ObsessiveCompulsive Behaviors Essay Research Paper ObsessiveCompulsive Behaviors

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? 343