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Clause -- - The following statements are mostly direct quotes that I have taken from books and other noted sources. I have not attempted to put them in my own words yet because I'm not a layman in writing. Plus, I feel it would only detract from the effectiveness of the statements. I will, perhaps, do this at a later date if desired.
Biotypes, the critical link between your personality and your health
Joan Arehart-Treichel., 1980
The Mental Disorder Biotypes
Mental disorders - abnormal thoughts, emotions, and behaviors-would be expected to have strong personality inputs. And indeed they do.
Suicides, schizophrenics, some criminals, persons subject to severe depressions, and child abusers often had a traumatic childhood, leading to loneliness and unhappiness, and perhaps to helplessness and hopelessness. They usually become disordered in the wake of one or more especially traumatic events. Each mental disorder personality is nonetheless unique. Mental disorder biotypes, with the exception of criminals, tend to suppress their distress with obsessive-compulsive behaviors, to the point that they are often too good for their own advantage.
Manic depression is so severe that it creates a temporary psychosis, frequently requiring hospitalization until the attack is past. Persons subject to this kind of depression are often subject to pathological "highs," or manias, as well. Between depressions and manias, however, manic-depressives tend to be pretty normal psychologically
Mental disorder biotypes tend toward nervousness and tension-especially in the face of stress-and toward anxiety and depression.
(Making the Diagnosis)
Do habits or thoughts get in the way of your work life, social life, or private life?
A thought or a habit is only considered an obsession or a compulsion if a person cannot stop it, if it gets in the way of their life in an important way, or, if a great deal of time and energy is spent fighting the thought or habit. Clinically, obsessions and compulsions range from mildly interfering to extremely incapacitating.
"Divided Consciousness
Multiple Controls in Human Thought and Action
Ernest R. Hilgard., 1977
Dreams
Dreams are the hallucinations of the normal. The dream was, as Freud said, "the royal road to the unconscious." Whether Freud was althogether right, he was certainly right in part. The dream, remembered, it qualifies as hallucination; furthermore, it has a spontaneous or nonvoluntary quality about it that distinguishes it from ordered rational thinking. In that sense it can be placed among dissociated experiences.
In another sense dreams do not belong among dissociations because the dream is more closely related to repressed experiences in the unconscious. That the hidden control processes that regulate dreaming are not directly recoverable and are known only by their derivatives indicates that they should be assigned to a deeper unconscious rather than to the more readily recoverable dissociations.
Hypnotic influences on Dreaming
pg .92 CH. 5
Dreams, Hallucinations. and Imagination
Treatment of the Obsessive Personality
"Leon Salzman, M.D."
Copyright 1985, 1980
The obsessive-compulsive neurosis is one of the most difficult and frustrating therapeutic problems a therapist faces.
They still don't understand why these defensive techniques develop in one individual and not in another, or why in some they are extremely incapacitating while in others they are adaptive, economical, and productive. Ultimately potentionaly refusal to acknowledge the reality limitations of being human will lead the individual to deny all reality and become psychotic.
("out-of-awareness" ideas and impulses)
Such manifestations might indicate neurosis.
Freud describes the condition masterfully in the following way: *"Obsessional neurosis is shown in the patients being preoccupied with thoughts in which he is in fact not interested, in his being aware of impulses in himself which appear very strange to him in his being led to actions the performance of which give him no enjoyment but which it is quite impossible for him to omit. The thoughts (obsessions) may be senseless in themselves, or merely a matter of indifference to the subject; often they are completely silly, and invariably they are the starting-point of a strenuous mental activity, which exhausts the patient and to which he only surrenders himself unwillingly.
"Certainly, this is a crazy illness, what is carried into action in an obsessional neurosis is sustained by an energy to which we probably know nothing comparable in normal mental life. The whole position ends up in an ever-increasing degree of indecision, loss of energy and restriction of freedom. At the same time, the obsessional neurotic starts off with a very energetic disposition, he is often extraordinarily self-willed and as a rule he has intellectual gifts above the average. He has usually reached a satisfactorily high level of ethical development."
