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Obsessive Compulsive Disorders

In the seventeenth century, obsessions and compulsions were often described as symptoms of religious melancholy. Around this time, a new word for obsessions and compulsions came into usage, scrupulosity. In 1660, Jeremy Taylor, Bishop of Down and Connor, Ireland, was referring to obsessional doubting when he wrote of “scruples”. “[A scruple] is trouble where the trouble is over, a doubt when doubts are resolved.” Nowadays most people think of scrupulosity as meaning obsessive religiosity, but in earlier centuries it encompassed all types of obsessions and compulsions.

By the 1700s, clergy were increasingly deferring to physicians’ expertise in treating obsessions and compulsions. Physicians of the 1700s and 1800s described many types of obsessions and compulsions, including compulsive washing, compulsive checking, obsessive fear of syphilis, aggressive and sexual obsessions, and “responsibility” obsessions. The shift to a primarily medical understanding of obsessions and compulsions had serious consequences for those afflicted; the most dramatic consequence being the institutionalization of sufferers in asylums.

Nineteenth-century researchers gave many specific types of obsessions and compulsions their own names, for instance, arithmomania (compulsive counting), mysophobia (obsessive fear of contamination), and délire du toucher (touching compulsions). They also debated whether obsessions and compulsions should be considered a form of insanity or not. By the end of the century, a consensus had been reached that obsessions and compulsions were a neurosis rather than a psychosis. As this consensus developed, physicians began to voice opposition to institutionalizing persons with obsessions and compulsions in asylums.
Two figures dominated the early 20th century history of OCD: the French psychiatrist Pierre Janet and the Austrian psychiatrist Sigmund Freud. While Janet expanded on existing medical ideas, Freud called the illness Zwangsneurose. In England this term was translated as “obsession” and in America it became “compulsion.” The term obsessive-compulsive disorder was eventually adopted as a compromise.




Characteristic Symptoms

The Obsessive Compulsive Disorders are characterized by recurrent thoughts (obsessions) or rituals (compulsions) that people feel they cannot control.

Obsessions are persistent thoughts that one recognizes as intrusive and inappropriate and that result in marked distress. Common obsessions include fear of germs or contamination, unwanted forbidden or taboo thoughts involving sex, religion, and harm, aggressive thoughts towards others or self, and having things symmetrical or in a perfect order.

Compulsions are rituals that are performed to try to prevent or stop the anxiety related to the obsessions. For instance, an individual with this type of disorder may be obsessed with germs and dirt, constantly fearful of contamination. In an attempt to deal with his fear, he washes his hands over and over, hundreds of times throughout the day. Most people with this condition recognize that what they are doing is senseless, but they cannot stop.

 

Types of Obsessive Compulsive Disorders

Obsessive Compulsive Disorder 

Obsessive Compulsive Disorder (OCD) is characterized by unwanted and disturbing thoughts, images, or urges (obsessions) that cause a great deal of anxiety or discomfort, which the individual tries to reduce by engaging in repetitive behaviors or mental acts (compulsions).

Body Dysmorphic Disorder

Body Dysmorphic Disorder is characterized by obessional thinking about one or more perceived defects or flaws in one’s appearance; a flaw that, to others, is either minor or not observable. The individual may feel so ashamed and anxious because of the “flaw” that they avoid social situations.

Hoarding Disorder 

Hoarding Disorder is a persistent difficulty discarding or parting with possessions because of a perceived need to save them. A person with hoarding disorder experiences distress at the thought of getting rid of the items. Excessive accumulation of items, regardless of actual value, occurs.

Trichotillomania

Trichotillomania, also called hair-pulling disorder, is characterized by recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop.

Excoriation Disorder

Excoriation Disorder, also called Dermatillomania, is characterized by repeated, compulsive picking at one’s own skin resulting in skin lesions.


Prevalence and Age of Onset

The prevalence and onset of the obsessive compulsive disorders is quite similar. The lifetime prevalence of OCD is estimated to be 2.3 % of the population. OCD usually begins before age 25 years and often in childhood or adolescence. Females are affected at a slightly higher rate than males in adulthood, although males are more commonly affected in childhood. Body dysmorphic disorder (BDD) is estimated to occur in 2.4% of the population. The median age of onset for BDD is 15 years with males and females affected equally. Epidemiological studies suggest 2-5 % of the general population presents with problematic hoarding. Hoarding symptoms often first emerge in early adolescence. Lifetime prevalence of trichotillomania is estimated to be 1% of the population. Onset of hair pulling most commonly coincides with, or follows the onset of puberty. Females are more frequently affected than males, at a ratio of approximately 10:1. Excoriation disorder occurs in 1.4% of the population. Like trichotillomania, the onset of skin picking is most often in adolescence, commonly coinciding with or following the onset of puberty. Three-quarters or more of individuals with excoriation disorder are female.

