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Obsessive-Compulsive Disorder Treatment
What causes obsessive-compulsive disorder?
There are many theories as to what is behind this disturbing disorder. One prominent trend is that anxiety disorders develop when children fear their own unconscious impulses and use defense mechanisms to reduce the resulting anxiety. Obsessive-compulsive disorder is distinguished from other anxiety disorders by the fact that the battle between the internal impulses that cause anxiety and the defense mechanisms that reduce anxiety is not buried in the unconscious, but takes place in expressed and dramatic thoughts and actions. Internal impulses usually take the form of obsessive thoughts, and defenses take the form of counterthoughts or compulsions.
Bridges to Recovery understands the suffering that occurs when an individual has this psychiatric disorder. Residential treatment in our community helps the individual learn to deal with underlying problems. Our clinical treatment approach includes individual therapy four times a week and regular visits to a psychiatrist. Recognizing the opportunities for time between impulsive thoughts and impulsive behaviors is part of the recovery process.
An excerpt from Macbeth…
Doctor: What are you doing now? Look how he rubs his hands.
Gentlewoman: It’s a habit with her, she seems to wash her hands that way. I knew he would go on for a quarter of an hour.
Lady Macbeth: Yet there is a place here. In the damn place! Who will I say!… Still, who would have thought that there was so much blood in the old man?” (Macbeth, Act V, Scene 1)
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unwanted, distressing, and persistent thoughts or ideas. Thoughts seem intrusive and foreign to the people experiencing them. The thought can be offensive because it represents an overtly sexual or aggressive thought, or it can be neutral. Attempts to ignore or resist these thoughts can create more anxiety and soon return stronger than ever. In obsessive-compulsive disorder, obsessions are not just thoughts; rather, urges to perform some disturbing act. People with OCD rarely act out their hostile or sexual fantasies, but they are terrified of doing so. They are aware that their thoughts are excessive and inappropriate, yet they find them repulsive and painful.
Excerpt from Spitzer
“He now spent hours every evening ‘re-processing’ the day’s events, especially his interactions with friends and teachers, and endlessly ‘fixing’ all his regrets. He likened the process to playing a video of each event over and over again. his mind, asking himself if he had done the right thing, and telling himself that at every step he did his best, or at every step he said the right thing. He did this while sitting at his desk, supposedly studying; and it was not unusual that. after such rumination, look at the clock and notice that, to your surprise, two or three hours have passed” (Spitzer et al., 1981, pp. 20-21).
Compulsive actions are another component of the disability syndrome. These are repetitive actions that the individual feels compelled to perform without understanding why. If you’ve ever gone on vacation and come home to check that you’ve locked the front door or left the oven on, you may have some insight into the relationship between obsessive thought and compulsive action. Behaviors or “rituals” are often performed in hopes of preventing or stopping unwanted thoughts and reducing anxiety. Compulsive rituals provide only temporary relief, but failure to perform them dramatically increases anxiety. Common sources of anxiety for OCD sufferers include contamination with germs or dirt, repeated washing by the sufferer, incessant doubt that causes locks, doors and windows to be checked over and over again, or a desire for order that requires straightening, repeating words , praying or counting. These symptoms cause significant distress and interfere with daily life. People with OCD often recognize that their behavior is excessive or unreasonable. But they are powerless to stop them. This can make suffering embarrassing and unbearable.
Here is an example that vividly conveys obsessional symptoms and their intimate relationship with compulsive actions:
“Shirley K., a twenty-three-year-old housewife, came to the clinic with complaints of frequent headaches and dizziness. Over the past three months, recurring thoughts worried that she might harm her two-year-old son, Saul. , either by stabbing or strangling [the obsessive thought]. She had to constantly go into her room and touch the baby and feel the air to reassure herself that Saul was alive. [the compulsive act]; otherwise he became unbearably nervous. If he read an account of a child’s murder in the daily paper, he became agitated because it reinforced his fear that he too was acting on her impulse. Shirley turned to the interviewer and asked frantically if this meant she was ‘going crazy’” (Goldstein & Palmer, 1975).
However elaborate the sufferer’s complex of obsessive thoughts and compulsive rituals, they do not reduce anxiety. Most people with obsessive-compulsive disorder report constant tension and dissatisfaction with their lives, and it is not unusual for this dissatisfaction to merge unnoticed into feelings of depression.
Example of an interview
Patient: If I heard the word something that had to do with germs or disease, I would label it as something bad, and so things would go through my mind like “cross this out and everything’ll be fine” hearing that word.
Interviewer: What things?
Patient: Like numbers or words that seemed to be protective.
Interviewer: What numbers and words were these?
Patient: In the beginning it was the number 3 and multiples of 3, then words like “soap and water”, something like that; and then the multiples of 3 got really high and you end up with 124 or something like that. Then it got really bad. (Spitzer et al., 1981, p. 137)
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