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Obsessive Compulsive Disorder

I have always been fascinated with behavioral disorders, especially OCD. I learned about OCD a few years ago when I was reading a medical journal. At first, it seemed like something very odd. The idea that otherwise normal people can do such strange things, and not be able to control themselves was fascinating. I wanted to know more about this topic, which is why I chose to write my paper on it. I thought that by knowing more about the subject, I will be able to better understand how these peoples lives can be literally taken over by their constant worries and anxiety.

Also, I think a lot of people exhibit these behaviors and arent even aware that they may have a severe problem, and more importantly, that they can be getting help to control these obsessions and compulsions. I also know that I have a lot of habits that could possibly be considered obsessive, and by writing this paper, I may have a better understanding of my own behaviors, and the ability to distinguish between a habit, and an obsession. Most importantly, however, thought it would be interesting to write a paper on something I did not already know that much about so that it would keep my interest.

Obsessive-Compulsive Disorder (OCD) is defined as an anxiety disorder where a person has recurrent unwanted ideas or impulses (called obsessions) and an urge or compulsion to do something to relieve the discomfort caused by the obsession (Mental Health Network, 2000). The obsessive thought range from the idea of losing control, to themes surrounding religion or keeping things or parts of ones body clean all the time. Compulsions are behaviors that help reduce the anxiety surrounding the obsessions. 90% of the people who have OCD have both obsessions and compulsions.

The thoughts and behaviors a person with OCD has are senseless, repetitive, distressing, and sometimes harmful, but they are also difficult to overcome. Some examples of common obsessions of OCD sufferers are fears of germ contamination, imagining having harmed self or others, imagining losing control of aggressive urges, sexual thoughts or urges, excessive religious or moral doubt, etc. As stated before, most cases of OCD have compulsions to satisfy their obsessions, or urges. Some of the compulsions for these urges are, excessive washing, repeating tasks, touching, counting, praying, etc.

Some sufferers have been known to wash their hands fir hours at a time, or to turn their stove off dozens of times, when it was never on in the first place, all because of the obsession in their mind imagining and fearing that the house would burn down. Worries, doubts, superstitious beliefs- all are common worries of everyday life. However, when they become excessive, or make no sense at all, then a diagnosis is made. In OCD, it is as though the brain gets stuck on a particular thought or urge and just cant let go, no matter how hard they may try.

OCD is a medical brain disorder that causes problems in information processing (Obsessive-Compulsive Disorder Foundation [OCD Foundation], 2000). Many patients believe that they somehow caused themselves to have these compulsive behaviors and obsessive thoughts. According to Neziraglu (1999), this is completely untrue; OCD is likely caused by a number of intertwined and complex factors which include genetics, biology, personality development, and how a person learns to react to the environment around them.

Also the OCD foundation (2000), says that even though no specific genes for OCD have been identified, research suggests that genes do play a role in the development of the disorder in some cases. Childhood-onset OCD tends to run in families. When a parent has OCD, there is a slightly increased risk that a child will develop OCD. While OCD runs in families, it is the general nature of OCD that seems to be inherited, not any specific symptoms. There is no single, proven cause of OCD. However, research suggests that OCD involves problems in communication between the orbital cortex and the basal ganglia (Wood & Wood, 1999).

These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are involved in OCD. Even though it is clear that serotonin levels play a role in OCD, there is no laboratory test for the diagnosis of OCD. Rather, the diagnosis is made based on an assessment of the persons symptoms. One such test from the OCD Foundation is the Florida Obsessive Compulsive Inventory Obsessive Compulsive Disorder screening test, developed by Dr. Wayne Goodman of the University of Florida (1994). It is an inventory of symptoms of OCD, and it can aid in the diagnosis of the disorder.

One of the main questions associated with OCD is, when does OCD begin? Well, OCD can start anytime from preschool age to adulthood. One-third to one half of adults with OCD report that it started during childhood. Unfortunately, OCD often goes unrecognized. Studies have found that it takes an average of 17 years from the OCD begins for people to obtain appropriate treatment. People with OCD may b secretive about their symptoms, be embarrassed about their compulsions, or lack insight about their illness, causing them to not seek treatment.

This is unfortunate, because earlier diagnosis and proper treatment can help people avoid the suffering associated with OCD and lessen the risk of developing other problems, such as marital and work problems (OCD Foundation, 2000). There are many other problems that are sometime confused with OCD. Some disorders that closely resemble OCD and may respond to some of the same treatments are trichotillomania (compulsive hair pulling), body dysmorphic disorder (imagined ugliness), and habit disorders, such as nail biting or skin picking.

