Obsessive Compulsive Disorder (Neuroses)

 

Definition

          “Obsessions are defined as persistent thoughts, impulses or images that occur repeatedly and are experienced as intrusive, inappropriate and distressing”.

 

          “Compulsions are repetitive behaviours or mental acts that an individual feels compelled to perform in response to an obsession or some rigid rules”.

 

          “Being preoccupied with certain thoughts that are viewed by the person to be embarrassing or shameful, and being unable to check the impulse to repeatedly carry out certain acts like checking, washing, counting, etc.”

 

Examples of Obsession and Compulsion

 

Obsessions – Occurrence of a repetitive thought (How dare he? Who is he to call me names?), fear of harming others, I may commit a mistake etc.

 

Compulsions – Repetitive Washing, Counting, Cleaning, Checking etc.

 

Introduction

          OCD is also known as OCN (Obsessive Compulsive Neuroses). Because in OCD individual displays maladaptive life style characterized by anxiety and defense-oriented avoidant behaviour (Coleman, 1988). Obsessions provoke anxiety due to which individual find it difficult to suppress or neutralize them. The obsessions are not simply worries about real life (DSM-IV). Interestingly, the person suffering from OCD are fully aware that obsessive thoughts are the product of their own mind without any interference from the outside objects. The individual suffering from this neuroses feels compelled to think about something that she/he does not want to think about or to carry out some action against her/his.

 

Why an Individual Engage in Obsessive Thoughts and Compulsive Acts

          It brings a feeling of reduced tension and satisfaction (Quoted by Coleman, 1988). If the person tries to resist the compulsion, he is overcome with anxiety.

OCD types

(i)       Hoarding,

(ii)      Contamination,

(iii)     Rumination,

(iv)     Orderliness, and

(v)      Checking.

 

Some Obvious Symptoms

(i)       Repetitive actions & activities (Washing hands).

(ii)      Ritualized patterns of behaviour.

(iii)     Obsessive [tormenting] thoughts on variety of topics (bodily functions, committing immoral acts, attempting suicide, or finding the solution to unsolvable problems).

(iv)     Individual feels inadequate and insecure.

(v)      Tendency of feeling guilt.

(vi)     Display symptoms of fear, worry, depression and anxiety frequently.

(vii)    Their actions are slow and to the level of perfection.

(viii)   Frequent bout of anger and irritative behaviour. 

 

Proteins and Chemicals (Neurotransmitters) Responsible for OCD

          Various research findings suggests that imbalance of the following neurotransmitters lead to OCD like symptoms.

(i)       Brain-Derived Neurotropic Factor (a protein that stimulates the production of new brain cells and makes existing ones stronger).

(ii)      Serotonin (low level in Basal ganglia)

(iii)     Dopamine (Increase levels in pre-frontal cortex)

(iv)     Glutamate (Increased levels in CSF)

Note: The impact of organic conditions on Basal Ganglia is known to induce repetitive & compulsive activities.

 

Important Causes and Determinants

Causes

(i)       Genetics,

(ii)      Environment,

(iii)     History of Psychiatric Disorders, and

(iv)     Emotional Trauma.

Determinants

(i)      Substitutive thoughts and activities – Defending self from anxiety [produced by threatening thoughts] by thinking something else or diverting to another activity. It’s a kind of escape-from-the-problem system.

(ii)     Guilt and fear of punishment – OCB usually stems from feelings of guilt and self-condemnation.

(iii)    Assurance of order and predictability – Maintaining meticulously methodical and rigid pattern of behaviour. Rigid behaviour provide mental solace and security against anything going wrong. 

 

Diagnostic Criterion

          The diagnosis must be done by expert, qualified and experienced individual on the set scientific standards. Some of them are described below (DSM V): -

(i)       The individual must experience that the obsession or compulsion are excessive and interfering in day-to-day life.

(ii)      Spent more than 1 hour per day in OCB.

(iii)     Cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

(iv)     OCB is not the result of some physiological substance such as drug or medication.

 

Characteristics of OCD/N

(i)       OCB (behaviour) is maladaptive.

(ii)      It represents irrational and exaggerated behaviour in the face of nonthreatening stresses.

(iii)     It reduces behavioural flexibility of the individual.

(iv)     Individual feels inadequate, insecure and highly vulnerable to threats.

(v)      Compulsive acts are performed in response to the obsessive thoughts.

(vi)     Thoughts can be in the form of language or images.

(vii)    OCD is neither a trait nor part of personality, rather a mental illness.

(viii)   OCB is the manifestation of anxiety not stress.

(ix)     OCD is gender neutral in its occurrence.

 

Treatment Strategy

          The 100% change of OCB of an individual is not always possible but combination of various therapies can alleviate the symptoms and significant improvement in life style.

Three basic strategies followed by a therapist are: -

(i)       Discriminate between thought and action and to accept the common desires as common to most people.       

(ii)      Discriminate between objective and imagined dangers.

(iii)     Blocking OCB by reinforcements (rewarding the departure from OCB).

 

Treatment

          The appropriate Medication and Behavioural therapy jointly can cure this mental illness.

(i)       Cognitive behaviour therapy.

(ii)      Exposure and response prevention (ERP) (Special CBT).

(iii)     Kundalini Yoga (Study by: The Institute for Nonlinear Science, University of California, San Diego, USA).

(iv)     Combination of Pranayama, Gayatri Mantra and Yogic Asana (Dev

Sanskriti University, Haridwar).

(v)      Ashwagandha herb (stimulates BDNF and inhibit the decline of BDNF).

 

References:

1.       Coleman, C. J. (1988). Abnormal psychology and modern life. Bombay, India: D. B. Taraporevala Sons & Co.

2.       https://iocdf.org/expert-opinions/expert-opinion-lutamate/

3.       https://zeenews.india.com/ayurveda/yoga-can-tackle-psychological-disorders_1309.html.

4.       https://www.segmento.com.au/post/fw-an-ayurvedic-herb-may-be-the-best-natural-treatment-for-ocd-obsessive-compulsive-disorder#:~:text=Ashwagandha.

5.       NCERT. (XII). Psychology Book.

 

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