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Obsessivecompulsive behaviors

Obsessive-Compulsive Behaviors

"Compulsive" and "obsessive" have become

everyday words. "I'm compulsive" is how some

people describe their need for neatness,

punctuality, and shoes lined up in the closets.

"He's so compulsive is shorthand for calling

someone uptight, controlling, and not much fun.

"She's obsessed with him" is a way of saying your

friend is hopelessly lovesick. That is not how

these words are used to describe Obsessive-

Compulsive Disorder or OCD, a strange and

fascinating sickness of ritual and doubts run wild.

OCD can begin suddenly and is usually seen as a

problem as soon as it starts.

Compulsives (a term for patients who mostly

ritualize) and obsessives (those who think of

something over and over again) rarely have

rituals or thoughts about nuetral questions or

behaviors. What are their rituals about? There

are several possible ways to list symptoms of

OCD. All sources agree that the most common

preoccupations are dirt (washing, germs,

touching), checking for safety or closed spaces

(closets, doors, drawers, appliances, light

switches), and thoughts, often thoughts about

unacceptable violent, sexual, or crude behavior.

When the thoughts and rituals of OCD are

intense, the victim's work and home life

disintigrate. Obsessions are persistant,

senseless, worrisome, and often times,

embarrassing, or frightening thoughts that repeat

over and over in the mind in an endless loop.

The automatic nature of these recurant thoughts

makes them difficult for the person to ignore or

restrain successfully.

The essence of a Compulsive Personality

Disorder is normally found in a restricted person,

who is a perfectionist to a degree that demands

that others to submit to his\her way of doing

things. A compulsive personality is also often

indecisive and excessively devoted to work to

the exclusion of pleasure. When pleasure is

considered, it is something to be planned and

worked for. Pleasurable activities are usually

postponed and sometimes never even enjoyed.

With severe compulsions, endless rituals

dominate each day. Compulsions are incredibly

repetitive and seemingly purposeful acts that

result from the obsessions. The person performs

certain acts according to certain rules or in a

stereotypical way in order to prevent or avoid

unsympathetic consequences. People with

compulsive personalities tend to be excessively

moralistic, and judgmental of themselves and


Senseless thoughts that recur over and over

again appearing out of the blue; certain "magical"

acts are repeated over and over. For some the

thoughts are meaningless like numbers, one

number or several, for others they are highly

charged ideas-for example, "I have just killed

someone." The intrusion into conscious

everyday thinking of such intense, repetitive, and

to the victim disgusting and alien thoughts is a

dramatic and remarkable experience. You can't

put them out of your mind, that's the nature of

the obsessions.

Some patients are "checkers," they check

lights, doors, locks-ten, twenty or a hundred

times. Others spend hours producing

unimportant symmetry. Shoelaces must be

exactly even, eyebrows identical to eachother. A

case studied by the well-known art therapist,

Judith Aron Rubin, Rubin tells of a young girl

named Mary, who suffers from OCD, and how

she drives her fellow waitresses frantic because

she goes into a tailspin if the salt and pepper she

has arranged in a certain order has been moved

around. All of the OCD problems have common

themes: you can't trust good judgment, you can't

trust your eyes that see no dirt, or really believe

that the door is locked. You know you have done

nothing harmful but in spite of this good sense

you must go on checking and counting.

There are many, many common obsessions,

of all of them the most common is called

"washing" this involves the victim to have a

constant feeling of conamination, dirt and\or

grime all over their body. The book,The Boy Who

Couldn't Stop Washing by Judith L. Rapoport

describes a long, sad case of a young boy who

spent three or more hours in the shower each

day. The boy "felt sure" that there was some

sticky substance on his skin. He thought of

nothing else.

Our normal functioning probably consists of

constant uncountable checking, a sort of radar

operation, that we could not do contiously and

still act efficiently. Something has gone wrong

with the process for obsessive compulsives, the

usual shut-off such as "my hands are clean

enough" or "I saw the gas was turned off on the

stove" or "The door was locked." does not get

through. Everyday life becomes dominated by

doubts, leading to senseless repetition and ritual.

Obsessive phobias tend to have distinct

features. According to Issac Marks, "They are

usually part of a variety of fears of potential

situations themselves. Because of the vagueness

of these possibilities, ripples of avoidance and

protective rituals spread far and wide to involve

the patients life style and people around

him\her. Clinical examination usually discloses

obsessive rituals not directly connected with the

professed fear; instead the obsessive fear is part

of a wider obsessive-compulsive


"The sustained experience of obsessions

and\or compulsions." make up what the

American Psychiatric Association's Diagnostic

and Statistical Manual of Mental Disorders, 3rd

edition, calls Obsessive-Compulsive Disorder. It

has also been called obsessional nuerosis.

