Obsessive-Compulsive Disorders

Among the persons suffering from anxiety and related disorders, a client who needs hospitalization is likely to have obsessive-compulsive disorder (OCD).

Obsessive-compulsive disorder OCD is the devastating culmination of the anxiety disorders. It is not uncommon for someone with OCD to experience severe generalized anxiety, recurrent panic attacks, debilitating avoidance, and major depression, all occurring simultaneously with obsessive compulsive symptoms.

In other anxiety disorders, the danger is usually in an external object or situation, or at least in the memory of one. In obsessive-compulsive disorder OCD, the dangerous event is a thought, image, or impulse that the client attempts to avoid as completely as someone with a snake phobia avoids snakes.

Obsessions are intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate. Compulsions are the thoughts or actions used to suppress the obsessions and provide relief.


Diagnostic Criteria for Obsessive-Compulsive Disorder.

A. Presence of obsessions, compulsions or both:

    • Obsessions are defined by 1 and 2:
      1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the
      disturbance, as intrusive and inappropriate and that
      in most individuals cause marked anxiety or distress
      2. The individual attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
    • Compulsions are defined by 1 and 2:
      1. Repetitive behaviors (e.g., handwashing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
      2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day), or cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
C. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder. (E.g., excessive worries, as in generalized anxiety disorder, or preoccupation with appearance, as in body dysmorphic disorder).

Specify if:

With good or fair insight: the individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. Poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true. With absent insight/delusional: the person completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.

Causes of OCD.

Many of us sometimes have intrusive, even horrific, thoughts and occasionally engage in ritualistic behavior, especially when we are under stress (Parkinson & Rachman, 1981a, 1981b). But few of us develop OCD.

The tendency to develop anxiety over having additional compulsive thoughts, however, may have the same generalized biological and psychological precursors as anxiety in general.

One hypothesis is that early experiences taught them that some thoughts are dangerous and unacceptable because the terrible things they are thinking might happen and they would be responsible. These early experiences would result in a specific psychological vulnerability to develop Obsessive-compulsive disorders OCD. When clients with OCD equate thoughts with the specific actions or activity represented by the thoughts. This is thought–action fusion.

Generalized biological and psychological vulnerabilities must be present for this disorder to develop. Believing some thoughts are unacceptable and therefore must be suppressed may put people at greater risk of OCD. However, a model of the etiology of OCD that is somewhat similar to other models of anxiety disorders.

Treatment for Obsessive-compulsive disorders.

They evaluated effects of drugs on OCD. Highly structured psychological treatments work somewhat
better than drugs, but they are not readily available. The most effective approach called exposure and ritual prevention (ERP). A process whereby they actively prevented the rituals. And also the patient is systematically and gradually exposed to the feared thoughts or situations.

Evidence-based psychological treatments for OCD have examined the efficacy of cognitive treatments with a focus on the overestimation of threat, the importance and control of intrusive thoughts. And the sense of inflated responsibility present in patients with OCD who think they alone may be responsible for preventing a catastrophe, as well as the need for perfectionism and certainty present in these patients.

However, Psychosurgery is one of the more radical treatments for OCD. “Psychosurgery” is a misnomer that refers to neurosurgery for a psychological disorder.


David H. Barlow, V. Mark Durand. Abnormal Psychology, An Integrative Approach. (7th ed).

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