Obsessive Compulsive Disorder
An OCD obsession is characterized by certain ideas, impulses and images that continue to run through the mind repeatedly again and again. The severity of the OCD will determine how often the obsessions return and how long or intense the obsession is. The person with OCD will obsess about such things as germs or feel dirty no matter how many times they wash their hands. Sometimes the obsessions will involve the thought of violence and fear, sexual acts or thoughts against a religious belief. These obsessions are usually very time consuming and will take over an hour to complete and can interfere with someone’s daily life. The adults with OCD will have knowledge of their repetitive behaviors as where a child might not be able to distinguish that this behavior is not natural.
OCD affects approximately 3.3 million adults and will affect men and women in about the same numbers. OCD is more likely to be seen in children or adolescence. At least 1/3 of all reported cases claim their symptoms began in early childhood. It is important to monitor the OCD closely in all ages because depression is very closely related to OCD. Also, we find that many OCD patients will resort to drugs or alcohol to try to dissipate the symptoms of OCD. The obsessions will often make it impossible to carry out their responsibilities at their place of employment or at home.
Compulsions are another symptom that is noted in the OCD patient. The compulsions are brought on by the patient’s extreme desire to control the obsessive behavior. These behaviors can sometimes be referred to as rituals. The compulsions are usually an ineffective way to control the obsessive behaviors and the OCD symptoms usually reappear after a short time. There are a lot of different symptoms or thoughts that OCD patients obsess over, such as concern with order or the feeling that everything has to be exact. The patient will feel the need to be constantly reassured of their potential or that they are doing well. They may also feel that their thoughts may lead to harming a family member or friend. This will often prevent the OCD patient from participating in any social events. Another issue that this type of patient may experience is not wanting to do certain task because they may be done poorly, even if it isn’t true.
Researchers are still doing various studies to find the cause of OCD and so far have not come up with any. There are some that support a variation in chemicals in the brain that cause a break in the messages that are delivered from cell to cell. One of the chemicals that are thought to cause the most concern is serotonin. Serotonin is usually decreased in OCD patients and needs to be adjusted by a medication that increases the production of serotonin.
Phobias, panic attacks and eating disorders are usually associated with OCD complications. Attention deficit hyperactivity disorder is usually another disorder associated with OCD. Unfortunately, if OCD is complicated with these disorders and makes a diagnosis of OCD.
There are several medications used to treat OCD. Prozac, Anafranil and Paxil are just a few of the many medications used as treatment. There are a lot of side effects associated with these medications. Some of the side effects include dry mouth, nausea and vomiting, drowsiness and possible change in sexual abilities. It is important to inform any patient that begins any of these medications to not expect results immediately and that it can take up to several weeks for any decrease in symptoms. The OCD patient must also know how dangerous it is to discontinue taking the medications after they have been on them for a long period of time because the symptoms of OCD may return and be even more extreme than before.
OCD patient’s can also be treated by a type of therapy that deals specifically with behaviors. During this therapy regime the patient will be asked to not perform the usual rituals that normally help control their fears. The therapist may ask the patient to use a public rest room and only wash their hands one time. This patient is usually disturbed by germs and will wash repeatedly until he/she feels they are clean. If able to complete this task, the patient is usually considered a mild case and will be able to continue therapy without medications. This is one of the reasons that it is so important to consult a doctor as early as the first sign of symptoms appear.
Many people may have or experience some of the symptoms or thoughts associated with OCD, but are able to control or eliminate the thoughts without any real problems. Being able to rid of the thoughts and not let them consume you is what the OCD patients are lacking. Once this happens and the patient is starting to feel the thoughts and ideas more often, they become more and more agitated which causes the symptoms to worsen. A lot of times a patient with OCD can hide that disease and cope while in front of any coworkers or family and friends. These patients are not considered dangerous or crazy, but the anxiety is sometime overbearing and very complicated. The patients need to keep the disease a secret may only increase the anxiety levels and cause the symptoms to worsen.
