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Obsessive-Compulsive Disorder Introduction Obsessive-Compulsive disorder (OCD) , although still unrecognized by most people, affects about six million Americans (Neziroglu and Yaryura-Tobias, 1991). This paper is written to give others a feel of OCD by explaining what it is, how to distiungiush it from other disorders, the way it effects their lives, the theories behind it, and its treatment. What is OCD? Obsessive-compulsive disorder is a frequent, chronic, costly, and disabling disorder that presents in several medical settings, but is under-recognised and undertreated (Stein, 2002). OCD is a disease of the brain manifested by intrusive, unwanted, and persistent thoughts that cannot be rejected and keep coming back over and over again (Neziroglu and Yaryura-Tobias, 1991.) OCD ranks fifth among the major psychiatric illnesses, with approximately 2.6% of the population suffering from OCD for at least six months (Yaryura-Tobias, Anderson, & Neziroglu, 2000). Obsessive-compulsive disorder is viewed as a good example of a neuropsychiatric disorder, mediated by pathology in specific neuronal circuits, and responsive to specific pharmacotherapeutic and psychotherapeutic interventions (Stein, 2002). Obsessive-compulsive disorder was once considered a rare condition, but is now viewed as not only one of the more prevalent psychiatric disorders, but also one of the most disabling medical disorders (Stein, 2002). It is regarded as a neuropsychiatric disorder mediated by specific neuronal circuitry and closely related to neurological conditions such as Tourette's syndrome and Sydenham's chorea (Stein, 2002). Obsessive-compulsive disorder is characterised by intrusive thoughts or images (obsessions), which increase anxiety, and by repetitive or ritualistic actions (compulsions), which decrease anxiety (Stein, 2002).Obsessions are defined as recurrent and persistent distressing thoughts, impulses or images, not due to real-life worries alone, that cannot be suppressed or ignored by these patients and that are perceived by them as originating from within their own minds (Shusta, 1999). An obsession is a passive experience : it happens to the person. A person may be engaged in some activity, like reading a book or driving a car, when the obsession intrudes into their consciousness disrupting their normal thinking or behavior (Silva & Rachman, 1998). Compulsions are defined as repetitive behaviors or mental acts that the person feels driven to (Shusta, 1999). The behaviour is not an end in itself, but is usually intended to prevent some event or situation (Silva & Rachman, 1998). No pleasure is derived from carrying it out, although it provides a release of tension or a feeling of relief in the short term (Silva & Rachman, 1998). Distiungishing OCD from other disorders Obsessions and compulsions should not be confused with the inflexible character traits that comprise obsessive-compulsive personality disorder (Stein, 2002). Obsessive-compulsive or stereotypic symptoms are an intrinsic component of many disorders, including autism, Tourette's syndrome, and frontal lobe lesions (Stein, 2002). Patients with symptoms of obsessive-compulsive disorder but a family history of Tourette's can have neurobiological dysfunction more similar to Tourette's than to primary obsessive-compulsive disorder (Stein, 2002). Some disorders have such closely related habits that it is unclear which disorder is really taking place. Dan Stein writes: Although the distinction between axis I (eg, a syndrome such as obsessive-compulsive disorder) and II (eg, a personality disorder such as obsessive-compulsive personality disorder) disorders is unclear at times, the obsessions and compulsions of obsessive-compulsive disorder differ qualitatively from obsessive-compulsive personality traits such as perfectionism and overconscientiousness. Similarly, despite the occasional overlap, the symptoms of obsessive-compulsive disorder differ clearly from the fears and worries seen in other anxiety disorders, from the actions characteristic of mood disorders, and from the delusionns of psychotic disorders (Stein, 2002). Some disorders will overlap with one another. Disorders that overlap with obsessive-compulsive disorder are postulated to lie on an obsessive-compulsive disorder spectrum of conditions (Stein, 2002). Freud postulated that there was a spectrum from obsessive-compulsive personality to obsessive-compulsive neurosis to psychosis (Stein, 2002).
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