Obsessive-Compulsive Behaviors

	
	"Compulsive" and "obsessive" have become
everyday words.  "I'm compulsive" is how some
people describe their need for neatness,
punctuality, and shoes lined up in the closets.
"He's so compulsive is shorthand for calling
someone uptight, controlling, and not much fun.
"She's obsessed with him" is a way of saying your
friend is hopelessly lovesick.  That is not how
these words are used to describe Obsessive-
Compulsive Disorder or OCD, a strange and
fascinating sickness of ritual and doubts run wild.
OCD can begin suddenly and is usually seen as a
problem as soon as it starts.
	Compulsives (a term for patients who mostly
ritualize) and obsessives (those who think of
something over and over again) rarely have
rituals or thoughts about nuetral questions or
behaviors.  What are their rituals about? There
are several possible ways to list symptoms of
OCD. All sources agree that the most common
preoccupations are dirt (washing, germs,
touching), checking for safety or closed spaces
(closets, doors, drawers, appliances, light
switches), and thoughts, often thoughts about
unacceptable violent, sexual, or crude behavior.
	When the thoughts and rituals of OCD are
intense, the victim's work and home life
disintigrate.  Obsessions are persistant,
senseless, worrisome, and often times,
embarrassing, or frightening thoughts that repeat
over and over in the mind in an endless loop.
The automatic nature of these recurant thoughts
makes them difficult for the person to ignore or
restrain successfully.
	 The essence of a Compulsive Personality
Disorder is normally found in a restricted person,
who is a perfectionist to a degree that demands
that others to submit to his\her way of doing
things. A compulsive personality is also often
indecisive and excessively devoted to work to
the exclusion of pleasure. When pleasure is
considered, it is something to be planned and
worked for. Pleasurable activities are usually
postponed and sometimes never even enjoyed.
With severe compulsions, endless rituals
dominate each day.  Compulsions are incredibly
repetitive and seemingly purposeful acts that
result from the obsessions.  The person performs
certain acts according to certain rules or in a
stereotypical way in order to prevent or avoid
unsympathetic consequences.  People with
compulsive personalities tend to be excessively
moralistic, and judgmental of themselves and
others.
	Senseless thoughts that recur over and over
again appearing out of the blue; certain "magical"
acts are repeated over and over.  For some the
thoughts are meaningless like numbers, one
number or several, for others they are highly
charged ideas-for example, "I have just killed
someone."  The intrusion into conscious
everyday thinking of such intense, repetitive, and
to the victim disgusting and alien thoughts is a
dramatic and remarkable experience.  You can't
put them out of your mind, that's the nature of
the obsessions.
	Some patients are "checkers," they check
lights, doors, locks-ten, twenty or a hundred
times. Others spend hours producing
unimportant symmetry. Shoelaces must be
exactly even, eyebrows identical to eachother. A
case studied by the well-known art therapist,
Judith Aron Rubin, Rubin tells of a young girl
named Mary, who suffers from OCD, and how
she drives her fellow waitresses frantic because
she goes into a tailspin if the salt and pepper she
has arranged in a certain order has been moved
around. All of the OCD problems have common
themes: you can't trust good judgment, you can't
trust your eyes that see no dirt, or really believe
that the door is locked. You know you have done
nothing harmful but in spite of this good sense
you must go on checking and counting.
	 There are many, many common obsessions,
of all of them the most common is called
"washing" this involves the victim to have a
constant feeling of conamination, dirt and\or
grime all over their body. The book,The Boy Who
Couldn't Stop Washing by Judith L. Rapoport
describes a long, sad case of a young boy who
spent three or more hours in the shower each
day. The boy "felt sure" that there was some
sticky substance on his skin. He thought of
nothing else.
	Our normal functioning probably consists of
constant uncountable checking, a sort of radar
operation, that we could not do contiously and
still act efficiently. Something has gone wrong
with the process for obsessive compulsives, the
usual shut-off such as "my hands are clean
enough" or "I saw the gas was turned off on the
stove" or "The door was locked." does not get
through.  Everyday life becomes dominated by
doubts, leading to senseless repetition and ritual.
	Obsessive phobias tend to have distinct
features. According to Issac Marks, "They are
usually part of a variety of fears of potential
situations themselves. Because of the vagueness
of these possibilities, ripples of avoidance and
protective rituals  spread far and wide to involve
the patients life style and people around
him\her. Clinical examination usually discloses
obsessive rituals not directly connected with the
professed fear; instead the obsessive fear is part
of a wider obsessive-compulsive
disorder."(Marks,1969)
	"The sustained experience of obsessions
and\or compulsions." make up what the
American Psychiatric Association's Diagnostic
and Statistical Manual of Mental Disorders, 3rd
edition, calls Obsessive-Compulsive Disorder. It
has also been called obsessional nuerosis.
Psychiatrists have been fascinated by this
disorder for over a hundred years.  Priests have
described symptoms like these for much longer
than that.(A.P.A.,80)
	Children suffer from OCD with exactly the
same symptoms as adults. Normally an early start
in mental disorder is unusual. Other mental
illnesses, such as depression or schitzophrenia
often apear in a differant form in young children
and in any case are much more rare in children
than in adults. But with OCD it is the same at any
age.
