OBSESSIVE-COMPULSIVE DISORDER


A person with this disorder will have obsessions and compulsions that occupy a lot of his/or her time and cause significant distress or impairment. The obsessions or compulsions will attempt to be ignored, suppressed, or eliminated. With this disorder, individuals do realize that the obsessions or compulsions are excessive and are created by their own minds. Obsessive-Compulsive Disorder (OCD) is chronic and tends to occur mostly with women.


Obsessions are repetitive ideas, images, or impulses that intrude into the individual's thinking. They are unwanted, distressful and are sometimes frightening and violent. An example of a frightening obsession is the impulse to jump in front of a car or the concern that the individual may attack a spouse or child. The person may ruminate endlessly about locking the door or turning off the stove. Compulsions are often obsessions made manifest. Common compulsions include counting, hand washing, and cleaning. Compulsions may become ritualized to the extent that they take up huge amounts of time. These rituals are often based on magical thinking (e.g. clapping my hands 50 time will prevent my mother from dying).


OCD afflicts 2% of the population and sometime remits spontaneously. Approximately 8% of first-degree relatives of OCD patients are also afflicted. Symptoms often begin in the 20s and have an episodic course. One of the differential diagnostic factors in OCD is the discomfort that the rituals cause. Sometimes, schizophrenics exhibit rituals, however, they are usually comfortable with them. OCD can reach psychotic proportions. Use caution not to overdiagnose Schizophrenia.


The theoretical approaches used in this disorder are behavioral, cognitive-behavioral, and rational emotive. Exposure and response prevention are the most successful for ritualizers. Patients with obsessions respond best to imaginal exposure and thought stopping. Patients with moderate to severe symptoms are prescribed psychotherapy and medication.


First, you will need to conduct an assessment and establish a working relationship so you can motivate the client for treatment. During the intervention phase, you will need a thorough clinical history including a psychosocial and family history. You will then need to determine if the behavior is ego-syntonic or ego-dystonic. Next, an agreement should be made with the patient on treatment goals and strategies. Finally, discuss the treatment and benefits with the patient so you can increase motivation.


Medication provides rapid change. Behavior therapy should always be used as a complement to medication for long-term change. One should be cautious that the patient does not leave therapy prematurely once he/or she receives some relief from the medication. Patients with OCD tend to have little insight into deeper aspects of their intrapsychic world. Obsessions and compulsions are means of keeping oneself unaware of more painful or unacceptable parts of oneself. Relief from these symptoms often significantly reduces the desire for treatment. It is vital that the clinician develop a strong therapeutic alliance and not push any "uncovering" work. Generally, the clinician should keep the focus on short-term and long-term symptom relief. Medication should be considered short-term relief, and behavioral psychotherapy should be framed as important for long-term change.