Abstract
Obstructive Compulsive and Related Disorders comprise of a series of mental health disorders characterized by compulsive control and obsession. The disorders were first discovered as separate conditions in the 1850s but have since been linked to neuroses. All the conditions similar to OCD are mainly diagnosed through observation of compulsive and obsessive symptoms such as repetitive picking of skin, plucking of hair. Obsessions with contamination, hoarding and symmetry also characterize the condition. The major causes that have been linked to OCD and related disorders include biological factors i.e. serotonin dysregulation and environmental factors such as parental divorce and sickness. The conditions are treated using pharmacological and psychological approaches are recommended for short term and long term treatment objectives respectively. For victims as well as the parents of children with OCD, the most essential aspect in self care is to ensure that acceptance and support is achieved.
Introduction
Obsessive Compulsive and Related Disorders comprise of a series of mental health conditions that are characterized by behavioral impulses. The disorders were named from the characteristic behaviors that are linked to the disorders. For instance, those who suffer from the disorders are often engaged I compulsive behaviors which are also repetitive hence the obsessive aspect. Obsessions such as washing, ordering and hoarding are common place among those with OCD and Related disorders. The disorders commonly arise during adolescence and early adult hood and can be chronic if not checked early enough. There are two models of obsessive compulsive disorders which include biological and cognitive behavioral models. The particular model of appearance in any individual determines the method of treatment that can be used to address/ treat the problem in each case. The two models of OCD occurrence both have sufficient empirical support, which has enabled the development of corresponding treatment procedures for each case (Abramowitz, 2009).
Diagnostic Criteria
Obsessive Compulsive and Related Disorders are often diagnosed through observations and medical testing processes. Obsessions and compulsions in this case must be occurring at a frequency that affects the daily operations of a person’s life. The compulsive acts carried out by individuals with OCD and related disorders are aimed at preventing certain dreaded event as well as for the reduction of distress. Although there are no medical diagnostics tests for OCDs and related disorders, the conditions are diagnosed based on clinical review. The reviews are guided by the Diagnostics and Statistical Manual of Mental Disorders (DSM- IV). According to this manual the affected individuals suffer from obsession that cause distress and are time consuming. The compulsions must also be ritualistic. The individual has to recognize during the course of the disorder that the obsessions are not normal and should thus find ways of averting the compulsive acts.
History of the Conditions
Berrios provides a clear history of Obsessive Compulsive Disorders and related disorders (1989). Obsessive compulsive disorders were first recognized in the 1850s. During these early years, the conditions included a range of mental health diagnoses that contributed to the old notion of insanity. People who exhibited the symptoms that are presently associated with OCDs and other related disorders were considered to be insane. The awareness of such conditions was made through clarification of the existence of separate conditions followed by association with the class of neuroses. OCDs were the first members of the newly formed neuroses class of disorders. After this development, OCDs and related conditions were then classified into a variant of the psychosis notion developed later following the neuroses. During the post 1880s, OCDs and related conditions were finally classified as a neurosis proper.
In the 1860s, the casual hypotheses regarding OCDs including association with autonomic nervous system dysfunctions were developed. It is also during this period that OCD was connected to causes such as emotional impairment, intellectual and volitional impairments. The 1890s led to the relation of OCD with personality types as well as with genetic factors. OCD was only fully defined nosologically by the late 1880s (Berrios, 1989). The history of OCD and related disorders has been one of slow progress. This is because despite the clear identification in the 1890s, new discoveries have continued to be made regarding the conditions, which have led to the development of new treatment procedures as well as realization of the importance of therapy in the treatment and prevention of OCD and related disorders (Berrios, 1989).
Causes of the conditions
There are various causes that have been associated with obsessive compulsive disorders and related conditions. However, all the causes can clearly be distinguished as either biological factors or environmental factors. The biological factors that result in the development of OCD and related conditions include disruption of the serotonin system in the brain. Despite this finding, serotonin dysregulation has also been associated with several other psychological disorders; OCD is associated with hypersensitivity of the postsynaptic receptors in the brain. As such, the individuals with OCD may have problems with encoding serotonin transporters due to genetic dysfunctions (Abramowitz et al., 2009). Apart from this, insufficient levels of neurotransmitters can also be responsible for causing OCD and related disorders. This is due to the inability to transport and encode information effectively, leading to the obsessive behaviors that are characteristic in OCD patients. Genetic factors resulting in OCD are indications that there could possibly other family members affected by the same conditions.
