Obsessive-Compulsive Behaviors”Compulsive” and “obsessive” have become everyday words. “I’mcompulsive” is how some people describe their need for neatness, punctuality,and shoes lined up in the closets. “He’s so compulsive is shorthand for callingsomeone uptight, controlling, and not much fun.
“She’s obsessed with him” is away of saying your friend is hopelessly lovesick. That is not how these wordsare used to describe Obsessive-Compulsive Disorder or OCD, a strange andfascinating sickness of ritual and doubts run wild. OCD can begin suddenly andis 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 orthoughts about nuetral questions or behaviors. What are their rituals about?There are several possible ways to list symptoms of OCD. All sources agree thatthe most common preoccupations are dirt (washing, germs, touching), checking forsafety or closed spaces (closets, doors, drawers, appliances, light switches),and thoughts, often thoughts about unacceptable violent, sexual, or crudebehavior.
When the thoughts and rituals of OCD are intense, the victim’s work andhome life disintigrate. Obsessions are persistant, senseless, worrisome, andoften times, embarrassing, or frightening thoughts that repeat over and over inthe mind in an endless loop. The automatic nature of these recurant thoughtsmakes them difficult for the person to ignore or restrain successfully.The essence of a Compulsive Personality Disorder is normally found in arestricted person, who is a perfectionist to a degree that demands that othersto submit to hisher way of doing things. A compulsive personality is also oftenindecisive and excessively devoted to work to the exclusion of pleasure. Whenpleasure 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 areincredibly repetitive and seemingly purposeful acts that result from theobsessions. The person performs certain acts according to certain rules or in astereotypical way in order to prevent or avoid unsympathetic consequences.People with compulsive personalities tend to be excessively moralistic, andjudgmental of themselves and others.Senseless thoughts that recur over and over again appearing out of theblue; certain “magical” acts are repeated over and over.
For some the thoughtsare meaningless like numbers, one number or several, for others they are highlycharged ideas-for example, “I have just killed someone.” The intrusion intoconscious everyday thinking of such intense, repetitive, and to the victimdisgusting and alien thoughts is a dramatic and remarkable experience. Youcan’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 studiedby the well-known art therapist, Judith Aron Rubin, Rubin tells of a young girlnamed Mary, who suffers from OCD, and how she drives her fellow waitressesfrantic because she goes into a tailspin if the salt and pepper she has arrangedin a certain order has been moved around. All of the OCD problems have commonthemes: you can’t trust good judgment, you can’t trust your eyes that see nodirt, or really believe that the door is locked. You know you have done nothingharmful 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 commonis called “washing” this involves the victim to have a constant feeling ofconamination, dirt andor grime all over their body.
The book,The Boy WhoCouldn’t Stop Washing by Judith L. Rapoport describes a long, sad case of ayoung boy who spent three or more hours in the shower each day. The boy “feltsure” that there was some sticky substance on his skin.
He thought of nothingelse.Our normal functioning probably consists of constant uncountablechecking, a sort of radar operation, that we could not do contiously and stillact efficiently. Something has gone wrong with the process for obsessivecompulsives, the usual shut-off such as “my hands are clean enough” or “I sawthe gas was turned off on the stove” or “The door was locked.” does not getthrough. Everyday life becomes dominated by doubts, leading to senselessrepetition and ritual.Obsessive phobias tend to have distinct features. According to IssacMarks, “They are usually part of a variety of fears of potential situationsthemselves.
Because of the vagueness of these possibilities, ripples ofavoidance and protective rituals spread far and wide to involve the patientslife style and people around himher. Clinical examination usually disclosesobsessive rituals not directly connected with the professed fear; instead theobsessive fear is part of a wider obsessive-compulsive disorder.”(Marks,1969)”The sustained experience of obsessions andor compulsions.” make upwhat the American Psychiatric Association’s Diagnostic and Statistical Manual ofMental Disorders, 3rd edition, calls Obsessive-Compulsive Disorder. It has alsobeen called obsessional nuerosis. Psychiatrists have been fascinated by thisdisorder for over a hundred years. Priests have described symptoms like thesefor 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 youngchildren and in any case are much more rare in children than in adults. But withOCD it is the same at any age.In the book The Boy Who Couln’t Stop Washing, there is a story of afourteen-year-old girl who has been diagnosed with OCD. As she is talking toher psychiatrist she says, “I have really lost touch with myself and that isreally frightening. I wish I could get the ‘old Sally’ back.