While they share superficial similarities, impulse control problems, such as substance abuse, pathological gambling, or compulsive sexual activities are probably not related to OCD in any substantial way. Depression and OCD often occur together in adults, and less commonly, in children and adolescents. However, unless depression is also present, people with OCD are not generally sad or lacking in pleasure, and people who are depressed, but do not have OCD rarely have the kinds of intrusive thoughts that are characteristic of OCD.

Although stress can make OCD worse, most people with OCD report that the symptoms can come and go on their own. Individuals with OCD may have substance-abuse problems, sometimes as a result of attempts to self-medicate. Specific treatment for the substance abuse is usually also needed. After a proper diagnosis, there are many treatments available for patients suffering from OCD. However, before any treatment is administered, the patient and family are educated about OCD and its treatment as a medical illness.

First of all, there are medications vailable. Due to the fact that it is believed that serotonin levels play a role in OCD, medications called selective serotonin reuptake inhibitors (SSRIs) these are medications more commonly known as anti-depressants and they also affect serotonin levels. These are such medications as Anafranil, Prozac, Luvox, Paxil, and Zoloft. These drugs have been known to have moderate improvement after 8-10 weeks on an SRI. Unfortunately, fewer than 20% of those treated with medication alone end up with no OCD symptoms.

This is why medication is often combined with something called Cognitive Behavioral Psychotherapy (CBT) to get more complete and lasting results. About 20% dont experience much improvement with the first SRI and need to try another one. CBT is the psychotherapeutic treatment of choice for children, adolescents, and adults with OCD. In CBT, there is a logically consistent and compelling relationship between the disorder, the treatment, and the desired outcome. CBT helps the patient internalize a strategy for resisting OCD that will be of lifelong benefit.

Behavior therapy helps people learn to change their thoughts and feelings by first changing their behavior. Behavior therapy for OCD involves exposure and response prevention (E/RP). Exposure is based on the fact that anxiety usually goes down after long enough contact with something feared. Thus people with obsessions about germs are told to stay in contact with germy objects until their anxiety is extinguished. The persons anxiety tends to decrease after repeated exposure until he no longer fears the contact.

For exposure to be of the most help, it needs to be combined with response or ritual prevention (RP). In RP, the persons rituals or avoidance behaviors are blocked. For example, those with excessive worries about germs must not only stay in contact with germy things, but must also refrain from ritualized washing (Breaking the Cycle, 2000). Exposure is generally more helpful in decreasing obsessions, and response prevention is more helpful in decreasing the compulsive behaviors, so a combination of both of these treatments makes this an effective therapy. Cognitive Therapy (CT) is the other component of CBT.

CT is often added to the E/RP to help reduce the catastrophic thinking and exaggerated sense of responsibility often seen in those with OCD. For example, a person with OCD may think that if they dont lock the door, it will cause someone to sneak in their house and kill them that night while they are sleeping. CT would help them to challenge that faulty assumption in this obsession. Also, it would help them to quit obsessing about locking the door 15 times, and realize that the door is locked the first time. People react differently to psychotherapy, just as they do to medicine.

CBT can be individual, group, or family, depending on the needs of the patient. Those who complete CBT report a 50% to 80% reduction in OCD symptoms after 12-20 sessions. Also, people with OCD who respond to CBT usually stay well, often for years to come. When someone is being treated with medication, using CBT with the medication may help relapse when the medication is stopped (Barlow & Burke, 1999). In a December 1999 report, Hyman and Schwartz state that OCD can be a devastating disease, and it affects 1 in 40 people (slightly more women than men), and can come and go many times in ones life.

However, in the past 20 years, treatment has improved drastically upon more knowledge of this disorder. Thus making it highly treatable. The first step is education; without this, it is hard to recognize, diagnose, and treat OCD. With all of the treatments available today, people shouldnt have to live with this embarrassing, and controlling disorder. There is help, and through education, awareness, and treatment, people dont have to live with it anymore. In conclusion, I found that writing this paper was quite fascinating and informative.

It also helped me to recognize that although my habits may seem odd at times, they are just that, habits. Obsessions are a lot more extreme than the average habit or quirk. I think it is so important that people who think that they may have this problem seek help, because it is so easily treated. The problem, most people are embarrassed by their obsessions, and are too ashamed to tell anyone or to seek professional help. I enjoyed writing my paper on OCD, and I know now that I will be able to recognize the symptoms in people around me, and hopefully be able to help them out with my knowledge.

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