Cause Of Obsessive Compulsive Disorder example essay topic

Obsessive-Compulsive Disorder Obsessive-Compulsive Disorder (OCD) is a mental illness that traps people in endless cycles of repetitive thoughts and behaviors and must repeat certain actions over and over to relieve that stress or to obtain from danger. Pierre Janet described obsessive-compulsive disorder by using the term psychasthenia. Sigmund Freud described obsessions and compulsions as psychological defenses used to deal with sexual and aggressive conflicts in the unconscious mind (Bruce Bower: 1987). OCD is also known as "The Doubting Disease", because it's as though the mind doesn't register when the person does a certain action, which triggers the source of the obsession (USA Today: 1995). Unlike most people with anxiety disorders, those diagnosed with OCD are more obsessed with what will happen to others instead of themselves (Edna Foa: 1995).

Obsessive-Compulsive Disorder occurs in a spectrum from mild to severe. At some point the person will see the actions or thoughts as unreasonable and senseless. All people have habits and routines, but what makes obsessive-compulsive people different is the fact that their obsessions and compulsions interfere with their daily lives (American Family Physician: 2000). They spend large amounts of time doing odd rituals. The rituals can take hours a day and make the sufferers miserable and doesn't allow them for much of a business or social life (Harvard Mental Health Letter). At one OCD clinic, many had lost years of work to their symptoms.

Seventy-five percent said the disorder interfered with their family lives and thirteen percent had attempted suicide (Harvard Mental Health Letter: 1998). Phebe Tucker, a psychiatrist at the University of Oklahoma Health Sciences Center, explained, the most common obsession is washing hands for fear of contamination. Other acts are counting over and over, checking locks, hoarding items such as newspapers or cartons, repeatedly dressing and undressing, and walking in and out of doorways. The thought and behavior patterns are senseless and distressing. They can make it very difficult for a person to function properly at work, school, or even at home.

Obsessions take the form of doubts, fears, images, or impulses. (Harvard Mental Health Center: 1998) Obsessions are unwanted ideas, images, and impulses that run through a person's mind over and over again. They are intrusive, unpleasant and produce high anxiety. (web April 2000) Sometimes the obsessions come once and a while and other times the thoughts are constant and cause tremendous distress. (American Family Physician: 2000) The most common obsessions are the fear of getting dirty or infected, fear of getting AIDS, disgust of being infected with bodily wastes or discretion's, concern of doing something poorly or incorrectly, the fear of thinking evil or having sinful thoughts, extreme concern with certain sounds, images words or numbers, thoughts of killing or harming someone, or fear of disaster. (USA Today: 1995) The person feels the need to do things correctly and perfectly. Compulsions restore the comfort destroyed by obsessions.

Compulsions are done purposefully to satisfy those obsessions. They are overt actions such as checking, cleaning, putting things in order, or repetitive words and actions such as mental rehearsal, silent prayer or counting, repeated demands, or repetition of phrases or sounds. Yielding the compulsions relieves growing tension and anxiety, but usually the relief is temporary. Twenty percent of those with OCD have only obsessions or only compulsions, but eighty percent have both.

(USA Today: 1995) In the early years it was very rare to have obsessive-compulsive disorder. People who had symptoms were embarrassed and ashamed, so they never wanted to receive help. In the 1980's the National Institute of Mental Health did a survey and it showed that 2-3 percent or about 5 million people have OCD or had it sometime throughout their life. OCD is more common than such mental illnesses as schizophrenia, bipolar disorder, or panic disorder. OCD usually affects those in teenage years or early adulthood. Obsessive Compulsive Disorder is the same among all ethnic races and is equally affecting males and females. (web 2000) OCD tends to last for years or even decades.

Obsessive Compulsive Disorder affects many people and many lives. There have been tons of researches and experiments associated with OCD. By observing several journal articles, books, and Internet, the question that arises is what causes OCD and what is the best approach for treatment? The cause of Obsessive Compulsive Disorder is still being researched but there are two main theories. Like any other disease the controversy of the cause is between the biological theory and environmental theory. Symptoms usually begin in the teenage or early adulthood years.

Although, some children develop the illness at earlier ages, even during preschool years. At least one-third of cases of OCD in adults began in childhood. The search for causes now focuses on the interaction of neuro biological factors and environmental influences as well as cognitive processes. Other theories focus on the interaction between behavior and environment and beliefs and attitudes as well as how information is processed.

