Obsessive Compulsive Disorder
Obsessive Compulsive Disorder is categorised in the official diagnostic criteria as a form of anxiety disorder. It affects approximately 3% of the British population, and seems to affect men and women equally. The average age of onset tends to be adolescence.
Individuals suffering from Obsessive Compulsive Disorder tend to possess certain personality traits that have led to its onset. Generally, those who suffer from this disorder are more likely to be introverted and neurotic.
This disorder has been a problematic disorder to diagnose. In the past its symptoms have often been confused with other disorders or explained away as a natural (though eccentric) stage of development, a phase. The anxiety suffered with Obsessive Compulsive Disorder, is often indistinguishable from the typical amount of anxiety one may experience in their everyday life. In this sense, the boundary between normal and abnormal behaviour can be difficult to distinguish.
The core symptoms of Obsessive Compulsive Disorder are:
(1) Inexplicable and exaggerated feelings of apprehension and caution
(2) Obsessive thoughts that focus on details, routines, repetition, organisation, rules
(3) An intense perfectionism (that is often counter-productive)
(4) Adherence to a self-imposed rigid routine
(5) Persistent and repetitive thoughts or compulsions that cause distress
(6) An excessive need to visually scan their environment for any threat or risk
It is often the cause that individuals suffering from Obsessive Compulsive Disorder adopt strict routines and rituals in order to combat and exert some control over their feelings of dread or anxiety. These compulsions are time consuming and greatly interfere with the individual's ability to function in their daily life.
Significantly, individuals with Obsessive Compulsive Disorder tend to be aware of the irrationality of their obsessions and compulsions.
It is rare that they will seek out treatment, though some will attempt to self-medicate their anxiety with alcohol. Self-harm is also prominent as a coping strategy.
Explanations
One explanation of why people develop Obsessive Compulsive Disorder is that the individual has a tendency to perceive and integrate information about the world in an unhealthy manner. They overestimate their own vulnerability and exaggerate threat and the risk of danger. Also, the individual will tend to be more sensitive to the existence of a threat i.e. they are tuned in to it and are more likely to notice its presence in their environment when others may overlook it. This will inevitably lead to feelings of apprehension and anxiety. This susceptibility to anxiety varies from person to person. It is said to have initially stemmed from negative experiences and feelings of vulnerability in the individual's past that they have integrated in to their beliefs about themselves and the world. This leads to a distorted perception of reality in which they interpret it to be threatening.
Obsessive Compulsive Disorder is also argued to arise from an inner conflict stemming from childhood. As the typical age of onset is adolescence, it is theorised that this disorder is linked to issues in passing from childhood to adulthood, from dependency to independency.
It has also been argued by psychoanalytic approaches (which focus on unconscious conflict) that Obsessive Compulsive Disorder arises as a consequence of an unresolved conflict that the individual is attempting to hide from themselves due to it being distressing. The obsessive thoughts are pervasive and consuming and in that sense they distract their attention away from the inner conflict as an extreme form of defence.
This line of thought has influenced many explanations of Obsessive Compulsive Disorder and a more recent adaptation of this view is that the individuals who develop this disorder tend to be bad at distracting themselves from troubling thoughts. Therefore, obsessions develop as a more intense means of distraction.
Treatment
The treatment for this disorder (known as Exposure and Response Prevention Therapy) tends to consist of a combination of three stages that focus on the anxious response to their environment. First of all, the therapist themselves will confront the fears of the patient. The therapist will make contact with whatever it is that the patient fears and aim to show them that it is safe. This should help to ease the feeling of anxiety associated with it as the patient can observe from a safe distance.
Secondly, the patient will be advised to join the therapist in directly confronting their fear. The therapist will support them and try to talk out any negative thinking styles that lead the patient to become anxious. The aim is to move towards a realisation that it is nothing threatening.
Thirdly, the therapist will try and help the patient deal with their response to the object of fear. Rather that reduce the anxiety by performing compulsions, the patient will be encouraged to find alternative techniques to manage their reaction whenever it arises.
For instance, a patient has obsessive thoughts about accidently leaving on electrical appliances that might cause a fire. This may have led them to adopt compulsions whereby they repetitively check that they have unplugged and switched off everything in the house. This ritual may be quite a time consuming task that they perform in order to reduce their anxiety. With Exposure and Response Prevention Therapy, the patient will be asked to leave the house without performing their compulsion of checking the switches. The therapist will accompany them and talk through their fear, helping to find other strategies to cope with their obsessive thoughts, without resorting to compulsions.
This form of treatment aims to adjust the patient's thinking patterns and the way they appraise their situations and to enable them to handle stress when it arises.
There is also a course of drugs available for Obsessive Compulsive Disorder, known as Cloripramine. After three weeks it reduces the obsessions, which enables the patient to stop performing ritualistic compulsions. It is successful in approximately 55% of patients but also has severe side-effects. More importantly, drug therapy may reduce the obsessions, but it does not attack the cause of this disorder. Consequently, many who stop taking the medication will suffer a relapse.
