It was 9:30 a.m., and Nancy, a 36-year-old attorney, had arrived late for work
again. Nancy knew she needed to catch up on her legal assignments, but a
familiar worry nagged at her. No matter how hard she tried, Nancy could not
dislodge the thought that she had left a pot burning on the stove. The image of
her home engulfed in flames was so vivid she could almost smell the smoke. Nancy
tried to shut the thought out of her mind, reassuring herself that she had
turned the gas jet off. But even remembering her hand touching the cool stove
burner-a precaution she took whenever she left the house-still left her
wondering whether she had checked carefully enough. The pot and stove were not
all that had been on Nancy’s mind that morning. For Nancy, leaving the house
entailed a time-consuming routine designed to ensure that no major or minor
disaster-such as a fire, burglary, or household flood-would strike while she was
away. Like a pilot preparing for take-off, she would spend more than an hour
checking and rechecking that all appliances were turned off, all water faucets
shut, all windows closed, and the doors to the house securely locked. Except for
necessities such as work, Nancy avoided going out because it meant performing
this arduous routine. But even these measures were not enough to keep her from
worrying. A few weeks earlier, Nancy had hit on the idea of documenting that
everything was safe before she left home. Now, sitting at her desk, she pulled a
completed checklist from her purse and reviewed it to see if the “stove and
oven” item and been marked off. At first, she felt relieved to see that it
was. But then a new thought struck: What if this wasn’t today’s checklist?
Panic overtook reason. Nancy dialed the local fire department and asked that
truck be sent to investigate a fire at her house. (Goodman, 1994, pp 103, 104)
The first modern description of OCD was provided in 1838 by Jean-Etienne
Dominique Esquirol, a French psychiatrist. Esquirol called the disorder the
folie de doute, or doubting madness, and suspected it was rooted in a physical
problem in the brain. During much of the 1900’s, psychoanalytic theories
dominated the study of OCD. Many psychoanalytic theorists believed OCD
originated from conflicts early in a child’s development over such issues as
toilet training. (Goldman, 1994, p.104) Researchers theorize that an antibody
may actually cause OCD. The antibody called D8/17, is produced to fight
streptococcus bacterium that causes rheumatic fever. However D8/17 may attack
healthy cells in the brain’s basal ganglia region, which helps control basic
movement sequences, such as walking or eating. (Klobuchar, 1998, p.266) The
obsessions or compulsions must cause marked distress, be time consuming (take
more than 1 hour per day), or significantly interfere with the individual’s
normal routine, occupational functioning, or usual social activities or
relationships with others. Obsessions or compulsions can displace useful and
satisfying behavior and can be highly disruptive to overall functioning. Because
obsessive intrusions can be distracting, they frequently result in inefficient
performance of cognitive tasks that require concentration, such as reading or
computation. In addition, many individuals avoid objects or situations that
provoke obsessions or compulsions. Such avoidance can become extensive and can
severely restrict general functioning. (Diagnostic and Statistical Manual of
Mental Disorders, 1994). Symptoms of OCD include repetitive, ritualized
behavior, such as counting, hoarding objects, or handwashing; obsessive fear of
threats, such as germs; or a fear of committing violent acts. (Klobuchar 266)
The American Psychiatric Association classifies OCD as an anxiety disorder.
People with OCD suffer from persistent and disturbing thoughts, images, or
impulses, called obsessions. They relieve the anxiety caused by their obsessions
through compulsions-repeated behaviors that they feel driven to perform.
(Goodman, 1994, p.104) The DSM-IV defines obsessions as recurrent thoughts,
images, or impulses that are anxiety-provoking and are perceived as intrusive or
senseless. (Gragg ; Francis, 1996, p.1) The intrusive and inappropriate
quality of the obsessions has been referred to as “ego-dystonic.” This
refers to the individual’s sense that the content of the obsession is alien, not
within his or her own control, and not the kind of thought that he or she would
expect to have. However, the individual is able to recognize that the obsessions
are the product of his or her own mind and are not imposed form without (as in
thought insertion). (Diagnostic and Statistical Manual of Mental Disorders,
1994). Obsessions typically fall within seven major categories. i.e.
Contamination obsessions, which typically involve excessive concerns about
germs, disease, and cleanliness. Somatic obsessions, which are persistent,
repetitive thoughts about physical concerns. Children may experience intrusive
thoughts that they have a tumor or that they are developing sensory impairments.
Sexual/Aggressive obsessions typically involve recurrent thoughts or images that
one has committed an unacceptable sexual or aggressive thought or act in the
past or is likely to do so in the future. Hoarding obsessions are worries that
things should not be thrown away just in case they might be needed later.