The belief that OCD resulted from life experiences has been weakened. The growing evidence shows that biological factors are the primary contributor to the disorder. It is no longer only attributed to attitudes learned during childhood. (web 2000) Obsessive Compulsive Disorder is connected with an imbalance in a brain chemical called serotonin, which is a bridge between the basal ganglia and frontal cortex, which sends nerve impulses from one nerve cell to the next and it regulates repetitive behaviors (American Family Physician: 2000). OCD is seen to be genetic and often occurs with depression. Little is known about what parts of the brain help to produce the disorder's bizarre thoughts and actions. Scientists at the University of California at Los Angeles School of Medicine suggest that an imbalance in the energy-conversion of two structures of the frontal lobes work together to help channel incoming sensations and perceptions.

Lewis Baxter, who is the director of the project, says that the mismatch accompanies OCD, but it doesn't necessarily cause it. The report is based on Positron Emission Tomography (PET). Several groups of investigators report their findings from the PET scans, which suggest that the brain activity in OCD patients is different from the people without a mental illness or a different mental illness. There is evidence that there is brain abnormality in those diagnosed with OCD. The PET scanning devices transform measures of the metabolic activity throughout the brain into color-coded pictures.

Since glucose is a prime energy source in the brain, the PET experiments radioactively labeled glucose compound was used to gauge tissue responses. Those with OCD had increased glucose metabolism in the frontal lobe, known as the orbital gyrus. The orbital gyro, says Baxter, is involved in directing attention toward specific objects. In animal test, damage to this area causes repetitive behaviors (Bruce Bower: 1987). It is also noticed, by studies of the brain using magnetic resonance imaging, that the subjects with obsessive-compulsive have significantly less white matter than did normal control subjects. (web 2000) Obsessive-compulsive disorder also occurs at a high rate with those who have the brain disorder, Tourette's syndrome, which are involuntary shouting, movements, and obscenities. It is suggested that the brain circuit that generates necessary actions to function properly is functioning improperly, which creates the urge to perform them over and over again when the need is absent.

Compulsive rituals may also be related to genetically based complex fixed patterns, such as courtship dances, which is released in animals by certain environmental stimuli (Harvard Mental Health Letter: 1998). It is also seen that there is a malfunction in the part of the brain called the caudate nucleus, which is a gearshift that processes thought. When it fails, the brain structure called the orbital cortex, which alerts us when something is dirty, becomes continuously engaged (Sharon Begley: 1996). There is evidence that obsessive compulsive disorder is genetic.

The concordance between identical twins is sixty percent. Among the family members of patients, the rate is ten to fifteen percent, and another ten percent have some of the symptoms in milder forms. (Harvard Mental Health Letter: 1998) The concordance rate for obsessive compulsive rate is higher for monozygotic twins than for dy zygotic twins. Like any other mental illness, the environment plays a role in creating an illness. If a parent is obsessive-compulsive, then there is a chance that the child will be obsessive-compulsive too. However, there are several ways to treat obsessive-compulsive disorder.

Depending upon the time occupied with the symptoms, the perceived senselessness of the symptoms and the amount of distress caused by the symptoms as to which treatment would be the best approach. There may be two types of OCD patients. One has exaggerated reactions to normal thoughts, which can be treated with cognitive therapy, and whose beliefs are delusional and not responsive to cognitive therapy. (Behavioral Health Treatment: 1997) One patient may benefit from behavior therapy and another from medication. Some may start with medication to gain control of symptoms and then behavior therapy.

There is evidence that treatment with medications or behavior therapy induces changes in the brain coincident with clinical improvement. (web 2000) Clinical trials have shown that drugs that affect the neurotransmitter, serotonin, can decrease the symptoms of OCD. The inhibitor specifically approved for OCD is (Anafranil). Others used are (Prozac), (Lu vox), and (Paxil), which all have been approved by FDA. The side effects of these drugs are overstimulation, insomnia, nausea, and loss of sexual desire. The most popular used is Prozac. Studies show that more than three-quarters of patients are helped by these medications at least a little bit.

In at least half of the patients, medications relieved symptoms, by diminishing the frequency and intensity of the obsessions and compulsions. The improvement usually takes at least three weeks or more. (web 2000) OCD had been a difficult illness to treat until recently. However, has several side effects. Almost everyone will suffer with side effects, such as, dry mouth, weight gain, constipation, drowsiness, and sometimes the inability to have an orgasm. (American Family Physician: 2000) In a large-scale experiment, 55% of the patients taking achieved at least a 35% reduction in symptoms with seven percent given a placebo. Unfortunately, patients usually relapse unless they take the drug indefinitely.