During intense episodes of OCD symptoms the patient may have the notion to escape or avoid any ideas or thoughts he/she are having. Some of the behaviors you may see first is the repeated words or upset phrases that they use when they begin to lose control. One way for us to get a true feeling of what they are going through is remember when you get a song stuck in your head and you can’t get it out and you sing it over and over. Well this is how they are feeling all the time and have no way of controlling when it starts and when it stops. A lot of these patients will use a method of problem solving as a way of controlling the situation and attempting to rid of the thoughts and ideas that are becoming intense. During some of these episodes there will be an intense sense of superstitious- ness. This will cause events that will make numbers take on a different meaning like possibly a negative number brining on a negative event. Or a positive number bringing on a positive event or happening. A lot of times this patient will take on to counting and touching rituals until he/she can get a safe number and can move forward safely without any bad happenings. This type of symptoms doesn’t always have to be numbers, it can be other superstitions ads well. Some OCD patients will walk completely out of their way, walk sideways, backwards or stand still for long periods of time to avoid walking on cracks or under a ladder. This is a very strong sense of demise for the patient and they will avoid it at all cost.
The OCD patient can become involved in over excessive feeling of responsibility. This is basically when the patient feels deep concern for someone else and not themselves. They are truly concerned with the well being of another person or a group of people or society. The person with this disorder will attempt to steer clear of others in order as to not affect them with any germs or disease. Or the patient may pray for no harm or disease to come to anyone or any individual. You may find this type of OCD patient encouraging others to over cleanse themselves or certain areas to prevent the spread of disease or germs, but at the same time does not fear that he/she is in danger. A person with this type of disorder will obsess over another person’s danger or distress. These types of OCDs are extremely hard to treat because they are extremely anxious and hold a lot of guilt for feeling like they are responsible for causing the problems.
Another type of disorder that is associated with OCD is dysmorphia, which is when a person focuses on one body part and sees this body part as deformed or vulgar. Although others see nothing wrong with the limb or body part, but the deformity is truly seen and unacceptable to the OCD patient. This condition will become so severe that the patient will have multiple consults and surgeries for this deformity. They will spend a long time in front of mirrors examining the body part and obsessing over the problems they see with it.
There are so many different types of symptoms or problems that OCD patients experience. This one is basically involved with the sense of smell. During the episodes of this disorder, the patient may feel they smell bad or funny and become totally obsessed with their smell. They continuously ask people close by if they smell that odd smell and attempt to describe what it is they smell and see if anyone else smells it as well. Most often when they are obsessing over the smell, it involves their breath or feet and could also be the genitalia area or under their arms. Socially this is very bad for the patient because they fear public events or they are continuously going into the restroom to check and see if they can control or confine the smell so no one else can smell it. It is a very difficult disorder to over come.
The OCD patients will often be diagnosed with something called to hypchondriasis and will cause the patient to believe that they are cursed with a disease such as cancer or some other terminal disease in which they are dying. They will research the disease and become completely concealed in the disease and its symptoms and will continue to report symptoms that they discovered in their research.
Physicians have a very difficult time while treating a patient with OCD because there are so many different diagnoses that go with the disease itself. There are many different causes that contribute to the disease process and it can be based on biological and psychological factors. Some physicians will blame it on the structure of the patient’s brain or family genetics, but most of it is completely unclear and relate differently in each patient.
While many physicians struggle with how they should treat the patient’s disorder or the complications extending from the disorder, most will rely on behavioral theory or therapy. The majority of therapist can show that OCD can be treated by using the therapy on one ritual and then enforcing the same therapy on all other rituals that are apparent or immersing. Basically when attempting this therapy the patient must face his/her obsessions and be able to deal with each one individually and try to conquer them. While the patient is going through this therapy the bases of this therapy is using visual imagery and making the patient confront their obsessions. During the therapy the use a series of lessons that expose the patient to areas of his/her obsessions and make them see and deal with the obsession. Once the patient faces their fears they don’t tend to have the same impact on the patient as before.
