Obsessive Compulsive Disorder : It is defined by the occurrence of unwanted and intrusive obsessive thoughts that are usually accompanied by compulsive behaviors performed to neutralize the obsessive thought. Criteria for Obsessive Compulsive Disorder (According to DSM-IV-TR)
Obsession is defined by :
• Recurrent and persistent thoughts that are intrusive and cause anxiety.
• Intrusive thoughts come frequently and . trigger extreme anxiety that gets in the way of day-to-day functioning.
• Person attempts to suppress, ignore or neutralize them by some other thought or action.
• Person recognizes thoughts are a product of his/her own mind.
Compulsion is defined as :
• Repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting). The person feels driven to perform in response to obsession.
• Behaviors or mental acts aim at preventing or reducing distress.
1. Person recognizes that the obsessions and compulsions are excessive and unreasonable.
2. Obsessions and compulsions cause marked distress and interfere significantly with normal functioning.
Causes:
Biological factors:
(i) Genetic influences : Evidence from twin studies reveal a moderately high concordance rate for monozygotic twins and a lower concordance rate for dizygotic twins.
(ii) Abnormalities in brain function : PET scans have shown that people with OCD have abnormalities in the active metabolic levels in the caudate nucleus, the orbital frontal cortex and cingulated cortex.
(iii) The role of serotonin : Current evidence suggest that increased serotonin activity and sensitivity of some brain structure to serotonin are involved in OCD symptoms.
Psychosocial factors:
(i) Behavioral viewpoint: According to O.H. Mower’s twoprocess theory of avoidance learning, neutral stimuli become associated with frightening thoughts or experiences through classical conditioning and elicit anxiety. For example – touching a doorknob or shaking hands might become associated with the ‘scary idea’ of contamination. Once learned such avoidance responses are extremely resistant to extinction.
(ii) Cognitive biases and distortions : People with OCD seems to have difficulty blocking out negative irrelevant input or distracting information so they may attempt to ‘suppress’ negative thoughts stimulated by this information. Trying to suppress negative thoughts may paradoxically increase their frequency.
OCD is also caused by the faulty belief where a person believes that having a thought about doing something (for instance killing a person) is equivalent to doing it (having killed a person). This is known as thought-action fusion. This belief keeps increasing the anxiety due to expectation of causing harmful consequences. This impels the person to engage in various compulsive behaviours to reduce the likelihood of any harmful consequences.
Psychodynamic perspective : This view suggests that obsessions and compulsions stem from unconscious conflicts arising when primitive Id impulses are conflicting with socially acceptable behaviours. Since the conflict is highly distressing the person may resort to something more manageable, like an intrusive thought or an associated compulsive behaviour