Abnormal behavior was often thought to be caused by a disorder of the bodily humors, hereditary factors, or invasion of witches or other ungodly creatures.
The obsession is a persistent, ritualized thought pattern, whereas the compulsion is a persistent ritualized behavior pattern.
Obsessive character structures were described by Freud as orderly, stubborn, and parsimonious; others have described them as being obstinate, orderly, perfectionistic, punctual, meticulous, parsimonious, frugal, and inclined to intellectualism and hair splitting discussion. Pierre Janet described such people as being rigidly, inflexible, lacking in adaptability, overly conscientious, loving order and discipline, and persistent even in the face of undue obstacles. They are generally dependable and reliable and have high standards and ethical values. They are practical, precise, and scrupuluos in their moral requirements. Under conditions of stress or extreme demands, these personality characteristics may congeal into symptomatic behavior that will then be ritualized.
When present, the rituals are dramatic and pathogmonic. The combination of character traits described above is also easily identified. As the purpose and adaptive functions of the variety of personality traits and the ritual are better understood, it will be seen that they all subserve the need of achieving control of oneself and the environment. Such bizarre behavior has great meaning to the person. A concept of an "unconscious" and the notion that ideas and feelings outside of immediate awareness are possible and can nevertheless significantly influence behavior.
The term obsessive neurosis refers to a wide variety of phenomena that may be manifested at any time in a person's life. It refers to thoughts, feelings, ideas, and impulses that an individual cannot dispel in spite of an inner desire to do so. The compelling nature of the activity even though it may be illogical, undesirable, and unnecessary - is the central issue. Generally such thoughts or feeling are alien to the individual's usual attitudes and are experienced as being somewhat strange, even outrageous, sometimes disgusting and at times, frightening. Their presence is embarrassing and quite distressing. It is an intriguing development - particularly in the face of current notions of free will and freedom of choice - because despite all the wishes, desires, and active opposition of the person, he is forced by some internal pressure to concern himself with a variety of experiences that may be distasteful or frightening. It is considered a neurosis rather than traits or personality manifestations when it becomes disruptive and unproductive and produces anxiety not relievced by the compulsive rituals designed to alleviate that anxiety. The distress can be severe enough to immobilize the individual and impair all his functioning.
What extraordinary phenomena obsessions and compulsions are! Ideas, thoughts, or insistent demands for action that are entirely alien to his conscious mind or his moral or ethical standards - like an army of psychic demons or sophisticated electronic rays from outer space overcome an individual. He can neither expel nor terminate the thoughts, and all conscious efforts to do so only aggravate and enhance these intruders. In fact, invasion by demons was the explanation for this phenomenon for many years, until Freud first suggested an explanation based on the recognition of unconscious feeling and attitudes which reside in the individual himself rather than forces which intrude from the outside. During the christian era, prior to Freud's formulations, such experiences were viewed as possession states in which devilish, anti-God forces overcame and took hold of a person's being and controlled his thoughts and behavior. Yet in spite of the adhesive persistence of thoughts, some rarely get carried into action, since they are defenses or distractions and ways of avoiding confrontation with more threatening ideas or attitudes that will humiliate and totally undermine the individual's security. These intrusive thoughts and obsessive ideas are defined as "ideas, emotions and impulses which occupy consciousness, irrespective of the subjects desire, intruding themselves at inopportune times and occupying consciousness to the exclusion of other ideas. Compulsions, which are aspects of the same dynamic issue but manifested in action, are defined as behavior which is compelled by unkown sources and while the individual is fully aware of how foolish, inappropriate and illogical these ideas and actions are, he cannot alter them."*
Whether they are present, stored in an area of the mental apparatus called the unconscious, or simply outside the immediate fringe of awareness and subject to focal attention by some mysterious process in the individual, obsessional ideas can exert profound effects on behavior by demanding full attention all the time in the most severe cases or by distracing usual activities by an insistent intrusiveness in other cases. The obsessional individual cannot identify the source without help or guidance, since the thoughts are alien, unacceptable, and grossly discordant with his public personality patterns of thinking, and behaving. He therefore describes them as outside of his own self and as unwelcome intruders into his functioning.