	In the book The Boy Who Couln't Stop
Washing, there is a story of a fourteen-year-old
girl who has been diagnosed with OCD.  As she is
talking to her psychiatrist she says, "I have really
lost touch with myself and that is really
frightening.  I wish I could get the 'old Sally'
back.  I keep hoping it's just a dream and that I'll
wake up and everything will be normal.  I used to
like who I was a lot, but now I feel I don't even
know myself anymore.  I have so many goals and
dreams I would like to accomplish, but I know I
will never acomplish them with OCD.  I feel like I
am in a mental labyrinth from which I can't
escape.  I hope I can get better." (Rapoport,'89,p.80)
	To quote the author and psychiatrist, Judith
L. Rapoport, "The disease affects some of the
most able, sensitive, and talented people I have
met.  Their otherwise normal ability to function,
to become a good  husband, wife, or friend
makes working with obsessive-compulsive
patients very rewarding and, when they are
severely ill, very painful."(Rapoport,'89, p.3)
	 A few individual cases of OCD have been
reported in the medical literature over the past
150 years, but only recently have we learned of
the large number of adolesence and adults who
suffer with it.  More than 4 million people in the
United States suffer from its' disabling thoughts
or rituals. Amazingly most of them keep their
problem hidden.  We are finding out that many of
the adults who are being treated for it now went
pretty much their whole life hiding the problem
because they were too humiliated or did not
want to be considered crazy and thown in a
mental institution.
	In spite of the interesting individual cases of
OCD in the past one hundred fifty years, there
was not much work on treatment.  There is little
incentive to evaluate or develop new treatments
for rare disorders.  So up until the 1970's the
recommended treatment was psychotherapy or
psychoanalysis.  Doctors made these suggestions
for lack of an alternative, but severe cases and
follow-up studies of adults could not show any
advantadge for this treatment.
	The Best studied Drug to reduce or stop
OCD,is called Anafranil. Anafranil was first put on
the market in 1990.  The side effects of Anafranil
range from mild to severe. The most common
side effects are dry mouth, constipation, and
drowsiness.  However a tremor, loss of sexual
appetite, impotence-which is temporary until you
stop taking the drug, and excessive sweating can
be major problems. These are all side effects
common to tricyclic anti-depressants-the group of
which Anafranil belongs.
	In the most severe cases of OCD,
psychosurgery was used regularly until the
1950s.  With availability of other treatments
psychosurgery is now a last resort.  In some
cases, however, this drastic treatment seems to
work when everything else has failed. A few
medical centers in Boston, London, and
Stockholm, for example, will still perform limited
operations using newer techniques.
	The two newer treatments, behavior therapy
and drug treatment with Anafranil, both seem to
have long-term benefits. Behavior therapists have
followed up their patients for a year or two and
the effect seems to last.  Anafranil has not been
as well studied in follow-up, but what studies
have been done show that it too is helpful over
at least two years.	
	Even though Anafranil does work well it is
not always nessesary. There are other aproaches.
Some OCD's have gotten help from just "coming
out of the OCD closet". Support groups have also
been known to help. There is a wide variety of
things you can do to help a person diagnosed
with OCD. 	
	"Scientists have suggested that there may be
a biological explanation for some obsessive
compulsive disorders. There may be an
imbalance in the frontal lobes of the brains of
obsessive-compulsives that prevents the two
brain regions from working together to channel
and control incoming sensations and
perceptions."(Boulougouris,1971)	
	The American Psychiatric Association's
Diagnostic and Statistical Manual of Mental
Disorders requires at least five of the following
symtoms to be characteristic of the persons
functioning. In addition, the symptoms must
cause some problems with personal or work life.
  "1. Restricted ability to express warm and 		
	 tender emotions.
   2. Perfectionism that interferes with overall 	
	 ability to see the needs of a situation.
   3. Insistence that others submit to the person's
	 way of doing things without awareness of 	
	 how this makes others feel.
   4. Excessive devotion of work to the exclution 	
	 of pleasure.
   5. Indecisiveness to the point wher decisions 	
	 are postponed avoided, or protracted. 		
	 Assignments may not get done on time        	
	 because of thinking about priorities.
   6. Preoccupation with details, rules, lists or 	
	 schedules to the extent that the major point
	 of the activity is lost.
   7. Overconscientiouness, scrupulousness, and 	
	 inflexibility about moral or ethical matters.
   8. Lack of generosity in giving time, money or 	
	 gifts.
   9. Inability to discard worn out or worthless    	
	 objects." (A.P.A.,'80)
	So much is asked about where our everyday
lives stop and OCD begins.  The basis of
Obsessive -Compulsive Disorder is still unknown.
The evidence for a biological cause is compelling
but unfortunately it is still necessary to speak of
the biology of behavior in vague terms.  The
effect of a drug, and the normality of many of the
families with an OCD kid makes the importance
of "poor upbringing" as a cause of OCD uncertain
to say the least. This is a disease that may be
thought of as doubts gone wild. Patients doubt
their very own senses. They cannot believe any
reasurance of everyday life.
	Reassurance does not work. The notion that
there is a biological basis for a sense of
"knowing" has interesting philosophical
implications.  We are normally convinced that
what we see and feel is truely there.  If this is a
"doubting disease," and if a chemical controls
this sense of doubt, then is our usual, normal
belief in what our everyday senses and common
sense tell us similarly determined by our brain
chemistry?