Mental health: obsessive-compulsive disorder - Research Paper Example

?Introduction Obsessive-compulsive disorder is a type of anxiety ailment characterized by persistent and severe obsessions capable of disrupting the normal functioning of the affected individual (APA, 203). Currently, the disorder is not only one of the most common psychiatric condition but one of the most debilitating medical conditions. In modern psychiatry, obsessive-compulsive disorder is considered as a “neuropsychiatric condition, relayed by particular neuronal circuitry” (Dan, 397). This paper examines obsessive-compulsive disorder focusing on the symptoms, diagnosis and management of the condition. The major defining characteristics of obsessive-compulsive disorder are intrusive impulses, thoughts or images that heighten the level of anxiety in the affected individual (Dan, 398). In order to decrease the resulting high level of anxiety, the affected person undertakes repetitive and ritualistic activities, which become compulsions. Most people suffering from the disorder exhibit unjustified fear of contracting diseases and as a result, they maintain high levels of hygiene by frequently washing their hands even when it is not necessary. Other people with the disorder exhibit high levels of worry about harm to oneself or other people and hence they constantly check on places such as doors and exits to ascertain their security. Other obsessions include saving, precision or symmetry concerns (Stein, et al 36). People with saving obsession have a compulsion of hoarding goods while those with precision or symmetry concerns demonstrate a compulsion of arrangement and order. The symptoms of compulsive disorder vary from person to person depending on the age of the person and the type of compulsions. This implies that the common symptoms could change with time as the person advances in age (Dan, 398). However, the common types of obsessions demonstrate sexual, musical religious, somatic symptoms. Dan (399) notes that people afflicted with the disorder are usually cognizant about their obsessive behavior on a particular issue but their insight varies. Stein et al attributed the lack of insight to presence of frontal lesions in the brain (36). According to APA (2000), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) asserts that symptoms portrayed by people with obsessive-compulsive disorder should not be caused by a substance or another medical disorder. Taking substances such as cocaine and methlyphenidine could make the person to show symptoms similar to obsessive-compulsive disorder. In addition, people suffering from streptococcal infection could demonstrate obsessive symptoms. In order to make appropriate clinical diagnosis for obsessive-compulsive disorder, the symptoms should be accompanied by noticeable dysfunction and suffering (APA, 107). The subclinical symptoms of the disorder are rare and they are usually noticeable during the normal developmental process. However, obsessive-compulsive disorder severely undermines the quality of life and wellbeing of the affected individual (Stein, et al 36). The disorder has noticeable difference with obsessive-compulsive personality disorder. People with obsessive-compulsive personality disorder cannot change their character and they demonstrate traits such as “perfectionism and over conscientiousness” (Dan 400). However, in obsessive-compulsive disorder, the compulsion is an acquired condition, which could be reversed upon implementing an appropriate clinical intervention. Obsessive-compulsive disorder also demonstrates several similarities with anxiety and psychotic disorders. However, the degree of worries and fears clearly distinguishes the condition from anxieties, mood disorders and other depressive conditions (Eisen and Rasmussen, 378). DSM-IV defines obsession as “a recurrent and unrelenting impulses, thoughts or images experienced for a moment during the disturbance period” (APA, 137). These impulses are inappropriate and intrusive, causing considerable distress and anxiety to an individual. Persons afflicted with obsession try to contain or neutralize the thoughts, images and impulses by undertaking particular repetitive action or thoughts referred as compulsions. Dan (400) defines compulsion as “recurring behavior such as washing hands, checking, ordering or mental activities such as praying, counting and repeating words silently”. People with compulsions feel compelled to respond to an obsession in order to reduce the severity or prevent the feared event from happening. However, these actions, behaviors or thoughts are either not realistically designed to prevent the feared event or are absolutely excessive. According to Eisen and Rasmussen (380), the affected person is aware that the obsessive thoughts originate within his or her mind but not from external stimulus. In addition, people with obsessive-compulsive disorder are aware that the compulsions or obsessions are