So overpowering are these tendencies that no act of will, determination, or effort can terminate them, nor can drugs, electroshock treatment, or lobotomies - even though these treatment modalities can reduce some of the anxiety that accompany these thoughts. Only an investigation of the origin of these forces, coupled with a commited intention to change, will reduce or eliminate them. Although behavior-modification techniques may alter some of the compulsive behavior phenomena, they cannot influence the underlying personality structure that requires such drastic security measures.
Overpowering feelings, thoughts or pressures to think or behave in ritualized ways are consistent and dramatic features of human behavior. These persistent feelings are called obsessions, and when they are expressed in behavioral acts, they are called compulsions, clearly, the same psychic mechanisms are at work, manifesting themselves in either action or thought. Such obsessions can get bad enough that the individual is unable to proceed with his daily living. Such rituals are terminated by fatigue or when the ludicrousness of the process becomes apparent to the individual. If the rituals are prematurely terminated or prevented from being expressed, severe anxiety or panic may ensue.
In the presence of obsessions a person is overwhelmed with persistent thoughts that cannot be extruded, eliminated, or denied, and they may interfere with his functioning in ways that completely tie up his living and prevent him from performing or pursuing other reasonable tasks and goals that are essential to his well-being. The awareness of the nature of the demands that are being made and the inability to be free to choose or to alter such demands are paramount features of this disorder. Obsessions and compulsions interfere and, at times absolutely prevent choices because their imperious demand, the source of which the individual cannot identify, must be acknowledged and pursued. These intrusive thoughts, which are clearly unsolicited, can determine and influence one's behavior. They are the clearest evidence of the presence of what is called the unconscious, or the out-of-awareness elements in human mentation and activity.
The obsessive-compulsive aspect of human behavior becomes a disorder only when it is excessive and becomes the dominating feature in a person's living. Prior to a scientific understanding that allowed for a rational explanation, abnormal behavior was often thought to be caused by a disorder of the bodily humors, hereditary factors, or an invasion of malevolent or ungodly forces.
Obsessional persons may be bright, capable of understanding complicated, highly technical issues, or philosophically astute with high I.Q.'s and still incapable of alternating trivial, nonsensical items of thought or behavior. Such persons strive to achieve; they often claim an omniscience and omnipotence of superhuman proportions, the amount that enables one to function without undue anxiety to that which pervades a person's living, whether or not it impedes that living or impairs his performance, if it does that it is called neurotic.
The obsessional demand for guarantees does not indicate a higher virtue or a more dedicated conviction; rather it shows an unwillingness to face life with all its possibilities. The existential dilemma which has confused our generation deals precisely with this matter. To be happy, one must risk unhappiness; to live fully, one must risk death and accept its ultimate decision.
There is some validity to the idea that a neurosis may protect the individual against a psychotic breakdown, since the longer one has managed to function effectively with a neurosis the less likely is a psychotic breakdown to occur in later years, when the demands on one's living have lessened. This is not always true, however, in the obsessional neurosis - when aging is accompanied by the actual lessening on one's physical and mental capacities - a fact the obsessional cannot accept. The accompaniments of aging, with it's biminution of psychological and physical capacities, can and do aggravate the obsessional disorder.
A predominantly obsessional illness can become, particularly in the later years, an involutional depression or a schizophrenic illness with delusions and hallucinations. Usually such people may have been functioning successfully until the crisis of aging overtook them. This would suggest that neurosis does not neccessarily ward off a psychosis.
Obsessive Compulsive Disorder
"By Roy C.
Copyright1993, 1999 by Obsessive Compulsive Anonymous World Services, Inc.
OCD is a chronic illness like cancer, chemical addiction or clinical depression in that it is often progressive and usually not curable, but it is treatable, and with treatment people with OCD can live full, healthy lives.
When the person attempts to resist a compulsion, there is a sense of mounting tension that can be immediately relieved by yielding to the compulsion. In the course of the illness, after repeated failure at resisting the compulsions, the person may give in to them and no longer experience a desire to resist them. Complications include Major Depression and the abuse of alcohol and anxiolytics.
