PSYCHOLOGICAL DISORDERS

Obsessive Compulsive Disorder and Its Treatment

Obsessive/compulsive disorder (OCD) is a type of anxiety disorder in which time-consuming obsessions and compulsions significantly interfere with a person’s routine, making it difficult to work or to have a normal social life or relationships. OCD can strike at any age hut often begins in adolescence or early adulthood. Afflicting nearly 4 million Americans, OCD is equally common in men and women and knows no geographic, ethnic, or economic boundaries.

Obsessions

Obsessions are constant, intrusive, unwanted thoughts that cause distressing emotions such as anxiety or disgust. People experiencing obsessions recognize that these persistent images are a product of their own mind and are excessive or unreasonable. Yet, these intrusive thoughts cannot be settled by logic or reasoning. For example, some people may constantly fear bringing harm or injury to themselves or others or worry that they could violate social norms by swearing or making sexual advances. Others worry about germs and contamination.

Most people quickly become accustomed to an experience that only appears to be a threat. After repeated exposure to it, they eventually no longer feel threatened by it. People with OCD continue to experience these anxious feelings of threat and do not realize that the “threat” might be minuscule. Over the course of several months, these feelings develop into an obsession that becomes a threat on its own. Often, people with OCD find that repeated behaviors (rituals) decrease their concern, and so they feel compelled to repeat them in order to reduce their discomfort.

Compulsions

Compulsions are urges to do something to lessen discomfort, usually dis-comfort that is caused by an obsession. Rituals are the behaviors in which people engage in response to a compulsion.

In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible. Compounding the anguish these rituals cause is the knowledge that the compulsions are irrational.

Cleaning Provoked by the fear that real or imagined germs, dirt, or chemicals will “contaminate” them, some spend hours and hours washing themselves or cleaning their surroundings.

Repeating To dispel anxiety, some utter a name, phrase, or behavior several times. They know these repetitions won’t actually guard against injury but fear harm will occur if they don’t do it.

Completing People with this compulsion must perform a series of complicated behaviors in an exact order or repeat them again and again until they are done perfectly.

Checking The fear of harming oneself or others by forgetting to lock the door or turn off the gas stove develops into the ritual of checking. Others repeatedly retrace routes they drive to be sure the haven’t hit anyone or caused any accidents.

Being meticulous While neatness and tidiness don’t signify a disorder, some individuals with OCD develop an over whelming concern about where things go on a desk or the appearance of a room.

Avoiding Compulsive avoiders stay away from the cause of their anxiety and anything related to it. One patient became so anxious about chocolate that she avoided not only the candy but also anything else that was brown.

Hoarding One of the less common compulsions, hoarding involves the constant collection of useless items. People with this compulsion may collect anything—scraps, newspapers, clothing, containers, cans, stones, garbage, even excrement—to the point that rooms are filled, doorways are blocked, and health hazards develop.

Slowness Also a rather uncommon compulsion that strikes mostly men, this compulsion causes people to do certain tasks very, very slowly.

Other varieties of compulsions include excessive and ritualized praying, counting, and list making.

Treatments

Behavior Therapy
One of the most effective treatments is a type of behavior therapy known as exposure and respouse prevention.

During treatment sessions, patients are exposed to the situations that give rise to their anxiety and provoke compulsive behavior or mental rituals. Through this exposure, the patients learn to decrease and then stop the rituals that plague their lives. They find that the anxiety arising from their obsessions lessens without their engaging in ritualistic behavior. For example, therapy for a compulsive cleaner who previously could not handle money without washing her hands might involve counting dollar bills without washing her hands.

This technique works well for patients whose compulsions focus on situations that can be re-created easily. A few engage in compulsive rituals because they fear catastrophic events that can’t be recreated. Therapy for these patients must rely more on imagining exposure to the anxiety producing situations.

Throughout behavior therapy, the patient follows guidelines or a “contract” on which the psychiatrist and patient agree. For example, the contract may outline whether a patient can perform any part of his or her ritualistic behavior and, if so, for how long and under what circumstances. A compulsive washer may agree to shower for only 10 minutes a day. Compulsive checkers may be permitted to check door locks, gas stoves, or knives only once a day.