On the other hand, environmental factors could also result in the development of OCD and related disorders. According to Abramowitz, OCD and related disorders always develop during adolescence and early adulthood. This implies that there is a probability that some environmental factors result in the conditions. Factors such as parental divorce, school-related physical or emotional abuse, illness and the death of a loved one can also result in OCD. These factors result in stress for the affected leading to development of compulsive and obsessive behaviors aimed at preventing certain perceived disasters and alienation of stress. Parental divorce is the greatest probable cause of these conditions. Illnesses that interfere with the neurotic system are also some of the factors that result in OCD. Such illnesses often come about following accidents and paralysis (Berrios, 1989).
Symptoms
The conditions including and related to OCD are symptomatically heterogeneous. Various kinds of compulsions and obsessions exist in OCD. The occurrence of the compulsions and obsessions is linked to five major dimensions. The key symptoms are associated with repetitive thoughts and compulsions. Abramowitz et al describe the five dimensions of OCD symptoms as responsibility obsessions, symmetry obsessions, repugnant obsessions; hoarding and contamination obsessions. Responsibility obsessions are driven by the need to prevent and/ or avoid causing harm. This obsession drives the victims towards persistent and repetitive checking and reassurance seeking in order to achieve harm prevention. Symmetry obsession is characterized by counting and ordering rituals which are also repetitive in nature. Repugnant obsessions have to do with religion, sex and violence while contamination obsessions are characterized with cleaning and washing rituals. Some of the OCD victims may also harbor sexual obsessions such as intrusive thoughts concerning intercourse, sex, fondling and kissing among others. Hoarding on the other hand is characterized by repetitive thoughts on acquisition and object retention (Abramowitz et al., 2009).
In addition to the obsessive behaviors, OCD and related conditions are also characterized by compulsive behaviors such as reporting words spoken by others and excessive counting and recounting practices. According to an article by Freeston (2003), these are carried out with the objective of achieving accuracy and understanding as well as confirming the words of others. People with OCD carry out these activities in order to find relief from anxiety generated through obsessions. For instance, the repetitive ordering and counting could be a result of excessive obsession with a general sense of tension and disarray which is accompanied by the belief that there can be no procession in life while disorder persists. Although some of the victims may be aware of the irrationality of their actions, they continue to engage in the compulsive behaviors to ward off feelings of anxiety.
Types of OCD and Related Conditions
Different conditions have been classified under OCD. For instance research indicates that conditions such as body dysmorphia disorder, hoarding disorder, trichotillomania, skin picking disorder and induced OCD are all indicative of OCD. These conditions have the characteristics associated with OCD and related conditions albeit with little variations between them. For instance, body dysmorphia condition is characterized by excessive worry regarding one or more perceived flaws in the body. Victims of body dysmorphilia are obsessed with the need to hide their perceived flaws from others on a daily basis. They therefore think about the flaw for hours each day. Trichotillomania on the other hand is characterized by compulsion to pull out one’s hair. The victims pull out the hair on their heads as well as those on other parts of the body such as the eyebrows and eye lids. The condition can be described as an impulse control disorder and is further observed through individual embarrassment and guilt following their actions. Skin picking disorder is also an impulse control disorder like trichotillomania although it is characterized by the compulsive picking of the victim’s skin by himself (NHS Choices, 2014).
Based on the different types of OCD and related conditions it can be argued that the conditions can be classified as either compulsive or obsessive. The impulse control conditions such as trichotillomania, body dysmorphilia and skin picking disorder are classified under compulsive OCD types while the others such as hoarding, responsibility and contamination disorders are classified under obsessive OCD types.
Prevention of Obsessive Compulsive and Related disorders
Although there are no possible ways of preventing the start of OCD and related disorders, one can be helped to prevent a relapse of the symptoms of the conditions involved. This can be achieved through measures such as staying on therapy and following pharmacological prescriptions as directed by the physicians. Staying with therapy implies that one has to be aware of OCD warning signs through recognition of the symptom triggers. The victims should then make plans on the probable actions in case the symptoms reappear and be ready to notify the therapist or doctor in case any changes are observed in the symptoms. In addition to this, the victims should also make it a habit to check with their doctor before taking any other medications. This is particularly important when the medication in question includes over the counter drugs, herbal remedies, supplements and vitamins in order to avoid drug interactions. It is also important for the victims to practice all that they learn during therapy to prevent the escalation of the condition.