(Edna Foa: 1995) Baxter noted that metabolic rates in the forward portion of the frontal cortex distinguish obsessive-compulsive patients rather well from patients with serious forms of depression. The caudate nuclei and gyro contain large quantities of serotonin, which Insel and his colleagues believe plays a major role in obsessive-compulsive disorder. The ant-depressant drug, , blocks the action of serotonin and often provides dramatic relief to OCD patients. UCLA investigators say that leads to sedation, impotence and tremors. The NIMH researchers have also found that a patient's obsessive thoughts will rapidly worsen after taking a drug that stimulates a specific class of serotonin percept ors. (Bruce Bower: 1987) Susan Ball, assistant professor of psychiatry at the Indiana University School of Medicine, suggests that there needs to be an assessment for the different kinds of symptoms.

If a person is severely depressed and has severe obsessions and compulsions, then medication should be given first, allow the medication to kick in to reduce depression, and maybe the severity of OCD, and then do the behavioral therapy. (Behavior Health Treatment: 1997) Thirty percent of OCD patients do not respond well to medication and it the patient stops taking the pill, the symptoms return. (Sharon Begley: 1996) Another approach of treatment is Exposure and Response Prevention. This is when the patient purposefully and voluntarily confronts the feared object or idea. And at the same time the patient is encouraged to refrain from the ritual that they are having problems with. As treatment progresses, patients experience less anxiety and are able to resist the compulsive urges.

It has found to be successful for the majority of the patients who use it. Three hundred patients were treated by exposure and response prevention. Up to 76% still showed relief from three months to six years after treatment. (web 2000) Once the symptoms are defined, the therapist and patient rank thoughts and situations by the degree of anxiety and discomfort, and exposure proceeds upward on the scale. The exposure reduces the distress and the response prevention stops the compulsive behavior. (Edna Foa: 1995) Behavioral therapy is used to lessen the unwanted compulsions. People are exposed to the situations that produce the anxiety, and then resist from performing the rituals that usually ease that anxiety.

The person must really want to use this method for it to be successful and to be able to tolerate the high levels of anxiety that result. (American Family Physician: 2000) In Foa's 3-week program, patients are not allowed to wash their hands at all. The anxiety goes down by a habituation process, and the ritual goes down over time. (Behavioral Health Treatment: 1997) The rate of improvement of behavioral therapy is fifty to eighty percent and it is usually maintained for several years. In Foa's experiment, 75%of the patients given treatment showed significant improvements and a symptom reduction of more than thirty percent. (Edna Foa: 1995) Studies show that behavior therapy is found to be the most successful treatment for the majority of the patients who complete it.

Changing the way a person acts and changing the way a person thinks can alter the biology of the brain. Swartz, a psychiatrist, says that the mind can change the brain. There are also other treatment methods used. Habit rehearsal used. It is a variant of ERP. It is especially useful for touching compulsions, hair pulling, and skin picking.

The patient charts the compulsive urges and tries to substitute it with other actions, such as deep breathing, muscle relaxation, or fist clenching. Anxiety management, relaxation training, and assertiveness training are sometimes added. Cognitive Therapy helps people to learn to question the importance of their obsessions and the belief that rituals protect them. This variant of behavior therapy emphasizes changing a person's beliefs and thinking patterns. Mutual aid groups are also increasingly popular, because they allow people with OCD to help themselves by helping others. Surgery is used as a last resort in cases where nothing else works.

Surgical procedures serve to interrupt and eventually alter the routing of the neural transmission in the circuit that runs through the frontal cortex and basal ganglia. (Harvard Mental Health Letter: 1998) Treatment improved obsessions in 85% of the patients receiving behavior therapy, 52% of those receiving medication, and 19% of those receiving a placebo. The improvement rates for rituals were 100% for therapy, 43% for medication, and 12% for a placebo. Patients who continued to take the drugs sixteen months later were doing as well as those who had behavior therapy, but the patients who had stopped using the drugs lost their gains. (Edna Foa: 1995) Edna Foa states, "There is no question among experts that behavioral therapy works better than medication". The cause of obsessive-compulsive is still unclear.

There is a lot of evidence that proves the problem is biological. Tests show that there is an imbalance in the brain between someone without a mental illness or with a different mental illness. I agree somewhat, but I think that the environment has a big influence on what we do and how we act. It is clear that behavioral therapy is more successful than medication. It seems as though the exposure and response therapy leads to the best results. I however, agree with Sharon Begely that the mind can change the brain.

Since the mind can change the brain, the medication is useless. It depends upon the person with the illness as to which treatment they shall take. For behavioral therapy to work, the patient really needs to want to get better. If the person is really dedicated, then eventually the brain will change, and there won't be a problem with the frontal lobes. Unless a person wants to be stuck taking drugs for the rest of their life, I recommend they do behavioral therapy. Eventually they will overcome their compulsions and be able to control their obsessions.

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