 


Treatment & Support

Obsessive Compulsive Disorder (OCD), like many psychiatric disorders, is most effectively treated with a combination of medication and psychotherapy.

 

Psychotherapy

It is possible that you may have heard of Cognitive Behavior Therapy (CBT) before. CBT refers to a group of similar types of therapies used by mental health therapists for treating psychological disorders, with the most important type of CBT for OCD being Exposure and Response Prevention (ERP).
The exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions. The response prevention part of ERP refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been “triggered.” All of this is done under the guidance of a therapist at the beginning, though the client eventually learns to do ERP exercises on their own to help manage their symptoms.

Pharmacotherapy

Selective serotonin reuptake inhibitors (SSRIs) are the primary medication used in the treatment of OCD. Examples of SSRIs include Prozac, Zoloft, Paxil, and Celexa. These drugs work specifically to increase levels of serotonin in the brain. Older medications such as tricyclic antidepressants (e.g., Anafranil) and monoamine oxidase inhibitors (e.g., Nardil) that affect a wider range of neurotransmitters are also prescribed for OCD. Because the side effects of these medications can be severe, most physicians and patients prefer the SSRIs.

 

A Spiritual Perspective

The core feature of OCD is unrealistic fear: fear of failure, fear of catastrophe, fear of the unknown. In ministering to those with OCD, we must show them that the perfect love of God casts out all fear (1 John 4:18). In the Sermon on the Mount, Jesus speaks directly to those who are anxious and fearful about their daily lives (Matthew 6:25–34). This passage of Scripture is a good place to start when ministering to those struggling with anxiety disorders.

Individuals with OCD are often so focused on trying to control their circumstances and avoiding some potential catastrophe that they begin to perceive God as punitive, perfectionistic, and authoritative. He is seen as someone they can never satisfy, no matter how hard they try. When ministering to those struggling with anxiety, we can remind them that because of God’s grace and forgiveness we do not have to “perform” to earn His love and acceptance—we already have it if we are in Christ.

  

Finding Care

The links and information below will provide you with a starting point in terms of finding mental health care providers, treatment facilities and support groups for those struggling with OCD.

Mental Health Care Providers

When assisting an individual it is important to help them find the right type of mental health care provider. These links will assist you in beginning your provider search. Knowing and building relationships with providers in your area can prove invaluable. Both in aiding the individual in getting an appointment, as well as, being able to better support them once they begin receiving professional treatment.

An individual struggling with obsessive compulsive disorder will most likely need to see both a clinical psychologist / therapist for psychotherapy (talk therapy) and a psychiatrist for medication.

By providing your zip code the following search engines will give you information about local mental health care providers.

Clinical Psychologists / Therapists Psychiatrists


Treatment Facilities

In some people, OCD can become so severe that a hospital stay is needed. This may be necessary if the individuals seeking your care can’t take care of themselves properly or are in immediate danger of harming themselves or someone else. Psychiatric treatment at a hospital can help keep them calm and safe until their mood improves.

Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get symptoms under control.

By providing your zip code the following search engine will give you information about mental health treatment facilities in your area.

Substance Abuse and Mental Health Services Administration American Residential Treatment Association

 

Support Groups

Recognizing that community is one of the factors necessary for successful recovery, attending support groups can be a powerful and meaningful way to connect with others facing similar challenges. Support group experiences allow people affected by mental health difficulties and disorders to connect in a safe and supportive environment. Support groups are led by trained facilitators and teach coping skills, help reduce anxiety, build resiliency and provide a place for people to share common concerns and receive emotional support.

These links will give you information on support groups in your area.

International OCD Foundation National Alliance on Mental Illness Grace Alliance


Supporting the Family

Many times the family caring for an individual with a mental illness is overlooked. They are often the front line support for the individual. The responsibility of care can take a physical and psychological toll on caregivers. Many times the caregiver needs as much support as the individual that has the illness. Caregiver support groups are available for the families of those struggling with OCD.

These links will give you information on caregiver (family) support groups in your area.

National Alliance on Mental Illness – Family Support Group National Alliance on Mental Illness – Family to Family Support GroupGrace Alliance




Educational Resources

Here are some links to aid you in learning more about Obsessive Compulsive Disorders. The more information you have, the better you will be able to help those seeking your guidance.

National Institute of Mental Health Mental Health America


Downloadable Resources 

First Step – What to do once a diagnosis has been made.

Daily Steps – Developing a holistic mental health care plan.

Difficult Steps – Navigating destructive behavior and legal issues.

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