Obsessive–compulsive syndrome, the DSM says, involves recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and that cause marked anxiety or distress. These thoughts, impulses, or images are of a degree or type, eg preoccupations with sexual, violent or religious thoughts, that lies outside the normal range of worries about conventional problems.
Multiple psychological and biological factors may be involved in causing obsessive–compulsive syndrome.
In 80% of cases, symptoms present before the age of 18. It can be triggered by an emotional trauma, but establishing a cause and effect relationship is difficult, as in the majority it appears to arise spontaneously. It can affect any sort of person from any social background.
It has been proposed that sufferers are generally of above-average intelligence, as the nature of the disorder necessitates complicated thinking patterns.
Its sufferers commonly share personality traits such as high attention to detail, avoidance of risk, careful planning, exaggerated sense of responsibility and a tendency to take time in making decisions.
OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer’s self-concept so causes much distress.
Within and among individuals, the initial obsessions, or intrusive thoughts, vary in their clarity and vividness. A relatively vague obsession could involve a general sense of disarray or tension accompanied by a belief that life cannot proceed as normal while the imbalance remains. A more intense obsession could be a preoccupation with the thought or image of someone close to them dying. Other obsessions concern sexual obsessions that may involve intrusive thoughts or images of “kissing, touching, fondling, oral sex, anal sex, intercourse, incest and rape” with “strangers, acquaintances, parents, children, family members, friends, co-workers, animals and religious figures”, and can include “heterosexual or homosexual content” with persons of any age. People with OCD may attach extraordinary significance to the thoughts and develop obsessive fears about their sexual orientation. Furthermore, the doubt that accompanies OCD leads to uncertainty regarding whether one might act on the troubling thoughts, resulting in intense self-criticism or self-loathing.
“They depend on one’s fear of them for their very existence.”
“The greater the taboo, the more vivid, intrusive and persistent the obsession.”
“Cannot resist testing one’s own suggestibility – how bad can it be?”
Purely Obsessional OCD
OCD sometimes manifests without overt compulsions. Nicknamed “Pure-O”, could, characterize as many as 60% of cases. The person with this subtype might perform more covert, mental rituals, or might feel driven to avoid the situations in which particular thoughts seem likely to intrude. As a result of this avoidance, people can struggle to fulfil both public and private roles, even if they place great value on these roles and had fulfilled the roles successfully in the past. Moreover, the individual’s avoidance can confuse others who do not know its origin or intended purpose, as it did in the case of a man whose wife began to wonder why he would not hold their infant child. The covert mental rituals can take up a great deal of a person’s time during the day.
OCD is capable of giving rise to other conditions. For example, as with many chronic stressors, OCD can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD’s effects on day-to-day life, particularly its substantial consumption of time, can produce difficulties with work, finances, and relationships.
A genetic link is not yet established, but studies are in progress. Recent evidence supports the possibility of a heritable predisposition for neurological development favouring OCD. A mutation has been found in the human serotonin transporter gene, hSERT, in unrelated families with OCD. Moreover, data from identical twins supports the existence of a “heritable factor for neurotic anxiety”. Further, individuals with OCD are more likely to have first-degree family members exhibiting the same disorders than do matched controls. In cases where OCD develops during childhood, there is a much stronger familial link in the disorder than cases in which OCD develops later in adulthood. In general, genetic factors account for 45-65% of OCD symptoms in children diagnosed with the disorder.
People with OCD evince increased grey matter volumes in bilateral lenticular nuclei, extending to the caudate nuclei, while decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri. These findings contrast with those in people with other anxiety disorders, who evince decreased (rather than increased) grey matter volumes in bilateral lenticular / caudate nuclei, while also decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri. Orbitofrontal cortex overactivity is attenuated in patients who have successfully responded to SSRI medication, a result believed to be caused by increased stimulation of serotonin receptors 5-HT2A and 5-HT2C. The striatum, linked to planning and the initiation of appropriate actions, has also been implicated; mice genetically engineered with a striatal abnormality exhibit OCD-like behavior, grooming themselves three times as frequently as ordinary mice.
Rapid onset of OCD in children and adolescents may be caused by a syndrome connected to Group A streptococcal infections (PANDAS) or caused by immunologic reactions to other pathogens (PANS).
