Obsessive Compulsive Disorder

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					Obsessive Compulsive
   Since the fourth century BC, obsessional behavior was
    explained as “melancholia”, a distinct disease with
    particular mental and physical symptoms. For centuries in
    Europe, from the early Middle Ages, satanic possession was
    believed to be the primary cause of blasphemous, sexual,
    or other obsessive thoughts. Treatment involved the

   In 17th century England, the concept of "religious
    melancholy" became established as the cause of a many
    mental disorders including those with OCD-like symptoms,
    but rather religious melancholy supposedly sprang from
    overzealous devotion to God. Mental distress caused by
    religious melancholy could be cured by “the comfort of
    cheerful friends and productive work" and the avoidance of
    "solitariness and idleness".
                  History cont.
   Austrian psychiatrist Sigmund Freud believed
    obsessive-compulsive behavior is linked to
    unconscious conflicts manifested as symptoms of
    the illness. Conflict develops between the desires
    and subsequent actions of the conscious and
    unconscious minds. OCD sufferers, frequently
    "compelled" to carry out actions giving only
    temporary relief from anxiety, still "know" it’s
    ridiculous or embarrassing to do so. Freud
    developed psychoanalysis for curing OCD and
    other mental disorders through extensive
    dialogue between patient and psychoanalyst.
   Obsessions are involuntary, seemingly
    uncontrollable thoughts, images, or
    impulses that occur over and over again in
    your mind. You don’t want to have these
    ideas – in fact, you know that they don’t
    make any sense. But you can’t stop them.
    Unfortunately, these obsessive thoughts
    are usually disturbing and distracting.
   Compulsions are behaviors or rituals that
    you feel driven to act out again and again.
    Usually, compulsions are performed in an
    attempt to make obsessions go away.
             Symptoms cont.
   Most people with obsessive-compulsive disorder
    fall into one of the following categories:
   Washers are afraid of contamination. They
    usually have cleaning or hand-washing
   Checkers repeatedly check things (oven turned
    off, door locked, etc.) that they associate with
    harm or danger.
   Doubters and sinners are afraid that if
    everything isn’t perfect or done just right
    something terrible will happen or they will be
   Counters and arrangers are obsessed with
    order and symmetry. They may have superstitions
    about certain numbers, colors, or arrangements.
   Hoarders fear that something bad will happen if
    they throw anything away. They compulsively
    hoard things that they don’t need or use.
                    Symptoms cont.
                                            Common compulsive
                                             behaviors in OCD include:
   Common obsessive thoughts               Excessive double-checking of
    in OCD include:                          things, such as locks,
   Fear of being contaminated by            appliances, and switches.
    germs or dirt or contaminating          Repeatedly checking in on
    others                                   loved ones to make sure
   Fear of causing harm to yourself         they’re safe.
    or others
    Intrusive sexually explicit or
                                            Counting, tapping, repeating
                                             certain words, or doing other
    violent thoughts and images
    Excessive focus on religious or
                                             senseless things to reduce
    moral ideas                              anxiety.
   Fear of losing or not having            Spending a lot of time
    things you might need                    washing or cleaning.
   Order and symmetry: the idea            Ordering, evening out, or
    that everything must line up “just       arranging things “just so.”
                                            Praying excessively or
   Superstitions; excessive attention       engaging in rituals triggered
    to something considered lucky or
    unlucky                                  by religious fear.
                                            Accumulating “junk” such as
                                             old newspapers, magazines,
                                             and empty food containers, or
                                             other things you don’t have a
                                             use for.
   The etiology of obsessive-compulsive disorder is
    uncertain, but it appears to include a combination
    of neurological and psychological factors. The
    dominant neurochemical theory of obsessive-
    compulsive disorder suggests that the
    neurotransmitter serotonin plays a central role in
    the development of the condition. Drugs that
    increase the availability of serotonin in the body
    are effective in ameliorating the symptoms of
    obsessive-compulsive disorder, while
    nonserotonergic medications have been found to
    have little or no effect.
   There are many effective treatments for
    obsessive-compulsive disorder (OCD),
    ranging from therapy to self-help and
    medication. However, the treatment for
    OCD with the most research supporting its
    effectiveness is cognitive-behavioral
    therapy. Cognitive-behavioral therapy for
    obsessive-compulsive disorder involves
    two components- exposure and response
    prevention and cognitive therapy.
        Treatment/Therapy cont.
   Exposure and response prevention involves repeated
    exposure to the source of your obsession. Then you are
    asked to refrain from the compulsive behavior you’d usually
    perform to reduce your anxiety.
   For example, if you are a compulsive hand washer, you
    might be asked to touch the door handle in a public
    restroom and then be prevented from washing up. As you
    sit with the anxiety, the urge to wash your hands will
    gradually begin to go away on its own. In this way, you
    learn that you don’t need the ritual to get rid of your
    anxiety – that you have some control over your obsessive
    thoughts and compulsive behaviors.
        Treatment/Therapy cont.
                                     Four Steps for Conquering
                                      Obsessive Thoughts and
   The cognitive                     Compulsive Urges
    therapy component for            RELABEL – Recognize that the
                                      intrusive obsessive thoughts
    obsessive-compulsive              and urges are the result of
    disorder (OCD) focuses on         OCD.
    the catastrophic thoughts        REATTRIBUTE – Realize that
    and exaggerated sense of          the intensity and intrusiveness
    responsibility you feel. A        of the thought or urge is caused
    big part of cognitive             by OCD; it is probably related
    therapy for OCD is                to a biochemical imbalance in
                                      the brain.
    teaching you healthy and
                                      REFOCUS – Work around the
    effective ways of             
                                      OCD thoughts by focusing your
    responding to obsessive           attention on something else, at
    thoughts, without resorting       least for a few minutes. Do
    to compulsive behavior.           another behavior.
                                     REVALUE – Do not take the
                                      OCD thought at face value. It is
                                      not significant in itself.
                                     Source: Westwood Institute for
                                      Anxiety Disordersa
              Additional Therapy
   Medication – Antidepressants are sometimes used in
    conjunction with therapy for the treatment of obsessive-
    compulsive disorder. However, medication alone is rarely
    effective in relieving the symptoms of OCD.
   Family Therapy – Because OCD often causes problems in
    family life and social adjustment, family therapy is often
    advised. Family therapy promotes understanding of the
    disorder and can help reduce family conflicts. It can also
    motivate family members and teach them how to help their
    loved one.
   Group Therapy – Group therapy is another helpful
    obsessive-compulsive disorder treatment. Through
    interaction with fellow OCD sufferers, group therapy
    provides support and encouragement and decreases
    feelings of isolation.
                Current research
   is focused on a new hypothesis of OCD: that its symptoms
    may, at least in some cases, result from an imbalance in
    the brain of the neurotransmitter glutamate. This suggests
    that medications that modulate glutamate levels may help
    those patients who get little or no benefit from established
    therapies. Indeed, recent studies from the clinic, and
    elsewhere, suggest that glutamate-modulating drugs hold
    promise for some patients with difficult-to-treat OCD.
   These include riluzole, memantine, gabapentin, N-
    Acetylcysteine, and lamotrigine. MDMA, which is a powerful
    and illicit serotonergic drug, has also been anecdotally
    reported to temporarily alleviate the symptoms of OCD
   The atypical antipsychotics olanzapine, quetiapine,
    and risperidone have also been found to be useful as
    adjuncts to an SSRI in treatment-resistant OCD. However,
    these drugs are often poorly tolerated, and have significant
    metabolic side effects that limit their use.
   http://www.youtube.com/watch?v=Q

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