Careful studies show that behavior therapy can effectively reduce compulsive behavior and significantly lessen the chances for relapse. But behavior therapy depends on the patient’s willingness to participate and ability to keep his or her part of the treatment contract. Throughout therapy the psychiatrist coaches the patient to fight the compulsion. Often, family members also coach and support their loved ones in sticking with their therapy.

Medication

Various studies indicate that behavior therapy is successful for 50% to 90% of those with OCD. However, some patients will not agree to participate in behavior therapy because it can be difficult. Others also have depression which must be treated simultaneously.

Numerous studies have demonstrated that a class of medications known as serotonin reuptake inhibitors are often effective in the treatment of OCD.

The Role of Medication in Treating Mental Illness

When a depression becomes so severe that it interferes with a person’s productivity, interpersonal relationships, spiritual life, and daily activities, anti-depressant medication is necessary

When people come to Pine Restfor treatment, they are first evaluated to determine the nature of their illness and the most helpful treatment approach. Treatment often includes individual counseling, education, pastoral counseling, family therapy, and group therapy. Another aspect of treatment may be medication.

Whenever a psychiatrist recommends that medication be part of a treatment program, patients and their families may have some ethical and spiritual concerns. The treating physician should be sensitive to these concerns and answer them openly before embarking on a course of treatment that involves the use of medications.

The cause of much of the controversy surrounding this subject lies in the tendency of some people to view illness as either a totally physical or a totally emotional/spiritual phenomenon. This “either/ or” pattern results in two opposing sets of reasoning:

1. All psychiatric illness results from emotional and spiritual causes. Therefore any use of medication represents a crutch or “bandaid” approach that undercuts the process of recovery involving emotional and spiritual struggle.
2. All psychiatric illness results from disturbances in brain chemistry and can best be treated with chemical agents to restore normal functioning. Emotional and spiritual factors have little relevance in this process.

However, neither of these views adequately describes the complexity of human illness. There is growing evidence that emotional and spiritual difficulties are associated with increased vulnerability to physical illness, (e.g., There is a significant increase in the incidence of serious physical illness during periods of mourning and grief.)Similarly, physical illness and chemical disturbances in the brain often manifest in mental and emotional symptoms, (e.g., Severe deficiencies of critical nutrients such as vitamin B12 can cause mental depression or confusion.) Humans consist of an integrated whole of body, mind, and soul none of which can be viewed separately. The greatest success in treatment is usually achieved when all aspects of the person are addressed simultaneously.

Children and adolescents experience many of the same psychological problems as adults. However, they are not “miniature adults.” They often act differently from adults when they are depressed, out of control, or anxious. They are evaluated in the context of family and school. Their treatment focuses on helping rebuild their relationship with their family and restoring their ability to function in school and prepare for life. If medications are needed in their treatment, they are prescribed with the full understanding and consent of their parents and are carefully monitored.

The severity of the illness often determines the choice of treatment. For example, a mild case of diabetes can often be controlled by the proper diet and weight control, while severe diabetes requires the use of insulin.

A mild depression can be helped with counseling, proper rest, diet, and exercise. When a depression becomes so severe that it interferes with a person’s productivity, interpersonal relationships, spiritual life, and daily activities, anti-depressant medication is necessary. This medication corrects the abnormality of the neurotransmitters in the limbic system of the brain.

Here’s an example. Harold, a 50-year-old engineer, was functioning well at work and at home. Then his wife noticed that he began to withdraw to his room whenever he was at home. Next he stopped eating. He became restless pacing the floor. Harold cried easily and could not sleep. He stopped going to work. He became obsessed with feelings of guilt, believing that his prayers were pointless and his life had lost its meaning. Finally he went for professional help. A psychiatrist prescribed an antidepressant medication for him, and Harold also became involved in individual psychotherapy. Within a few weeks, his appetite returned and he became more relaxed and hopeful.

Anti-depressants are not addictive or habit forming. They do not change a person’s basic personality or produce an artificial “high.” Some anti-depressants are also useful in the treatment of anxiety and panic attacks.

Another condition that responds successfully to medication is mania. Sue often embarrassed her friends and relatives by her attitude and behavior. Suddenly she’d have boundless energy, require no sleep, run up thousands of dollars of credit card charges, talk of grand schemes to save the world, and say whatever came to mind including rude comments and profanity. Trying to talk reason with Sue did not help. Medication did.