* British poet, essayist, and lexicographer Samuel Johnson had elaborate rituals for crossing the thresholds of doorways, and repeatedly walked up and down staircases counting the steps, and much more.
* American aviator and filmmaker Howard Hughes is known to have suffered from OCD. Friends of Hughes have mentioned his obsession with minor flaws in clothing and great fear of germs, common among OCD patients.
* English footballer David Beckham has been outspoken regarding his struggle with OCD. He has told media that he has to count all of his clothes, and his magazines have to lie in a straight line. He has expressed a desire to get help for his problems.
* Canadian comedian, actor, television host, and voice actor Howie Mandel, best known for hosting the game show Deal or No Deal, has written an autobiography, Here’s the Deal: Don’t Touch Me which includes descriptions of how OCD and mysophobia (fear of germs) affect his life. Larry King has called it an “important book”.
* American game show host Marc Summers has written a book about how OCD has affected his life. The book is titled Everything in Its Place: My Trials and Triumphs with Obsessive Compulsive Disorder.
* Movies and television often portray idealized representations of disorders such as OCD.
Sarah believes she has always had OCD. She was an anxious child. She had little rituals and habits and understands now why she did certain things during her young life.
But it was the birth of her daughter, Beatrice, that triggered a more serious side to her OCD. And, within weeks of her becoming a new mum, it had spiralled out of control.
“I was diagnosed with postnatal depression,” said Sarah.
“I think this was a trigger to the worst episode of OCD I have experienced so far.
“But after Bea was born, I started having intrusive thoughts. These thoughts would be absolutely horrendous and I would feel physically sick and ill.
“It’s hard to explain how it was for me – but I’ll try to tell you. Imagine being in town shopping and walking past the escalator. Imagine thinking ‘if I pushed the pram down the escalator the baby will die’. After that, I’d be consumed with guilt. I’d be thinking ‘why did you just think that … maybe you wanted to do it … you’re a bad mother’. I’d feel so ashamed that I’d even had a thought like that. It would completely consume me. I’d be upset that I’d even been capable of thinking about something so horrible. I’d cry and feel really upset. I’d tell myself that I was a bad person and that I didn’t deserve to be a mum. The responsibility of looking after Bea was huge. I found it very hard at times and these intrusive thoughts were just horrendous. Some are too horrific to tell you. For about a year, I struggled to cope with all these obsessive thoughts. They overtook my life. I felt ashamed about what I was thinking.”
Desperate for help, Sarah saw a private consultant. She had regular sessions of behavioural therapy – but she did not feel cured.
Reading about OCD and learning about other people’s OCD was the best form of medicine for Sarah.
She says she gradually improved things by working hard to phase out the intrusive thoughts. Going back to work after her maternity leave also helped.
“It was very hard to tell myself how unrealistic these thought were,” said Sarah. “I tried so hard to put them out of my mind but, when I had them, it was really bad.
“I felt I didn’t cope as a new mum. My anxieties deepened and that’s probably because I felt so responsible for my baby. Her care was in my hands. I was in charge of someone else’s welfare and I felt overwhelmed by it.”
At times, she felt like ending it all. On a bad day, suicide seemed like a good way out. I remember being out once and thinking: ‘I wish this car would hit me’. I didn’t want to be here. Living with all the thoughts was just too much,” she said. “My life was on a knife’s edge.”
Sarah thinks OCD and anxiety runs in her family. Her grandad, she says, had some obsessive behaviour and her mum is an anxious character. She thinks she has inherited a bit from both of them.
“OCD is horrible,” she said. “It takes over your life and makes you feel very, very low. It makes you feel uneasy and apprehensive. You feel worried and scared.
“I had awful, horrible absolutely terrible thoughts about my little girl – same as what you’ve described – yet I never spoke out, never talked to anyone about it – till now. I thought I was evil to think such bad things. I realise, I must have had post natal depression alongside OCD like you and all I feel right now is to let this horrible thing pass me – let me go so I can get on with life.”
“I would just like to add that everyone has those same horrible thoughts that Sarah is so ashamed of. It’s just that those with OCD take them to heart. A good therapist will help someone with OCD realize that thoughts are just thoughts and mean absolutely nothing. I talk about anything and everything to do with OCD on my blog at: http://tinyurl.com/agflsmn OCD.”
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