Another type of therapy that physicians use focuses on blocking the compulsions. The patient will focus on blocking their obsessions from entering their thoughts. The patient must physically prevent the suggestions of ideas from starting. The idea also has a lot to do with associating a negative experience with the compulsion and this helps the patient to not want to go back to these thoughts and block them out. The more negative associations with this obsession will only further prevent and block the disorder from surfacing. This could be a very difficult task for a patient who obsesses about germs and dirt and having to expose themselves to the dirt and germs.
This is why it very important on how you plan to treat your OCD and understand how critical the treatment is to the OCD and any additional disorders. The therapist may have the patient record all activities associated with any ideas or fears. The steps in reducing the obsessions are very critical and should be followed without any type of skipping steps or deciding to move ahead to fast. The duration and exposure should be well planned out as to not allow the patient to take on more than they should and prevent the patient from wanting to attempt the therapy again. Medications are often given in this stage of treatment to reduce or control the levels of anxiety that patient may experience. During these stages of therapy the families should be encourages to support the patient as much as possible. While educating the families on the therapy it is important on coaching them with what types of help they should provide and what they should and should not say to the patient during the therapy. If blocking and exposing the patient to their fears and obsession do not appear effective, there is a possibility that they may need medications or other types of therapy. There are many different ideas about treating with or without medications and your physician will determine the best treatment for you. If all else fails they may need to resort to medications and with a lot of medications if they work they should be encouraged and used. Each medication is tested and it is determined by the severity of the OCD and its components.
While comparing the medications to each disorder, they may compare some medications with some behavioral therapy and combine two different types of treatment. Explaining the risks of each medication is very important while treating your patient. Thoroughly going over all advantages and disadvantages of each medication and that the patient should document all changes noted while on the medication as to make a note of any improvement of the condition.
While the patient is being diagnosed and treated, hospitalization rarely occurs. The patient’s therapy usually is done by office visits and extensive therapy sessions. The patient is even encourage to get involved in group therapy and find out what works for others and what doesn’t work for others. The OCD patients that are severe and tend to have convulsions and seizure disorders may have to have extreme therapy that involves electroconvulsive therapy and psychosurgery. This type of therapy is for severe cases and is used as a last resort in an attempt to treat the disorders.
Once treatment is started, there is a possibility for potential complications. Your patient may not want to finish treatment and stop coming to therapy. In this sense your patient may have a major set back and therapy may be harder to get under control once therapy has stopped. A lot of the fault is based on the patient’s non-compliance to taking or buying their medications, or finding transportation to their therapy sessions. That is why it is extremely important to inform the patient of the severity of the complications if therapy is interrupted at all. Once therapy is stopped and the patient is not attempting to get themselves back on the regime, they may start to experience new obsessions that will be in addition to the ones prior to the treatment program.
Patients may have problems at home or at work that will complicate the therapy. There is even the fact that the patient at times may have a fear or a hard time dealing with letting go of there obsessions and no longer having the compulsions. They become so dependent on the behaviors it is hard for them to function normally and become very fearful of letting go.
The more the disease is studied and the more cases that are treated, the better we understand the disease and how it should and can be treated. There is a lot that we still don’t know and soon will find out as we use all our resources to determine what can be done for the patients and how each individual therapy and medication can help. Future drug treatments will evolve and will make a huge impact on how we deal with the OCD patients in the future.
References
Grohol, John. Obsessive-Compulsive Disorder (OCD). Dr. Grohol’s Psych Central. 15 Feb. 2006 .
Obsessive-Compulsive Disorder. 24 OCT. 2001. Mental Help Net. 15 Feb. 2006 .
Obsessive-compulsive personality disorder. 7 Feb 2006. MedlinePlus Encyclopedia. 15 Feb. 2006 .
Obsessive-compulsive personality disorder. 2005. Internet Mental Health. 15 Feb. 2006 .
Phillipson, Steven. New Publication Available. OCDOnline. 15 Feb. 2006 .