Doubting obsessions are incessant worrying that one will be responsible for a
terrible consequence resulting from one’s failure to fulfill an obligation or
complete a task correctly. Religious obsessions typically involve thoughts about
committing or having committed an immoral act or sin. And lastly, a need for
symmetry and exactness. These obsessions are characterized by excessive concern
about putting objects in a specific position, scheduling events in a certain
order, doing and undoing motor acts in an exact fashion, or making sure that
things are precisely symmetrical. (Gragg ; Francis, 1996, pp.2,3) The
individual with obsessions usually attempts to ignore or suppress such thoughts
or impulses or to neutralize them with some other thought or action (i.e., a
compulsion). For example, an individual plagued by doubts about having turned
off the stove attempts to neutralize them by repeatedly checking to ensure that
it is off. (Diagnostic and Statistical Manual of Mental Disorders, 1994). The
DSM-IV defines compulsions as repeated behaviors or mental acts that a person
feels compelled or driven to perform, either in response to an obsessions or
according to a self-imposed, rigidly applied rule. (Gragg ; Francis, 1996,
p.4) There are six major types of compulsions. The most common compulsion is
washing, bathing, or cleaning to relieve an obsessive fear of contamination from
germs, dirt, or some imagined source. Washers may scrub their homes or bathe
until their skin is raw before they feel safe from the imagined danger. Checkers
may find themselves repeatedly driving back over a stretch of road to confirm
that they haven’t accidentally hit a pedestrian. (Goodman, 1994, p.107)
Washing and cleaning compulsions typically involves excessive washing and
cleaning of oneself and one’s surroundings, as well as active avoidance of
objects, places, or persons considered to be unclean. Checking compulsions
typically consists of an overwhelming urge to check and recheck objects and/or
actions. Repeating compulsions involve redoing physical or mental acts a certain
number of times or until it feels just right. Counting compulsions include
rituals that include having special or lucky numbers that dictate the number of
times they must do, say, or think things. Ordering compulsions are typically
associated with the obsessions involving the need for symmetry and exactness.
Hoarding compulsions are rituals that often occur in response to hoarding
obsessions, that involve the inability to throw things away or the need to
collect useless objects. (Gragg ; Francis, 1996, pp.4-6) OCD was once
thought to be rare. It is now estimated that up to 3 percent of the U.S.
population may suffer from OCD at some point in their lives (about 5 million
people). The disorder usually begins in adolescence or early adulthood, but it
may also occur in childhood. (AMI/FAMI). By definition, adults with
Obsessive-Compulsive Disorder have at some point recognized that the obsessions
or compulsions are excessive or unreasonable. This requirement does not apply to
children because they may lack sufficient cognitive awareness to make this
judgment. (Diagnostic and Statistical Manual of Mental Disorders, 1994) The
exact causes of OCD are still unknown. However, researchers strongly suspect
that a biochemical imbalance is involved. Alterations in one or more brain
chemical systems that regulate repetitive behaviors may be related to the cause
of OCD. These imbalances may be inherited. Psychological factors and stress may
heighten symptoms. (AMI/FAMI). We do not know why OCD bothers each person in a
different way. It does seem that it is almost as if OCD ‘knows’ what would
bother you the most and hones in on that. For example, if you are a particularly
religious person you might be plagued by repugnant religious OCD thoughts that
are a lot more upsetting to you than they would be to a person with below
average concern about religion. (National Anxiety Association). It has been
hypothesized that there is a relationship between OCD and the neurotransmitter
serotonin. Support for this theory is based primarily on evidence that OCD
symptoms decrease in response to treatment with medications that affect
serotonin levels. (Gragg ; Francis, 1996, p.8) In the 1960’s and 1970’s,
psychiatrist announced that a drug called clomipramine (trade name Anafranil)
was effective in treating OCD. After a nerve cells releases serotonin, it
reabsorbs any serotonin not captured by an adjoining nerve cell. This process,
known as serotonin reuptake, acts to recycle serotonin, making it available for
later use. Clomipramine and related drugs block the reuptake of serotonin,
preventing its return to its home nerve cell. (Goodman, 1994, p.112) In March
1997, the FDA approved the use of the drug fluvoxamine maleate, or Luvox,
previously approved to treat adults, prevents the neurotransmitter serotonin
from being reabsorbed into neurons. An inadequate level of serotonin in the
synapses between neurons has been linked to several mental illnesses including
OCD. (Klobuchar, 1998, p.266) Overall, my personal experience with OCD in my
family has really opened my eyes to many issues. Although many people laugh
about it, and consider OCD sufferers “crazy,” it is a very serious and
ailing disease. It has the potential to ruin a marriage or a family if not
treated accurately and quickly. I think that it would be an incredibly benefit
for people to take interest in this disease and other related disease, to better
aware themselves of worldly issues, that may, at one time or another, have
potential to affect their life.
Bibliography
Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). (1994).
American Psychiatric Association. Francis, G., ; Gragg, R. A. (1996).
Childhood obsessive compulsive disorder. London: Sage Publications. 1-6, 8
Goodman, W. K. (1994). The World book health and medical annual 1994. Chicago:
World Book. 103-104, 107 Jaffe, D. J. (1998). All about obsessive disorders (OCD)
and mental illness. New York: AMI/FAMI Klobuchar, L. (1998). The World book
health and medical annual 1998. Chicago: World Book. 266 National Anxiety
Association. (1992-1999). Obsessive-Compulsive Disorder. Kentucky: National
Anxiety Association.