When Sue and other people suffer a manic episode, their entire body seems “speeded up.” A chemical change in their limbic system keeps them in this abnormally accelerated state. They need a mood stabilizing medication to correct the condition.

The appropriate use of medications has brought relief from suffering to countless individuals restoring spiritual, physical, and emotional well being.

Lithium is a salt that acts to stabilize mood, allowing both the body and mind to return to their normal states. It also helps to prevent a recurrence of mania or a switch into depression. Many people with manic depressive illness are able to return to their productive, creative, and fulfilling lives after the proper dose of lithium is maintained in their system. Several other medications also successfully stabilize mood.

Major tranquilizers (anti-psychotic medications) are another group of medications. Psychiatrists use them in the treatment of mental illnesses in which the person becomes out of touch with reality and may behave in bizarre ways. People and objects often appear distorted. The person may hear strange and frightening voices when alone.

An example is Judy. She had always been a diligent and good student. A bit shy, she enjoyed reading and playing computer games for hours in her room. Judy’s parents were proud of her scholastic achievements. They were glad she respected her teachers, meticulously cared for her appearance, and enjoyed worshipping with them in church every week. After graduation, she was accepted at a well-respected college. Her freshman year was difficult, and her grades were much lower than she had expected. She didn’t make friends easily, and she became even more isolated and spent hours daydreaming.

When Judy returned for the beginning of her sophomore year, she told her parents that several of the students and faculty were conspiring to make her drop out of school. She believed they were controlling her thoughts and sending messages to her through the college radio station announcer.

Judy’s parents went to see her and found her room in shambles. They could hardly believe she was wearing dirty clothes and had obviously not washed her hair for days. Judy then told them she was hearing God and the devil argue. She said she continuously heard voices screaming at her. Judy’s parents took her to the Student Counseling Center. A counselor recommended psychiatric hospitalization. With supportive psychotherapy, antipsychotic medication, and encouragement from her parents and church, Judy began to improve.

Because many illnesses have disturbances of the physical, emotional, and spiritual aspects of a person, these all need to be addressed. Some people think psychiatrists prescribe medications to “dope someone up.” This is not an appropriate use of medication. Actually, medications help stabilize the patients’ brain chemistry so they can effectively deal with their problems. When a person is on medication, his/ her psychiatrist carefully monitors the dosage, response, and the length of treatment.

As with any other medication, side effects can be an issue. Most are mild. Common side effects include drowsiness, dry mouth, or increased thirst. Since everyone’s body chemistry is different, some people may not have side effects while others are more troubled by them. If side effects are more severe, they can usually be managed by changing the dose of the medicine or the time of the day the patient takes the medication. Fortunately, the science of psychopharmacology has advanced rapidly in the past few years. Alternative medicines are available and can be used if a person is sensitive to a particular one.

The appropriate use of medications has brought relief from suffering to countless individuals. When medications are prescribed by a skilled, caring psychiatrist, they can be life-saving and instrumental in restoring spiritual, physical, and emotional well being.

Dr. Carol Fisk Owais received her medical education at the Loma Linda University School of Medicine. After an internship at Harding Hospital, she joined the Department of Psychiatry at Ohio State University where she completed her residency training in psychiatry and was appointed Clinical Instructor. She was active in the private practice of psychiatry and served on the psychiatry faculty at both West Virginia University and East Tennessee State University. Dr. Owais was a senior staff psychiatrist for Pine Rest’s Partial Hospitalization Program. Her special interests are in the areas of mood disorders, psychopharmacology, and the interface of psychiatric and neurological disorders.

Dr. Wisam Owais pursued his medical education at the Loma Linda University School of Medicine. He completed his residency training in psychiatry at Ohio State University where he was Chief Resident of Psychiatry and Child Psychiatry Fellow. He joined the faculty of West Virginia University and later of East Tennessee State University and was active in the private practice of psychiatry. When he was a senior staff psychiatrist for Pine Rest, Owais supervises the treatment team for the Short-Term Adolescent Unit. His areas of interest include the integration of psychotherapy and pharmacotherapy and the interface of religion and psychiatry.