Rituals & Repetitions: Obsessive Compulsive Disorder

With a description of ones experience with mental illness comes along a quick history of how mental illness has been conceptualized in the past and what the future may offer. With scientific development, new models of understanding human processes and novel concepts of mental illness have evolved and been established. At one time in our history, professionals made a sharp distinction between physical disorders and mental disorders that it- physical disorders involved the body and mental disorders involved the mind. Today, we have come to see the close connection of the brain with what has been previously considered mental processes. Further, those physiological processes involved in physical disorders such as the immune system, the turning on and off of genes, and the chemical processes of the body have also been broadly found to be involved in mental disorders.

OCD is characterized by repetitive thoughts and feelings usually followed by behaviors in response to them (William Ray, 2015). The thoughts are usually perceived as unpleasant and not wanted. Obsessive-compulsive disorder (OCD) features a pattern of unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress (William Ray, 2015). You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior — the vicious cycle of OCD.

Facts about OCD

* OCD can begin early, starting between ages seven and 12. In fact, up to half of all adults with OCD say their symptoms started when they were children.

* OCD is more common in boys than girls in childhood, but into adulthood, women are affected at a slightly higher rate than men.

* OCD symptoms can change over time. For example, when OCD first appears your child might begin with excessive washing compulsions, but over time this can shift to excessive checking compulsions while compulsive washing disappears.

* OCD occurs in 2-3% of children and adults during their lifetime (Anxiety BC, 2017).

* Seeking reassurance from others that things will be okay or a ritual was completed correctly is common in children and teens with OCD. This can include asking parents and siblings to do rituals as well (Anxiety BC, 2017)

Distinction between Obsessions and Compulsions

A distinction is made between obsessions and compulsions. Obsessions are generally unwelcome thoughts that come into ones head (William Ray, 2015) In studies examining these thoughts in patients with OCD, they involve avoiding contamination, aggressive impulses, sexual content, somatic concerns, and the need for order. Compulsions are the behaviors that one uses to respond to these thought. Some behaviors, like cleaning and placing objects in order, reflect a desire to respond to the obsessions. Other compulsions such as hand washing are more avoidant in nature for fear or what one might say, do, or experience in a particular situation. Often individuals with OCD will constantly check to see if they performed a particular behavior such as turning off the stove or unplugging an iron (William Ray, 2015). Interestingly, individuals with OCD may be aware that their thoughts and actions may seem bizarre to others, but they cannot dismiss the thoughts or need for action.

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 unwanted and that in most individuals cause marked anxiety or distress.

2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion), (William Ray, 2015).

Obsessions

1) Contamination Fear or distress about coming into contact with dirt, germs, sticky substances, or chemicals (e.g., household cleansers), or getting sick, or getting others sick after touching "dirty" or "contaminated" items

2) Accidental harm to self or others Fear of harming yourself or others through carelessness. For example, "what if I didn't clean off the counter properly and there are still germs on it, and my mom gets sick because of me!"

3) Symmetry and exactness A need to have items ordered in a certain way (for example, according to color, size, or facing a certain direction). Children and teens with this type of obsession are either anxious because "it just doesn't feel right" or because of a superstitious belief that something bad will happen (e.g., "if my shoes are not arranged properly, my mom will die!"). Often, the content of obsessions sounds very odd or makes no sense. For example, a child with OCD might say that he or she needs to arrange all the teddy bears from smallest to biggest or else something bad will happen to mom. Most children and teens are aware that these thoughts are strange; however, do not be surprised if your child doesn't think his or her thoughts are odd (William Ray, 2015). Most young children have no idea that their obsessions sound peculiar to others.

4) A need for perfection some kids and teens feel a strong need for things to be perfect or right. For example, your child might not be able to start her homework until her books are all ordered and perfectly arranged, or cannot turn in an assignment until she is certain its perfect. Other kids struggle to tolerate if something isnt 100% right, focusing on doing the right thing all the time or thinking about every tiny mistake.

5) Forbidden thoughts Entering into adolescence is a time of sexual maturity and most teens think about sex and sexual identity during this time. However, for some teens they are plagued with unwanted thoughts and images about being gay when they know they are not, or thinking about engaging in sexual behavior that feels upsetting and even repulsive to them (William Ray, 2015).

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, 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 anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive (William Ray, 2015)

Compulsions

1) Washing or cleaning Washing hands excessively, sometimes until they are raw and bleeding (Anxiety BC, 2017). There are many other types of washing behaviors, including:

Toilet rituals (e.g., excessive wiping)

Grooming/tooth brushing rituals (e.g., brushing each tooth in a particular order)

Showering rituals (e.g., washing each body part a certain number of times or in a particular order)

Cleaning compulsions (e.g., rituals and rules for how to wash laundry, clean the bathroom, kitchen, etc.)

2) Checking These types of compulsions can involve checking doors, locks, or backpacks, to make sure everything is safe. Some children and teens check to make sure that everyone is okay.

3) Counting, tapping, touching, or rubbing Compulsions can involve counting, touching, or tapping objects in a particular way. Some children and teens have lucky and unlucky numbers involved in their rituals (e.g., needing to touch a door four times before leaving a room).

4) Ordering/arranging This compulsion involves arranging items in specific ways, such as bed sheets, stuffed animals, or books in the school locker or book bag. For example, a child might need to line up all the shoes in the closet so that they all face forward, and are matched by color.

