Obsessive-Compulsive Disorder: Definition, Nature, Effects and the Possibility of Treatment and Cure

[Disclaimer: This is not a formal academic essay, but rather an informal, informative essay for families and friends who might be wondering about this. Nevertheless, the text consulted (Psychology: Themes and Variations, also represented as "ibid") by Wayne Weiten is perhaps the best introductory and most reliable introductory text to psychology. The author of this short essay advises readers who know someone with OCD to consult professional counsel, and not merely to go by the information presented here. --B. P. Burnett.]

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What is obsessive-compulsive disorder and how might one deal with it? Many people who know someone close to themselves who suffer from OCD can find it particularly distressing to observe the way this neurological dysfunction can intrude upon the life of the person, be they a family member, a friend, another loved-one or a neighbour and not know what to do. Some people may even find it slightly funny. However, the suffering which results from the psychological delusions which accompany those with OCD are not funny but are indeed potentially destructive properties to one’s personal health and to the welfare of those around them. This short paper therefore aims to provide a simple yet precise text-book introduction to OCD and thereafter to provide a discussion of two main different possibilities for treatment, though more could be added.

Firstly, What is OCD? According to Dr Wayne Weiten, professor of psychology at the University of Nevada, Las Vegas, and Fellow of Divisions 1 and 2 of the American Psychological Association, OCD is a subcategory of anxiety disorder. He explains:

            “Anxiety disorders are a class of disorders marked by feelings of excessive apprehension. There are five principal types of anxiety disorders: generalized anxiety disorder, phobic disorder, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. They are not mutually exclusive, as many people who one anxiety syndrome often suffer from another at some point in their lives (Merikangas, 2005). Studies suggest that anxiety disorders are quite common, occurring in roughly 19% of the population” (Wayne Weiten, Psychology: Themes & Variations (2008), p.582).

So OCD is classified as a state of progressive mental dysfunction and deterioration expressed by feelings of stress and tension (or, anxiety) which can be severely disruptive to a person’s life. As Weiten explains:

            “Obsessions are thoughts that repeatedly intrude on one’s consciousness in a distressing way. Compulsions are actions that one feels forced to carry out. Thus, an obsessive-compulsive disorder (OCD) is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions)” (ibid., p.583).

As a neurological dysfunction, OCD can be particularly distressing and awfully time-wasting dysfunction, affecting both one’s personal and professional life. As a rare dysfunction, OCD also maintains the dangerous potential of progressing into a violent disorder. As Weiten documents:

            Obsessions often center on inflicting harm on others, personal failures, suicide or sexual acts. People troubled by obsessions may feel that they have lost control of their mind. Compulsions usually involve stereotyped rituals that temporarily relieve anxiety. Common examples include constant handwashing; repetitive cleaning of things that are already clean, endless rechecking of locks, faucets, and such; and excessive arranging, counting, and hoarding of things (Pato, Eisen, & Phillips, 2003). Specific types of obsessions tend to be associated with specific typed of compulsions. For example, obsessions about contamination tend to be paired with cleaning compulsions, and obsessions about symmetry tend to be paired with ordering and arranging compulsions… [F]ull-fledged obsessive-compulsive disorders occur in roughly 2.5% of the population (Turner et al., 1997)… The typical age for onset of OCD is late adolescence, with most cases (75%) emerging before the age of 30 (Kesser et al., 2005a). OCD can be a particularly severe disorder, as it is often associated with serious social and occupational impairments (Torres et al., 2006)” (ibid., pp.583-584, emphasis added).

So according to Weiten, the nature of an obsession can be classified by the observation of its corresponding compulsion, and the chief goal of a person’s carrying out of a compulsion is the temporary relieving of tension (or, in the words of Weiten, anxiety) formed through irrational obsessions which can seriously impair daily living. This demonstrates that those with OCD suffer from a genuine and progressive mental disorder and they therefore must seek professional therapy from a clinical and/or counselling psychologist. Therapy refers to professional treatment from a trained therapist—a doctor. It is not enough, says Weiten, to simply seek the help and advice of friends, parents or religious leaders and guides. Psychologists are professional doctors who specialise in the treatment and diagnosis of neurological disorders and everyday behavioural problems such as OCD. Due to its potentially progressive nature, OCD is better dealt with sooner rather than later (ibid., p.624).

There exists a vast variety of different kinds of psychiatric therapies available, such as insight therapies. These are aimed at verbal interaction between doctor and client to enhance the client’s self-knowledge and thus engender change in personality and behaviour. Insight therapies include several different techniques, including: (1) Psychoanalysis, which emphasises the discovery of unconscious conflicts, motives and defence-mechanisms within persons through techniques such as free association (the investigation of the unconscious mind in which a relaxed subject reports all passing thoughts without reservation), transference (the redirection of a client’s emotions that were originally felt in childhood to the therapist), and dream analysis (in which the therapist interprets the symbolic meaning of their client’s dreams). Another insight-therapeutic method includes (2) Interpretation, which is aimed at trying to explain the significance of the client’s thoughts, feelings memories and behaviours (ibid., pp.626-627). Apart from these classic psychoanalytical therapies (1) and (2) (and given the fact that Freudian psychoanalysis (1) is not widely practised anymore today—(Kay & Kay, 2003)), there exists a host of other therapeutic methods such as (3) Client-Centred Therapy which emphasises providing a substantial foundation in the emotional support of their clients. According to this method, clients “play a major role in determining the pace and direction of their therapy” (ibid., p.628). What is most significant about this third approach is that it demonstrates that one’s choice to engage in serious therapy or not will dramatically determines the process of possible healing or the continual development in the severity of one’s anxiety disorder. In other words, one’s conscious choice to admit one has a problem and seek treatment or not (which may be a very long and gradual process of learning and healing) will dramatically alter the course of one’s life for the better (with treatment) or for worse (without treatment).