I keep hopingit’s just a dream and that I’ll wake up and everything will be normal. I usedto like who I was a lot, but now I feel I don’t even know myself anymore. Ihave so many goals and dreams I would like to accomplish, but I know I willnever acomplish them with OCD. I feel like I am in a mental labyrinth fromwhich I can’t escape. I hope I can get better.” (Rapoport,’89,p.80)To quote the author and psychiatrist, Judith L.
Rapoport, “The diseaseaffects some of the most able, sensitive, and talented people I have met. Theirotherwise normal ability to function, to become a good husband, wife, or friendmakes working with obsessive-compulsive patients very rewarding and, when theyare severely ill, very painful.”(Rapoport,’89, p.3)A few individual cases of OCD have been reported in the medicalliterature over the past 150 years, but only recently have we learned of thelarge number of adolesence and adults who suffer with it. More than 4 millionpeople in the United States suffer from its’ disabling thoughts or rituals.Amazingly most of them keep their problem hidden.
We are finding out that manyof the adults who are being treated for it now went pretty much their whole lifehiding the problem because they were too humiliated or did not want to beconsidered crazy and thown in a mental institution.In spite of the interesting individual cases of OCD in the past onehundred fifty years, there was not much work on treatment. There is littleincentive to evaluate or develop new treatments for rare disorders. So up untilthe 1970’s the recommended treatment was psychotherapy or psychoanalysis.
Doctors made these suggestions for lack of an alternative, but severe cases andfollow-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 Anafranilrange 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 excessivesweating can be major problems.
These are all side effects common to tricyclicanti-depressants-the group of which Anafranil belongs.In the most severe cases of OCD, psychosurgery was used regularly untilthe 1950s. With availability of other treatments psychosurgery is now a lastresort. In some cases, however, this drastic treatment seems to work wheneverything else has failed. A few medical centers in Boston, London, andStockholm, for example, will still perform limited operations using newertechniques.
The two newer treatments, behavior therapy and drug treatment withAnafranil, both seem to have long-term benefits. Behavior therapists havefollowed 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 beendone show that it too is helpful over at least two years.Even though Anafranil does work well it is not always nessesary. Thereare other aproaches. Some OCD’s have gotten help from just “coming out of theOCD closet”. Support groups have also been known to help.
There is a widevariety of things you can do to help a person diagnosed with OCD.”Scientists have suggested that there may be a biological explanationfor some obsessive compulsive disorders. There may be an imbalance in thefrontal lobes of the brains of obsessive-compulsives that prevents the two brainregions from working together to channel and control incoming sensations andperceptions.”(Boulougouris,1971)The American Psychiatric Association’s Diagnostic and Statistical Manualof Mental Disorders requires at least five of the following symtoms to becharacteristic of the persons functioning. In addition, the symptoms must causesome problems with personal or work life.
“1. Restricted ability to express warm andtender emotions. 2.
Perfectionism that interferes with overallability to see the needs of a situation. 3. Insistence that others submit to the person’sway of doing things without awareness ofhow this makes others feel. 4. Excessive devotion of work to the exclutionof pleasure. 5.
Indecisiveness to the point wher decisionsare postponed avoided, or protracted.Assignments may not get done on timebecause of thinking about priorities. 6. Preoccupation with details, rules, lists orschedules to the extent that the major pointof the activity is lost.
7. Overconscientiouness, scrupulousness, andinflexibility about moral or ethical matters. 8.
Lack of generosity in giving time, money orgifts. 9. Inability to discard worn out or worthlessobjects.” (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 abiological cause is compelling but unfortunately it is still necessary to speakof the biology of behavior in vague terms. The effect of a drug, and thenormality of many of the families with an OCD kid makes the importance of “poorupbringing” as a cause of OCD uncertain to say the least.
This is a disease thatmay 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 basisfor a sense of “knowing” has interesting philosophical implications. We arenormally 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 ourusual, normal belief in what our everyday senses and common sense tell ussimilarly determined by our brain chemistry?