unreasonable. The compulsions take longer than one hour daily and cause considerable interference on a person’s ability to undertake normal activities including academic, social, family and occupational roles (Dan, 402). The prevalence rate of obsessive-compulsive disorder in population is about 2.5% and it is the forth most common psychiatric ailment (Stein et al, 41). The occurrence of the disorder in both males and females is almost equal. This differs significantly with other psychiatric disorders where females have higher prevalence rate than males. Obsessive-compulsive disorder affects both children and adults. According to Stein et al, the disorder has two ages of onset, namely juvenile and during puberty or earlier. Most males develop the disorder during childhood while in females it mostly occur during pregnancy, after giving birth or after undergoing a traumatic event such as miscarriage. The disorder has a high comorbidity and it occurs in conjunction with anxiety and other mood diseases such as depression and phobia among others (43). Various factors contribute to poor management of the condition in the society. Some of the factors include misdiagnosis, which contributes to prescription of unsuitable treatment. In addition, most people suffering from the condition decline seeking medical attention because they fear being embarrassed (Dan, 401). Assessment of obsessive-compulsive disorder is undertaken by subjecting the individual through a meticulous psychiatric examination to determine the symptoms and establish other comorbid disorders. Thorough assessment ensures differentiation of the condition from other psychiatric disorders. To determine the severity of symptoms associated with obsessive-compulsive disorder, various rating scales such as Yale- Brown scale are used (Dan, 399) The main methods of treating obsessive-compulsive disorder are pharmacotherapy and psychotherapy. Pharmacotherapy entails use of drugs that stimulate selective serotonin reabsorption inhibitors (Dan, 401). A study conducted by Stein et al established that these drugs produce varying response in patients with the condition. Early side effects could be positive indicators about effectiveness of the drug. In other patients, the drug disguises the symptoms of the disorder and other associated comorbid conditions (pp 38-39). However, pharmacotherapy does not guarantee complete recovery but it improves the quality of life of the affected person by reducing the severity of the incapacitating symptoms. According to Dan (402), drugs for treating obsessive-compulsive disorder should be taken for a minimum of one year. However, proper evaluation of the patient’s response to the drugs should be determined in order to establish the duration of pharmacotherapy. Psychotherapy is the most common method of treating obsessive-compulsive disorder and it is effective in both children and adults. According to Dan (403), exposing the patient to controlled stimuli that cause intense fear is one of the most important techniques in psychotherapeutic treatment of the disorder. Other interventions under psychotherapeutic treatment include cognitive and behavioral therapy. In clinical practice, cognitive –behavioral intervention is often applied to individual patients and in groups of people suffering from the obsessive- compulsive disorder (Dan, 402). Due to the profound impacts that obsessive compulsive disorders has on the patient, family and close friends of the affected individual, it is important to involve their participation during the treatment process. In most cases, integrating both pharmacotherapy and psychotherapy in treatment of obsessive-compulsive disorder is done in order to enhance the patient outcome. However, combining both methods have elicited clinical debates on the best sequence to produce the most effective recovery results (Eisen and Rasmussen, 379). Conclusion Obsessive-compulsive disorder remains one of the most incapacitating mental disorders globally. Some of the factors that cause high prevalence of the condition include misdiagnosis and lack of willingness in seeking early medical attention. Obsessive-compulsive disorder has high comorbidity rate, which hinders its diagnosis. The condition could develop during infancy or in adulthood. Although considerable advances have been made in establishing its causes and appropriate treatment, better understanding of obsessive-compulsive disorder is important to enhance its management and diagnosis. References APA (American Psychiatric Association). Diagnostic and Statistical Manual of Mental Disorders.4th ed. Washington: American Psychiatric Press, 2000. Dan, Stein. “Obsessive-compulsive Disorder”. The Lancet 360, (2002): 397-405. Eisen, J.L., and Rasmussen, S.A. “Obsessive-Compulsive Disorder with Psychotic Features”. Journal of Clinical Psychiatry, 54 (1993): 373-380. Stein, Dan, et al. “Quality of Life in Obsessive Compulsive Disorder”. CNS Spectrums, 5(2000): 35-40. Read More