Psychiatrists have been fascinated by this

disorder for over a hundred years. Priests have

described symptoms like these for much longer

than that.(A.P.A.,80)

Children suffer from OCD with exactly the

same symptoms as adults. Normally an early start

in mental disorder is unusual. Other mental

illnesses, such as depression or schitzophrenia

often apear in a differant form in young children

and in any case are much more rare in children

than in adults. But with OCD it is the same at any


In the book The Boy Who Couln't Stop

Washing, there is a story of a fourteen-year-old

girl who has been diagnosed with OCD. As she is

talking to her psychiatrist she says, "I have really

lost touch with myself and that is really

frightening. I wish I could get the 'old Sally'

back. I keep hoping it's just a dream and that I'll

wake up and everything will be normal. I used to

like who I was a lot, but now I feel I don't even

know myself anymore. I have so many goals and

dreams I would like to accomplish, but I know I

will never acomplish them with OCD. I feel like I

am in a mental labyrinth from which I can't

escape. I hope I can get better." (Rapoport,'89,p.80)

To quote the author and psychiatrist, Judith

L. Rapoport, "The disease affects some of the

most able, sensitive, and talented people I have

met. Their otherwise normal ability to function,

to become a good husband, wife, or friend

makes working with obsessive-compulsive

patients very rewarding and, when they are

severely ill, very painful."(Rapoport,'89, p.3)

A few individual cases of OCD have been

reported in the medical literature over the past

150 years, but only recently have we learned of

the large number of adolesence and adults who

suffer with it. More than 4 million people in the

United States suffer from its' disabling thoughts

or rituals. Amazingly most of them keep their

problem hidden. We are finding out that many of

the adults who are being treated for it now went

pretty much their whole life hiding the problem

because they were too humiliated or did not

want to be considered crazy and thown in a

mental institution.

In spite of the interesting individual cases of

OCD in the past one hundred fifty years, there

was not much work on treatment. There is little

incentive to evaluate or develop new treatments

for rare disorders. So up until the 1970's the

recommended treatment was psychotherapy or

psychoanalysis. Doctors made these suggestions

for lack of an alternative, but severe cases and

follow-up studies of adults could not show any

advantadge for this treatment.

The Best studied Drug to reduce or stop

OCD,is called Anafranil. Anafranil was first put on

the market in 1990. The side effects of Anafranil

range from mild to severe. The most common

side effects are dry mouth, constipation, and

drowsiness. However a tremor, loss of sexual

appetite, impotence-which is temporary until you

stop taking the drug, and excessive sweating can

be major problems. These are all side effects

common to tricyclic anti-depressants-the group of

which Anafranil belongs.

In the most severe cases of OCD,

psychosurgery was used regularly until the

1950s. With availability of other treatments

psychosurgery is now a last resort. In some

cases, however, this drastic treatment seems to

work when everything else has failed. A few

medical centers in Boston, London, and

Stockholm, for example, will still perform limited

operations using newer techniques.

The two newer treatments, behavior therapy

and drug treatment with Anafranil, both seem to

have long-term benefits. Behavior therapists have

followed up their patients for a year or two and

the effect seems to last. Anafranil has not been

as well studied in follow-up, but what studies

have been done show that it too is helpful over

at least two years.

Even though Anafranil does work well it is

not always nessesary. There are other aproaches.

Some OCD's have gotten help from just "coming

out of the OCD closet". Support groups have also

been known to help. There is a wide variety of

things you can do to help a person diagnosed

with OCD.

"Scientists have suggested that there may be

a biological explanation for some obsessive

compulsive disorders. There may be an

imbalance in the frontal lobes of the brains of

obsessive-compulsives that prevents the two

brain regions from working together to channel

and control incoming sensations and


The American Psychiatric Association's

Diagnostic and Statistical Manual of Mental

Disorders requires at least five of the following

symtoms to be characteristic of the persons

functioning. In addition, the symptoms must

cause some problems with personal or work life.

"1. Restricted ability to express warm and

tender emotions.

2. Perfectionism that interferes with overall

ability to see the needs of a situation.

3. Insistence that others submit to the person's

way of doing things without awareness of

how this makes others feel.

4. Excessive devotion of work to the exclution

of pleasure.

5. Indecisiveness to the point wher decisions

are postponed avoided, or protracted.

Assignments may not get done on time

because of thinking about priorities.

6. Preoccupation with details, rules, lists or

schedules to the extent that the major point

of the activity is lost.

7. Overconscientiouness, scrupulousness, and

inflexibility about moral or ethical matters.

8. Lack of generosity in giving time, money or


9. Inability to discard worn out or worthless

objects." (A.P.A.,'80)

So much is asked about where our everyday

lives stop and OCD begins. The basis of

Obsessive -Compulsive Disorder is still unknown.

The evidence for a biological cause is compelling

but unfortunately it is still necessary to speak of

the biology of behavior in vague terms. The

effect of a drug, and the normality of many of the

families with an OCD kid makes the importance

of "poor upbringing" as a cause of OCD uncertain

to say the least. This is a disease that may be

thought of as doubts gone wild. Patients doubt

their very own senses. They cannot believe any

reasurance of everyday life.

Reassurance does not work. The notion that

there is a biological basis for a sense of

"knowing" has interesting philosophical

implications. We are normally convinced that

what we see and feel is truely there. If this is a

"doubting disease," and if a chemical controls

this sense of doubt, then is our usual, normal

belief in what our everyday senses and common

sense tell us similarly determined by our brain


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