Obsessive anxiety related disorder with physically debilitating obsessions

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Last updated: August 24, 2019

Obsessive Compulsive DisorderObsessive Compulsive Disorder (OCD) is an anxiety related disorder with physically debilitating obsessions and compulsions causing significant distress. Obsessions are considered to be the persistent, intrusive thoughts, images, wishes, doubts or impulses. They often are related to specific areas of an individual’s life revealing other cognitive factors, such as, impacting thought processing and views of self.

The obsessions also tend to interfere with daily functioning causing anxiety and despair. The compulsions are the repetitive behaviors performed in response to the obsession(s). They are aimed to reduce the anxiety or distress, and seek avoidance of the perceived harm the obsessions are causing them (Melli, Aardema, Moulding, 2016). Common obsessions include fear of contamination, aggressive thoughts toward themselves or others, precisely and symmetrically aligning objects, and experiencing unwanted, intrusive thoughts. Common compulsions  include excessive hand-washing and cleaning rituals, or repeated impulses of checking, or counting. This behavior is uncontrollable and excessive. Individuals normally spend at least 1 hour a day on these intrusive patterns.

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Often, there are feelings of brief relief but no pleasure is found (National Institute of Mental Health, 2016). The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines OCD as interferences impacting daily life and normal functioning. Some symptoms are more common than others. The most common symptoms include over obsessions of contamination, harm to oneself or others, repetitive hand washing, and checking and cleaning rituals.

Some of the less common symptoms include excessive arranging, and the seeking of reassurance. Most studies have followed a “four-factor solution” when describing common symptoms among OCD patients (Chang, O’Neill, & Rosenberg, pg. 43, 2013). The “four-factor solution” consists of, 1. “aggressive, sexual, religious, somatic or checking tendencies; 2.

Symmetry, ordering counting, or repeating; 3. Contamination or cleaning; and 4. Hoarding” (Chang, O’Neill, & Rosenberg, pg. 43, 2013). Individuals with a high number of obsessions, (specifically those who held checking, symmetry and order focusing rituals) also presented a comorbidity with tics. Individuals who held a prominence of hoarding revealed impaired decision making, influencing neurophysiological dimensions (Chang, O’Neill, & Rosenberg, 2013). The symptoms of OCD can be debilitating and time-consuming.

It is important to note; others experience incompatible obsessions that are not always associated with ritualized compulsions. Unfounded feelings of increased social pressure and stress related to a patient’s obsessions can cause intrusive and dysfunctional thought patterns. The dissatisfaction within individuals suffering from OCD, correlated with negative moods and unacceptable thoughts, can cause normal activities to be disrupted (Melli, Aardema, Moulding, 2016). High levels of impairment in academics, social settings, family and work-related realms are likely to occur (Thompson-Hollands, Edson, Tompson, & Comer, 2014).OCD can begin to show signs throughout childhood development and persist through the majority of adulthood. Individuals follow detailed rituals, primarily seeking order and balance (Comer, 2013). Comer (2013), expressed that about 1-2% in the world-wide population suffer at some point from OCD and about 3% develop it at some point in their lives. OCD is ranked as one of the top 10 most debilitating mental disorders (Melli, Aardema, Moulding, 2016).

Research has shown a higher prevalence rate among females than males, and reflects higher rates of OCD in Caucasians than non-Caucasians (Thompson-Hollands, Edson, Tompson, & Comer, 2014).Heredity plays a major role in the cause and prevalence of OCD. Evidence of gene mutations are indicated showing low levels of serotonin and glutamate activity. These findings are associated with fundamental differences in the orbitofrontal, parietal, cingulate and striatal cortexes (Chang, O’Neill, & Rosenberg, 2013). Studies between identical twins indicated that if one twin displays this disorder there is a 53% likelihood that the other twin will display it too (Comer, 2013). The risk of OCD is higher in a first degree relative, as opposed to a second degree relative. Perfectionistic behaviors are considered to be closely related to OCD.  Depression and difficulty holding strong peer relationships are common comorbidities within OCD patients (Chang, O’Neill, & Rosenberg, 2013).

