelaces must be exactly even, eyebrows identical to eachother. A case studied
by the well-known art therapist, Judith Aron Rubin, Rubin tells of a young girl
named Mary, who suffers from OCD, and how she drives her fellow waitresses
frantic because she goes into a tailspin if the salt and pepper she has arranged
in a certain order has been moved around. All of the OCD problems have common
themes: you can’t trust good judgment, you can’t trust your eyes that see no
dirt, or really believe that the door is locked. You know you have done nothing
harmful but in spite of this good sense you must go on checking and counting.
There are many, many common obsessions, of all of them the most common
is called “washing” this involves the victim to have a constant feeling of
conamination, dirt andr grime all over their body. The book,The Boy Who
Couldn’t Stop Washing by Judith L. Rapoport describes a long, sad case of a
young boy who spent three or more hours in the shower each day. The boy “felt
sure” that there was some sticky substance on his skin. He thought of nothing
else.
Our normal functioning probably consists of constant uncountable
checking, a sort of radar operation, that we could not do contiously and still
act efficiently. Something has gone wrong with the process for obsessive
compulsives, the usual shut-off such as “my hands are clean enough” or “I saw
the gas was turned off on the stove” or “The door was locked.” does not get
through. Everyday life becomes dominated by doubts, leading to senseless
repetition and ritual.
Obsessive phobias tend to have distinct features. According to Issac
Marks, “They are usually part of a variety of fears of potential situations
themselves. Because of the vagueness of these possibilities, ripples of
avoidance and protective rituals spread far and wide to involve the patients
life style and people around himer. Clinical examination usually discloses
obsessive rituals not directly connected with the professed fear; instead the
obsessive fear is part of a wider obsessive-compulsive disorder.”(Marks,1969)
“The sustained experience of obsessions andr compulsions.” make up
what the American Psychiatric Association’s Diagnostic and Statistical Manual of
Mental Disorders, 3rd edition, calls Obsessive-Compulsive Disorder. It has also
been called obsessional nuerosis. Psychiatrists have been fascinated by this
disorder for over a hundred years. Priests have described symptoms like these
for much longer than that.(A.P.A.,80)
Children suffer from OCD with exactly the same symptoms as adults.
Normally an early start in mental disorder is unusual. Other mental illnesses,
such as depression or schitzophrenia often apear in a differant form in young
children and in any case are much more rare in children than in adults. But with
OCD it is the same at any age.
In the book The Boy Who Couln’t Stop Washing, there is a story of a
fourteen-year-old girl who has been diagnosed with OCD. As she is talking to
her psychiatrist she says, “I have really lost touch with myself and that is
really frightening. I wish I could get the ‘old Sally’ back. I keep hoping
it’s just a dream and that I’ll wake up and everything will be normal. I used
to like who I was a lot, but now I feel I don’t even know myself anymore. I
have so many goals and dreams I would like to accomplish, but I know I will
never acomplish them with OCD. I feel like I am in a mental labyrinth from
which I can’t escape. I hope I can get better.” (Rapoport,’89,p.80)
To quote the author and psychiatrist, Judith L. Rapoport, “The disease
affects some of the most able, sensitive, and talented people I have met. Their
otherwise normal ability to function, to become a good husband, wife, or friend
makes working with obsessive-compulsive patients very rewarding and, when they
are severely ill, very painful.”(Rapoport,’89, p.3)
A few individual cases of OCD have been reported in the medical
literature over the past 150 years, but only recently have we learned of the
large number of adolesence and adults who suffer with it. More than 4 million
people in the United States suffer from its’ disabling thoughts or rituals.
Amazingly most of them keep their problem hidden. We are finding out that many
of the adults who are being treated for it now went pretty much their whole life
hiding the problem because they were too humiliated or did not want to be
considered crazy and thown in a mental institution.
In spite of the interesting individual cases of OCD in the past one
hundred fifty years, there was not much work on treatment. There is little
incentive to evaluate or develop new treatments for rare disorders. So up until
the 1970’s the recommended treatment was psychotherapy or psychoanalysis.
Doctors made these suggestions for lack of an alternative, but severe cases and
follow-up studies of adults could not show any advantadge for this treatment.
The Best studied Drug to reduce or stop OCD,is called Anafranil.
Anafranil was first put on the market in 1990. The side effects of Anafranil
range from mild to severe. The most common side effects are dry mouth,
constipation, and drowsiness. However a tremor, loss of sexual appetite,
impotence-which is temporary until you stop taking the drug, and excessive
sweating can be major problems. These are all side effects common to tricyclic
anti-depressants-the group of which Anafranil belongs.
In the most severe cases of OCD, psychosurgery was used regularly until
the 1950s. With availability of other treatments psychosurgery is now a last
resort. In some cases, however, this drastic treatment seems to work when
everything else has failed. A few medical centers in Boston, London, and
Stockholm, for example, will still perform limited operations using newer
techniques.
The two newer treatments, behavior therapy and drug treatment with
Anafranil, both seem to have long-term benefits. Behavior therapists have
followed up their patients for a year or two and the effect seems to last.
Anafranil has not been as well studied in follow-up, but what studies have been
done show that it too is helpful over at least two years.
Even though Anafranil does work well it is not always nessesary. There
are other aproaches. Some OCD’s have gotten help from just “coming out of the
OCD closet”. Support groups have also been known to help. There is a wide
variety of things you can do to help a person diagnosed with OCD.
“Scientists have suggested that there may be a biological explanation
for some obsessive compulsive disorders. There may be an imbalance in the
frontal lobes of the brains of obsessive-compulsives that prevents the two brain
regions from working together to channel and control incoming sensations and
perceptions.”(Boulougouris,1971)
The American Psychiatric Association’s Diagnostic and Statistical Manual
of Mental Disorders requires at least five of the following symtoms to be
characteristic of the persons functioning. In addition, the symptoms must cause
some problems with personal or work life.
“1. Restricted ability to express warm and
tender emotions.
2. Perfectionism that interferes with overall
ability to see the needs of a situation.
3. Insistence that others submit to the person’s
way of doing things without awareness of
how this makes others feel.
4. Excessive devotion of work to the exclution
of pleasure.
5. Indecisiveness to the point wher decisions
are postponed avoided, or protracted.
Assignments may not get done on time
because of thinking about priorities.
6. Preoccupation with details, rules, lists or
schedules to the extent that the major point
of the activity is lost.
7. Overconscientiouness, scrupulousness, and
inflexibility about moral or ethical matters.
8. Lack of generosity in giving time, money or
gifts.
9. Inability to discard worn out or worthless
objects.” (A.P.A.,’80)
So much is asked about where our everyday lives stop and OCD begins.
The basis of Obsessive -Compulsive Disorder is still unknown. The evidence for a
biological cause is compelling but unfortunately it is still necessary to speak
of the biology of behavior in vague terms. The effect of a drug, and the
normality of many of the families with an OCD kid makes the importance of “poor
upbringing” as a cause of OCD uncertain to say the least. This is a disease that
may be thought of as doubts gone wild. Patients doubt their very own senses.
They cannot believe any reasurance of everyday life.
Reassurance does not work. The notion that there is a biological basis
for a sense of “knowing” has interesting philosophical implications. We are
normally convinced that what we see and feel is truely there. If this is a
“doubting disease,” and if a chemical controls this sense of doubt, then is our
usual, normal belief in what our everyday senses and common sense tell us
similarly determined by our brain chemistry?
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