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Obsessive Compulsive Disorder, Plagued by Doubt

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Do you know anyone who cannot make a decision because they are always doubtful? Are you married to someone who is frozen in place because they cannot decide what house to buy and in what neighborhood? If this sounds like you, your spouse or someone you know then the problem could be Obsessive-Compulsive Disorder(OCD).

Some definitions:

According to the Diagnostic and Statistic Manual Volume 4(DSM 1V), "obsessions are persistent ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate." These thoughts cause enormous discomfort and anxiety to the individual experiencing them. Therefore, persons experiencing obsession are aware of what they are, try to suppress them and experience increased anxiety because of their inability to stop them. It is akin to having a song you recently heard go through your head repeatedly despite the fact that you want it to stop.

Compulsions are repetitive behaviors or mental acts whose purpose is to reduce anxiety but end in increasing anxiety and frustration. Here too, the individual is aware that the behaviors are inappropriate and useless, yet they cannot be stopped because of the felt strength of the need to perform them. Examples of compulsions are such things as repeatedly: hand washing, checking (to see if windows are shut, doors closed and locked, etc.), turning off the stove and, counting numbers, words, prayers and etc. Often compulsions accompany obsessions as with children who sing: "step on a line, break your mother’s spine," as they skip along a side walk avoiding cracks. In fact, childhood is a time when children normally experience obsessions and compulsions as in this example. The adult is someone who continues to experience these long after what was stage appropriate during childhood.

Doubt:

One of the driving forces of the compulsions is chronic doubt. Doors, windows, locks and other things must be checked repeatedly because of the fear that something has been overlooked despite repeated efforts.

Many patients have provided me with examples of these doubts. One example described to me was a twenty five year old man who, each time he drove into his parking space at work, would feel a compulsion to check the car windows and doors repeatedly. Then, as he walked away from his vehicle, he was plagued by a gnawing doubt that a window or door was left open. Regardless of how he tried to reassure himself that all was safe and secure,he would have to return to his car again. There were times when, despite having arrived at work early, he made himself late because of the need to repeat this ritual.

People with OCD do not find any of this to be comical. In fact, it causes them considerable emotional pain because they cannot stop what they know is absurd. Very often, they attempt to keep these rituals secret for fear of being embarrassed and humiliated. Once married, these individuals often attempt to enlist family members in performing the same rituals, such as checking windows, doors and stoves. There was one person who had an absolute need to have his wife shut the television off only when it is dialed to channel four. The thought that the television might be on any other channel, despite its being turned off, was intolerable.

Severity:

OCD is always experienced as distressing and often interferes, to one degree or another, with functioning in work and social life. However, there are degrees to which these symptoms interfere.

For instance, there are individuals whose symptoms are so very severe that they cannot leave the house. This is due to the fact that there are too many rituals that must be performed and the anxiety about leaving home can become so severe that the individual must remain at home.

I have seen examples of OCD hand washing that is so severe that the hands become reddened and severely chapped.

Then, too, obsessions can become so distracting that work performance suffers either at school or the work place.

It is also common to have this disorder associated with Major Depression and Phobias of all types.

One of the most common obsessions connected with OCD are hypochondriases. In this case, there is a chronic preoccupation with worries about health and exposure to infection and disease. I have seen many OCD patients who were unable to stop worrying that something might have caused them to develop some dread disease. In most cases they were aware that their fears were unfounded. However, in the worst cases, there can be little insight and the complete failure to dismiss these health worries.

A Common Factor:

Most of those with OCD and associated features believe they are responsible for the health and well being of others. Their obsessions contain fears that if they do not perform their rituals death or injuries can occur to loved ones.

Somewhat less common but very real in many cases of OCD is the presence of Tourette’s Disorder. Tourettes is marked by constant involuntary movements, twitches, and sounds over which the individual has no control. It is estimated that some 35 to 50 percent of severe cases of OCD also have Tourettes.

Treatment:

It is important to know that, untreated, OCD can worsen so that it spreads and can become paralyzing.

Cognitive Behavioral Therapy(CBT) and Behavior Modification are usually recommended for OCD. CBT enable patient and therapist to reveal the unrealistic or automatic thoughts that increase anxiety and depression. This technique teaches the patient how to modify their thinking to become more realistic, thereby reducing the exaggerated fearful thoughts that lead to OCD. However, there are times when this is not enough. Under those circumstances, Behavior Modification is used to help a patient overcome their obsessions and compulsions. Two behavior modification techniques are "flooding" and "blocking".

Flooding is a technique whereby the therapists require the compulsive behavior be repeated by the individual over and again until they are literally sick of it. If there are several compulsions, each is treated in this way until they are all eliminated.

Blocking is a technique whereby the therapists prohibit the patient from performing the ritual behavior regardless of their desire, motivation and demand that it be done. Each compulsion is blocked until they are all eliminated.

There are many cases in which medication is combined with therapy to reduce and end the OCD. Primarily there are two categories of medications used: Anti anxiety drugs and Anti depressant drugs. Because it is believed that OCD results from a deficiency of serotonin in the brain, anti depressants such as SSRI’s are used to boost serotonin brain levels and relieve the symptoms. Examples of these medications are Prozac, Zoloft and similar drugs.

Tell us about your experiences with OCD.

Keep Reading By Author Allan Schwartz, LCSW, Ph.D.
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