Obsessive-compulsive Disorder

OCD is an anxiety disorder where clients resort to ritual behaviour to try to gain control over dangerous events in their life. These dangerous events come in the form of impulses, images, and/or thoughts. These must be avoided at all costs because if they are experienced they can have the same intensity as the original trauma which was encoded.

Obsessional symptoms frequently are identified in areas related to: dirt, contamination, aggression, violence and religion.

DSM-III-R defines obsessions as persistent, recurring ideas, thoughts, or impulses. These thoughts, doubts, or fears may constitute an endless round of thinking, preoccupation with death or the worst happening, anxiety or guilt.

Compulsions have been classified into ritualistic behaviours in the areas of cleaning, checking, avoiding contaminating substances, counting rituals, and doing activities in slow motion, subdividing each activity into a number of stages. These serve as a neutralising function for intrusive internal, obsessional thoughts.

Intrusive thoughts in clients are more prevalent when clients are depressed and anxious. When there are periods of highly stressful periods the incidence of these rituals increases.

With OCD, clients are constantly in the throes of aversive, uncontrollable thinking processes. In the first instance clients resist these thoughts and develop other thoughts and behaviours to attempt to neutralise these compulsions. Because these negative thoughts are not controllable and are extreme examples of invasiveness there can be feelings of utter helplessness and correlate highly with depression.

In the first stage of assessment diagnostic tests are used to look at the areas of: -

1) Checking
2) Washing
3) Doubting
4) Slowness in tasks

Both an analysis of obsessional symptoms and personality traits are measured as well as levels of anxiety and depression.

Clients are also encouraged to self-monitor the frequency and duration of their obsessive thoughts as well as the intensity this distress has caused. Also, the nature and frequency of ritualistic behaviour is monitored.

CBT works in the first part of the treatments to bring anxiety and depression scores into the normative range. Standard CBT is used to teach clients the relationship between their thoughts, feelings and their OCD behaviours.

The preferred treatment is exposure when clients are prevented from performing rituals and were exposed to the circumstances that caused their compulsive behaviour, these rituals which have come to be associated with safety and protection, clients are forced to face their worst fears.

The origins of OCD

Evidence seems to point to the view that clients have learned that some of their thoughts are dangerous. These thoughts have then become encoded with strong negative emotions (tension, fear, panic, dread).

A combination of biological vulnerability to stress and learned responses within the home environment combine to increase the predisposition to developing OCD.

CBT/OCD Bandura (1977) theorised that increasing ones sense of self-efficacy or competences is the single goal in all successful anxiety therapies. CBT uses exposure to the feared compulsion whether directly by behavioural experiments or by visualisation to change the way that overvalued ideas are processed.

It is the way that information like fear of the worst happening are continuously present that produces this emotional processing.