OCD is likely to develop following stressful events or serious physical or sexual crisis’s. The traumatic events lead to the onset of negative personality traits like extreme conscientiousness and the fear of making decisions.   It is rare that patients experience full remission without treatment. It is critical that treatment is implemented early with proper interventions (Thompson-Hollands, Edson, Tompson, & Comer, 2014). Psychological interventions are often requested to ease the stress of and resist OCD symptoms.

Exposure and response prevention is a behavioral approach that involves the exposure of the patient’s fear in order to help prevent the compulsions that occur in response. Most times the patients are taught to manage their anxiety by gradual graded exposure to help prevent their distressing reactions (Brakoulias, 2015). This treatment allows for patients to deal with the stressor that triggers their compulsive behavior in a controlled, safe environment.Cognitive-behavioral therapy (CBT) is known to be an effective treatment for OCD. Therapists hold self-guided sessions that try and neutralize negative thought patterns.

This is proven to help patients become more convinced that their intrusive thoughts are, in fact, threatening (Brakoulias, 2015). CBT incorporates exposure and response treatment in children, adolescents, and adults. It targets improving social interactions and functional impairments (Crino, 2015).

Both CBT and group therapy together provide the advantage of individual support for behavioral and personality challenges. It also allows for clinician demand to be less due to the groups of patients carrying out the majority of the therapy sessions. The goal is to understand the distressing thoughts are considerations that do not need a reaction creating feelings of blame and liability. Most patients want to perform daily living activities again, which OCD debilitates. CBT has proven to subside symptoms including, checking, and cleaning behaviors by helping the patients to recognize the more the patients exposes themselves to the anxiety driven task, the quicker it subsides. Patients were able to gain momentum and challenge their compulsions revealing that CBT is one of the most effective models of treatment (Taylor & Reeder, 2015).

Drug treatment is also recommended for patients to help reduce obsessions and compulsions. Studies indicate 50% of patients successfully reached remission within a 12-week period when treated with Selective Serotonin Reuptake Inhibitors (SSRI’s) (Brakoulias, 2015). SSRIs is one the only drug classes that treats OCD.

Sertraline, paroxetine, flouxetine, citalopram, fluvoxamine, and escitalopram are considered the most frequently prescribed for treatment. This drug class works to prevent reuptake of serotonin into the presynaptic neuron, leaving more serotonin residing in the synapse to bind to the postsynaptic receptors. SSRIs are considered to be more tolerable than other antidepressants due to preventing worsening side effects and reducing compulsive behavior (Wald, Dodman, & Shuster, 2009). Family Inclusive Treatment (FIT) focuses on using the patient’s family context, and considers how the environment could be contributing to the perpetuating problem(s).

Substantial conflict can arise within families, but this treatment approach incorporates activities for families to take a “team approach” (Thompson-Hollands, Edson, Tompson, & Comer, 2014). This approach is oriented towards reducing adverse feelings and empowering the family to be supportive. The FIT approach provides patients and their families with skills to re-build an encouraging atmosphere with positive interactions. Family members are trained to act as coaches by bringing the patient through guided exposure to resist their fears and avoid distress.

Through this the family approach, it is proven to help gain an understanding of exposure, and to help their loved one come over a debilitating disorder. The FIT approach targets patients from childhood to adulthood. Families become significantly impacted when their loved one is experiencing OCD, and this treatment method works to minimize the associated patient and family distress (Thompson-Hollands, Edson, Tompson, & Comer, 2014). CBT in conjunction with medication is the treatment I believe would be most appropriate and effective. CBT works to neutralize and avoid feelings of negative outcomes. Most patients become convinced through this treatment their thought patterns and behaviors are dangerous and distressing. This revealing realizations that the persistent thoughts and repetitive behaviors are invading their mental status.

Abnormal serotonin activity is present in those suffering with OCD. Similar to what was stated above, the SSRI’s work to increase the activity to help subside the worsening signs and symptoms. SSRI’s and CBT in conjunction with one another work hand-in-hand to decrease the distressing thoughts and repetitive behaviors to allow for forming proper thought processing. This is proven to help cope with daily living and be proficient in decision making and facing their fears (Chang, O’Neill, & Rosenberg, 2013).

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