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?

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