According to Weiten, insight therapies such as mentioned above are overall especially advantageous if diligently pursued:

            “[T]housands of outcome studies have been conducted to evaluate the effectiveness of insight therapy. These studies have examined a broad range of clinical problems and used diverse methods to assess therapeutic outcomes, including scores on psychological tests and ratings by family members, as well as therapists’ and clients’ ratings. These studies consistently indicate that insight therapy is superior to no treatment or to placebo treatment and that the effects of therapy are reasonably durable (Kopta et al., 1999; Lambert & Archer, 2006). And when insight therapies are compared to head-to-head against drug therapies, they usually show roughly equal efficiency (Arkowitz & Lilienfeld, 2007; Pinquart, Duberstein, & Lyness, 2006). Studies generally find the greatest improvement early in treatment (the first 13-18 weekly sessions), with further gains gradually diminishing over time (Lambert, Bergin, & Garfield, 2004). Overall, about 50% of patients show a clinically meaningful recovery within about 20 sessions, an another 25% of patients achieve this goal after about 45 sessions (Lambert & Ogles, 2004). Of course, these broad generalizations mask considerable variability in outcome, but the general trends are encouraging” (ibid., p.632).

Another major source of therapy—probably most relevant to OCD—is behavioural therapy, which is a fruit from the psychological school of Behaviourism. According to Weiten, the difference between insight therapies and behavioural therapies is in that whereas the former sees symptoms as the effects of an underlying problem, the latter sees the symptoms themselves as the problem. Thus, as Weiten explains, “behavioural therapies involve the applications of learning principles to direct efforts to change clients’ maladaptive behaviours” (ibid., pp.633-634).  Behavioural therapy techniques include: (1) Systematic Desensitization developed by Dr Joseph Wolpe in 1958 which is used to reduce a client’s anxiety responses through counterconditioning which is accomplished by a three-step method: (i) the building of an anxiety hierarchy in which a client suffering from a particular phobia (for instance) lists from lowest to highest different scenarios in which his phobia is intensified; (ii) the training of the client in muscular relaxation during the construction of the anxiety hierarchy in which the client learns to engage in thorough relaxation techniques issued upon command from the therapist; and (iii) working through the anxiety hierarchy and learning to remain relaxed through each stimuli. As clients conquer each imagined stimuli, they learn how to deal with real stimuli. According to the theory underlying systematic desensitization, the development of relaxation techniques will counteract anxieties and thus eliminate them. According to Weiten, the success of such therapy has been ‘questioned’ but ‘well-documented’ (ibid., pp.634-635). There also exist a host of other methods which behavioural therapy offers including: (2) aversion therapy in which aversive stimulus is paired with addictive/maladaptive stimulus that elicits an undesirable response to the client; (3) social skills training which is designed to improve interpersonal skills that emphasise modelling, behavioural rehearsal and personal shaping; and (4) cognitive-behavioural treatments which utilise various combinations of verbal interventions and behaviour modification techniques to help clients change maladaptive patterns of thinking (ibid., pp.635-637).

This fourth method—cognitive-behavioural treatments—would be a particularly good behavioural therapy for someone suffering from OCD, given its utilisation of cognitive therapy. Cognitive therapy uses specific strategies to correct habitual thinking errors that underlie various types of disorders (ibid., p.636). This helps to help challenge clients’ maladaptive thinking and delusional beliefs through behavioural techniques including: (i) modelling, (ii) systematic behaviour-monitoring and (iii) behavioural rehearsals and practice (Wright, Beck and Thase, 2003). Cognitive therapy is also interactive in that often therapists give ‘homework tasks’ to their clients so that the client can gather and record information about himself and his thoughts in whatever specified circumstances by the therapist to use to work on during the subsequent therapy sessions (ibid., p.637). Generally, according to Weiten, behavioural therapeutic methods have been shown to have been very effective methods of treatment for clients. However, as Weiten warns we ought not to underestimate the fact that outcomes do vary from person to person and thus vast and hopeful generalisations do not necessarily pertain to all (ibid., p.637).

In final conclusion then, OCD has been shown to be a significantly rare and potentially dangerous and/or time-consuming disorder both practically and personally. A person possess OCD just if he experiences intrusive and unwanted thoughts (obsessions) which results in mindless and unnecessary patterns or rituals or patterns of behaviour (compulsions). Despite the potential severity of this maladaptive behaviour, there do exist effective and meaningful treatments through professional insight and/or behavioural therapies which, over time, can help a person if he perseveres and cooperates in therapy for whatever extended period of time necessary. Professional therapy therefore has good potential to help one’s personal condition and thus illuminate one’s professional and personal future. Therefore, therapy is highly recommended for those suffering from any form of OCD.

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++ Bibliography:

– Weiten, Wayne, Psychology: Themes & Variations (Dec. 17^th 2008), Wadsworth Publishing, University of Nevada, Las Vegas, 8^th edition.

++ List of cited studies (in order of appearance):

– (Pato, Eisen, & Phillips, 2003)
– (Turner et al., 1997)
– (Kesser et al., 2005a)
– (Torres et al., 2006)
– (Kay & Kay, 2003)
– (Kopta et al., 1999)
– (Lambert & Archer, 2006)
– (Arkowitz & Lilienfeld, 2007)
– (Pinquart, Duberstein, & Lyness, 2006)
– (Lambert, Bergin, & Garfield, 2004)
– (Lambert & Ogles, 2004)
– (Wright, Beck and Thase, 2003)