Ocd Disease

OCD Disease

It was 9:30 a.m., and Nancy, a 36-year-old attorney, had arrived late for work again. Nancy knew she needed to catch up on her legal assignments, but a familiar worry nagged at her. No matter how hard she tried, Nancy could not dislodge the thought that she had left a pot burning on the stove. The image of her home engulfed in flames was so vivid she could almost smell the smoke. Nancy tried to shut the thought out of her mind, reassuring herself that she had turned the gas jet off. But even remembering her hand touching the cool stove burner-a precaution she took whenever she left the house-still left her wondering whether she had checked carefully enough. The pot and stove were not all that had been on Nancy's mind that morning. For Nancy, leaving the house entailed a time-consuming routine designed to ensure that no major or minor disaster-such as a fire, burglary, or household flood-would strike while she was away. Like a pilot preparing for take-off, she would spend more than an hour checking and rechecking that all appliances were turned off, all water faucets shut, all windows closed, and the doors to the house securely locked. Except for necessities such as work, Nancy avoided going out because it meant performing this arduous routine. But even these measures were not enough to keep her from worrying. A few weeks earlier, Nancy had hit on the idea of documenting that everything was safe before she left home. Now, sitting at her desk, she pulled a completed checklist from her purse and reviewed it to see if the "stove and oven" item and been marked off. At first, she felt relieved to see that it was. But then a new thought struck: What if this wasn't today's checklist? Panic overtook reason. Nancy dialed the local fire department and asked that truck be sent to investigate a fire at her house. (Goodman, 1994, pp 103, 104) The first modern description of OCD was provided in 1838 by Jean-Etienne Dominique Esquirol, a French psychiatrist. Esquirol called the disorder the folie de doute, or doubting madness, and suspected it was rooted in a physical problem in the brain. During much of the 1900's, psychoanalytic theories dominated the study of OCD. Many psychoanalytic theorists believed OCD originated from conflicts early in a child's development over such issues as toilet training. (Goldman, 1994, p.104) Researchers theorize that an antibody may actually cause OCD. The antibody called D8/17, is produced to fight streptococcus bacterium that causes rheumatic fever. However D8/17 may attack healthy cells in the brain's basal ganglia region, which helps control basic movement sequences, such as walking or eating. (Klobuchar, 1998, p.266) The obsessions or compulsions must cause marked distress, be time consuming (take more than 1 hour per day), or significantly interfere with the individual's normal routine, occupational functioning, or usual social activities or relationships with others. Obsessions or compulsions can displace useful and satisfying behavior and can be highly disruptive to overall functioning. Because obsessive intrusions can be distracting, they frequently result in inefficient performance of cognitive tasks that require concentration, such as reading or computation. In addition, many individuals avoid objects or situations that provoke obsessions or compulsions. Such avoidance can become extensive and can severely restrict general functioning. (Diagnostic and Statistical Manual of Mental Disorders, 1994). Symptoms of OCD include repetitive, ritualized behavior, such as counting, hoarding objects, or handwashing; obsessive fear of threats, such as germs; or a fear of committing violent acts. (Klobuchar 266) The American Psychiatric Association classifies OCD as an anxiety disorder. People with OCD suffer from persistent and disturbing thoughts, images, or impulses, called obsessions. They relieve the anxiety caused by their obsessions through compulsions-repeated behaviors that they feel driven to perform. (Goodman, 1994, p.104) The DSM-IV defines obsessions as recurrent thoughts, images, or impulses that are anxiety-provoking and are perceived as intrusive or senseless. (Gragg & Francis, 1996, p.1) The intrusive and inappropriate quality of the obsessions has been referred to as "ego-dystonic." This refers to the individual's sense that the content of the obsession is alien, not within his or her own control, and not the kind of thought that he or she would expect to have. However, the individual is able to recognize that the obsessions are the product of his or her own mind and are not imposed form without (as in thought insertion). (Diagnostic and Statistical Manual of Mental Disorders, 1994). Obsessions typically fall within seven major categories. i.e. Contamination obsessions, which typically involve excessive concerns about germs, disease, and cleanliness. Somatic obsessions, which are persistent, repetitive thoughts about physical concerns. Children may experience intrusive thoughts that they have a tumor or that they are developing sensory impairments. Sexual/Aggressive obsessions typically involve recurrent thoughts or images that one has committed an unacceptable sexual or aggressive thought or act in the past or is likely to do so in the future. Hoarding obsessions are worries that things should not be thrown away just in case they might be needed later. Doubting obsessions are incessant worrying that one will be responsible for a terrible consequence resulting from one's failure to fulfill an obligation or complete a task correctly. Religious obsessions typically involve thoughts about committing or having committed an immoral act or sin. And lastly, a need for symmetry and exactness. These obsessions are characterized by excessive concern about putting objects in a specific position, scheduling events in a certain order, doing and undoing motor acts in an exact fashion, or making sure that things are precisely symmetrical. (Gragg & Francis, 1996, pp.2,3) The individual with obsessions usually attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action (i.e., a compulsion). For example, an individual plagued by doubts about having turned off the stove attempts to neutralize them by repeatedly checking to ensure that it is off. (Diagnostic and Statistical Manual of Mental Disorders, 1994). The DSM-IV defines compulsions as repeated behaviors or mental acts that a person feels compelled or driven to perform, either in response to an obsessions or according to a self-imposed, rigidly applied rule. (Gragg & Francis, 1996, p.4) There are six major types of compulsions. The most common compulsion is washing, bathing, or cleaning to relieve an obsessive fear of contamination from germs,

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