Obsessive Compulsive Disorder
Diagnostically Obsessive compulsive Disorder (OCD) is defined by the occurrence of unwanted and intrusive obsessive thoughts or distressing images; these are usually accompanied by compulsive behaviors designed to neutralize the obsessive thoughts or images or to prevent some dreaded event or situation. More specifically according to DSM – IV obsessions involve “recurrent and persistent thoughts, impulses or images”. That is experienced at some time during the disturbances, as intrusive and inappropriate.
The person attempts to ignore or suppress such thoughts, impulses or images or to neutralize them with some other thoughts or action. Compulsions involve “repetitive behaviors (for e.g. hand washing or re-checking of things) or mental acts (for e.g. praying, counting, repeating words silently)” that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however these behaviors either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive (DSM – IV 1994). In addition, the person must recognize that the obsession is the product of his own mind rather than being imposed from outside (as might occur in schizophrenia). It is also now recognized that there is a continuum and insight among obsessive – compulsives about exactly how senseless the excessive their obsessions and compulsions are (Riggs & Foe 1993). In most cases those people do have some recognition that their behavior is irrational, but they cannot seem to control it in minority of cases this insight is absent for most of the time. Finally the DSM – IV diagnosis requires that this seemingly involuntary behavior cause a person marked distress, consume excessive time (over an hour a day) or interfere with occupational or social functioning.
Most people with obsessive compulsive disorder experience both obsessions and compulsions. Although earlier estimates were that as many as 25% experienced pure obsessional disorder without any compulsive rituals (Ranchman & Hodgson 1980). Recent estimates from research conducted in the development of the DSM – IV are that over 90% experience both obsessions and compulsions.
Most of us have experienced minor obsessive thoughts, such as whether we remembered to lock the door or turn the stove off. In addition, most of us occasionally engage in repetitive or stereotyped behavior, such as checking the stove or the lock on the door, or steeping over cracks on a side walk. In the case of obsessive compulsive disorder, the thoughts are much more persistent and distressing. They generally appear irrational to the individual and along with the associated compulsive acts, they interfere considerably with everyday behavior. Nevertheless research indicates that normal and abnormal obsessions and compulsive behavior exist on a continuum.
Obsessive thoughts may center on a variety of topics. In one study the most frequent themes of obsessions were contamination (55%), aggressive impulses (50%), the need for symmetry (37%) somatic concerns (35%) and sexual content (32%) (Jenike etal 1986). Study of Obsessive compulsive disorder conducted in India revealed a similar range of themes, although the proportions showing obsessions about aggression and sex were somewhat smaller (Akhtar etal 1957).
As is the case of with obsessive thoughts, many of us show some compulsive behaviors, but without the degree of compulsiveness of people with obsessive compulsive disorder, who feel compelled to perform repeatedly the acts that seem pointless and absurd even to them and that they in some sense do not want to perform. What seems consistent across nearly all the different obsessive compulsive disorder is – (a) anxiety is the affective symptom (except with primary obsessional slowness); (b) nearly all people afflicted with Obsessive compulsive disorder(OCD) fear that something terrible will happen to themselves or others for which they will be responsible and (c) compulsions usually reduce the anxiety at least in the short term. Further it has been observed that most patients with obsessive compulsive disorder are continually worried about the possibility that something terrible will happen.