5) Mental rituals Not all children and teens with OCD will have compulsions that can be seen. Some perform rituals in their head, such as saying prayers or trying to replace a "bad" image or thought with a "good" image or thought. For example, a teen might have a bedtime prayer that he or she mentally repeats over and over again until it "feels right".

Risk factors

Understanding the risk factors involved in Obsessive Compulsive Disorder ranges from a plurality of direct causes as shown below.

* Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:

* Family history- Having parents or other family members with the disorder can increase your risk of developing OCD.

* Stressful life events- If you've experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD (Anxiety BC, 2017).

* Other mental health disorders- OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders

Causes & Complications

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

* Biology-OCD may be a result of changes in your body's own natural chemistry or brain functions (Anxiety BC, 2017).

* Genetics-OCD may have a genetic component, but specific genes have yet to be identified.

* Environment-Some environmental factors such as infections are suggested as a trigger for OCD, but more research is needed.

Problems resulting from OCD may include, among others (Mayo Clinic Staff):

a) Health issues, such as contact dermatitis from frequent hand-washing

b) Inability to attend work, school or social activities

c) Troubled relationships

d) Overall poor quality of life

d) Suicidal thoughts and behavior

Diagnosis

1) Physical exam-This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications.

2) Lab tests-These may include, for example, a complete blood count (CBC), a check of your thyroid function, and screening for alcohol and drugs.

3) Psychological evaluation-This includes discussing your thoughts, feelings, symptoms and behavior patterns. With your permission, this may include talking to your family or friends.

4) Diagnostic criteria for OCD- Your doctor may use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (Mayo Clinic Staff, 2016).

Getting Support and Treatment

a) Psychotherapy

Cognitive behavioral therapy (CBT), a type of psychotherapy, is effective for many people with OCD (Mayo Clinic Staff, 2016). Exposure and response prevention (ERP), a type of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn healthy ways to cope with your anxiety. ERP takes effort and practice (Mayo Clinic Staff, 2016), but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions. Therapy may take place in individual, family or group sessions.

b) Medications

Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first.

Lifestyle and home remedies

Obsessive-compulsive disorder is a chronic condition, which means it may always be part of your life (Mayo Clinic Staff, 2016). While OCD warrants treatment by a professional, you can do some things for yourself to build on your treatment plan:

a) Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications (Mayo Clinic Staff, 2016). If you stop, OCD symptoms are likely to return.

b) Pay attention to warning signs. You and your doctor may have identified issues that can trigger your OCD symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.

c) Check first before taking other medications. Contact the doctor who's treating you for OCD before you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, herbal remedies or other supplements to avoid possible interactions.

d) Practice what you learn. Work with your mental health professional to identify techniques and skills that help manage symptoms, and practice these regularly.

Coping and support

Coping with obsessive-compulsive disorder can be challenging. Medications can have unwanted side effects, and you may feel embarrassed or angry about having a condition that requires long-term treatment. Here are some ways to help cope with OCD:

Learn about OCD. Learning about your condition can empower you and motivate you to stick to your treatment plan.

Join a support group. Reaching out to others facing similar challenges can provide you with support and help you cope with challenges.

Stay focused on your goals. Keep your recovery goals in mind and remember that recovery from OCD is an ongoing process.

Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies and recreational activities. Exercise regularly, eat a healthy diet and get adequate sleep.

Learn relaxation and stress management. Stress management techniques such as meditation, visualization, muscle relaxation, massage, deep breathing, yoga or tai chi may help ease stress and anxiety.

Stick with your regular activities. Go to work or school as you usually would. Spend time with family and friends. Don't let OCD get in the way of your life.

Final Points

Now that we have discussed quite a bit about Obsessive Compulsive Disorder, lets have a discussion. You can answer all or any of the following questions:

1) Did you experience OCD? If Yes, how was your experience?

2) What kind of support system did you have during that time?

3) Have you seen anyone experience OCD? How did you support them?

4) As you know about OCD, in future how would you like to support someone dealing with OCD?

5) How do you think OCD affects your mental and physical health?

Thank you all for reading: Im waiting hopefully for your comments and answers.

Sources of Information:

William J. Ray, Abnormal Psychology, Neuroscience Perspective on Human Behavior and Experience, Pennsylvania State University, 2015

AskMayoExpert. Obsessive-compulsive disorder (OCD). Minn.: Mayo Foundation for Medical Education and Research; 2015.

Simpson HB. Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. http://www.uptodate.com/home. Accessed July 19, 2016.

2014-2015 Research report: Psychiatry and psychology. Mayo Clinic. http://www.mayo.edu/pmts/mc0700-mc0799/mc0710-11.pdf. Accessed July 18, 2016.

Anxiety BC. Resources. Relief. Results. Obsessive Compulsive Disorder. 2017

Mind For Better Mental Health. Obsessive Compulsive Disorder. July 2016

Links for further reading:

https://www.anxietybc.com/parenting/obsessive-compulsive-disorder

https://www.mind.org.uk/information-support/types-of-mental-health-problems/obsessive-compulsive-disorder-ocd/#.WeNONztx3Dc

Book Recommendation: Jeffrey M. Schwartz, Brain Lock, 1996

Watch these videos: https://www.youtube.com/watch?v=RLo_JkcSGyw

https://www.youtube.com/watch?v=AR6k2h9PRzc