Treatment plans for short term and long term goals
According to Abramowitz and others, the treatment of OCD and other related illnesses can be carried out through two key methods. First, achieving short term wellness is achieved through pharmacological treatment which involves administration of serotonin reuptake inhibitors. Such inhibitors include clomipramine. The administration of such medications is done at the maximum allowable dose and the patients observed for a period of three months. Following failure to fully respond to the serotonin reuptake inhibitors, research recommends the addition of psychotic medication such as haloperidol. Despite the confirmation that such medication is effective in adults; pediatric cases have shown a significant level of ineffectiveness. This implies that alternative medications such as antiglutamatergic agents like riluzole have to be used. These have shown significant effectiveness in both children and adults (Abramowitz et al., 2009).
In the long term, cognitive behavior therapy has been found to be most effective in minimizing the symptoms of OCD and related disorders. The key therapy used in the treatment of OCD is the Exposure and Response Prevention (ERP) strategy. This strategy involves repetitive exposure of the victims to the triggers of the OCD symptoms. The objective of this repetitive exposure is to show the victim that the perceived harm or negative aspect does not exist and subsequently to help them avoid the impulsive responses associated with the triggers. Abramowitz et al indicates that psychotherapy, which is majorly ERP in the case of OCD and related disorders is more effective than pharmacological therapy. It is therefore recommended that a combination of pharmacological and psychological treatments be used to achieve higher effectiveness. However, the effectiveness of ERP is reported to be only slightly lower than the effectiveness of the combination of pharmacological and psychological therapy. ERP also assists patients for longer compared to the pharmacological procedures.
Tips and Suggestions for Overcoming
Although it is impossible to completely cure OCD and related conditions, it is important for people to learn how to cope with the condition and thus overcome the difficulties associated with it. The key step in achieving this is acceptance. Most people resist the notion that they may be affected with OCD or other related conditions. Denial of the fact that one may be affected is one of the factors that contribute to the exacerbation of the condition among patients. The medications sometimes have adverse side effects and the victims may at times feel angry and/ or embarrassed for having a condition that needs long term treatment. It is crucial for the victims to learn about the condition. Learning can help victims to be motivated as well as empowered towards sticking to the OCD treatment. Accepting oneself can be very instrumental in developing a positive voice towards treatment.
Apart from this, joining a support group for people with OCD and other related conditions can help a person to be aware that they are not alone. This is through the recognition of others who face similar challenges and encouraging one another to help cope with the condition challenges. Remembering that treatment is an ongoing process and subsequently staying focused on the treatment goals can be very essential in achieving the desired level of recovery. Having the recovery goals in mind helps the victims to be able to work towards these goals by realizing the disparity between the prevailing and the desired condition. Relaxation and stress management techniques such as meditation, muscle relaxation, massage, yoga and deep breathing can all help in the achievement of recovery objectives (Freeston, 2003). Freeston further report that the practice of regular activities can help to maintain the victim’s way of life through constant interaction with friends and family.
Parenting Skills to help individuals with OCD and related disorders
Just like victims, parents of children with Obsessive compulsive and related disorders also find it difficult to deal with the children’s conditions. It is important for the parents to understand the need for supporting their children in coping with the symptoms of the condition. As for the victims, the parents should also learn about OCD and then join support groups with other parents whose children are affected. They can thus understand the needs of these children while taking care of them. The parents should accept their children regardless of the conditions. This makes it easier to deal with the demands of the conditions while at the same time paving the way for the children to accept themselves and subsequently to be treated for the condition. It is important for the children to be made aware that the issues they are experiencing have names and that they are not the only ones who suffer from the condition.
Daniels (2015) asserts that parents should not have the habit of pointing out ritualistic behaviors such as skin picking and others. Instead, the parents should avoid being part of the ritualistic behaviors by recognizing new rituals and helping the children to deal with their conditions. OCD is challenging and can consume the minds of the children with feelings of guilt and stigma. It is therefore important for parents to learn how to deal with stigma arising from being parents to a mentally disabled child. While doing this, learning stress management skills is one of the key steps that show progress and the eventual success of OCD management and overcoming efforts.
References
Abramowitz, J.S., Taylor, S. and McKay, D. (2009). Obsessive Compulsive Disorder. The Lancet, 372: 491-499.
Berrios, G.E. (1989). Obsessive Compulsive Disorder: Its Conceptual History in France during the 19th Century. Compr Psychiatry. PubMed.
Daniels, N. (2015). Five Tips for Parenting a Child with OCD.
Freeston, M.L. (2003). “What do Patients do with their Obsessive Thoughts?” Behavior Research and Therapy, 35(4), 335-348.
NHS Choices (2014). Trichotillomania.