National Institute of Mental Health
Obsessive-Compulsive Disorder
Decade of the Brain
Printed 1991, Revised 1994, Revised September 1996
Obsessions - These are unwanted ideas or impulses that repeatedly will up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.
Compulsions - Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.
Insight - Most People with OCD show a range of insight into the senselessness of their obsessions. Often, especially when they are not actually having an obsession, they can recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity.
Resistance - Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers' lives, making it impossible for them to continue activities outside the home.
Long-Lasting Symptoms - OCD tends to last for years, even decades. The symptoms may become less severe from time to time, and there may be long intervals when symptoms are mild, but for most individuals with OCD, the symptoms are chronic.
OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Co-existing disorders can make OCD more difficult both to diagnose and to treat.
A person with OCD has obsessive and compulsive behaviors that are extreme enough to interfere with everyday life. People with OCD should not be confused with a much larger group of individuals who are sometimes called "compulsive" because they hold themselves to a high standard of performance and are perfectionistic and very organized in their work and even in recreational activities. This type of "compulsiveness" often serves a valuable purpose, contributing to a person's self-esteem and success on the job. In that respect, it differs from the life-wrecking obsessions and rituals of the person with OCD.
Research into treatment for OCD is ongoing in this area - neurosurgery, a new approach to treatment - refractory OCD. In the very few centers where neurosurgery has been performed as a clinical procedure, candidiates are generally restricted to those who have failed to respond to conventional treatments, including behavior therapy and pharmacotherapy.
In addition to research into treatment modalities, NIMH researchers are conducting studies into possible linkage of OCD to some autoimmune diseases. (Diseases in which infection-fighting cells, or antibodies, turn against the body, trying to destroy it).
Ancedotal reports of the successful use of electroconvulsive therapy (ECT) in OCD have been published over the past several decades. Most often, the benefit from ECT has been short lived, and this treatment is now generally restricted to intances of treatment-resistant OCD accompanied by severe depression.
Individuals with OCD are protected under the Americans with Disabilities Act (ADA). Among organizations that offer information related to the ADA are the ADA Information Line at the U.S. Department of Justice, (202) 514-0301, and the Job Accommodation Network (JAN), part of the President's Committee on the Employment of People with Disabilities in the U.S. Department of Labor. JAN is located at West Virginia University, 809 Allen Hall, P.O. Box 6122, Morgantown, WV 26506, telephone (800) 526-7234 (voice or TDD), (800) 526-4698 (in West Virginia).
The Pharmaceutical Research and Manufacturers Association publishes a directory of indigent programs for those who cannot afford medications. Physicians can request a copy of the guide by calling 800-762-4636 (800-PMA-INFO).
September 1999 ?Revised
What Causes OCD?
There is growing evidence that OCD represents abnormal functioning of brain circuitry, probably involving a part of the brain called striatum.
Anxiety Disorders
What Are the Different kinds of Anxiety Disorders?
F Key Saver
Diagnostic and Statistical Manual of Mental Disorders
Fourth Edition
Published By The American Psychiatric Association Washington, DC
The most common obsessions for obsessive compulsive disorder are:
repeated doubts
compulsive gambling
compulsive masterbation
repeat peculiar acts
hoarding
{endless rearranging objects in an effort to keep them in precise alignment with each other}
mentally repeating phrases
listmaking
checking
hand-washing
having to count over and over to a certain number
touching
fear of harm to oneself or loved ones
intrusive sexual thoughts
recurrent blasphemous images
hoarding useless materials
screaming obscene words at inappropriate times or places
compulsive avoidance (phobias)
compulsive eating
compulsive drinking
compulsive stealing (kleptomania)
stripping clothes off (e.g., where people can see you)
thought
perfectionist
bad habit
contamination
a need to have things in a particular order
aggresive or horrific impulses
sexual imagery
ordering / arranging compulsions, packing and unpacking a suitcase, rearranging drawers
Mental Acts -- (e.g., praying, counting, repeating words silently) -- {the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification}
requesting or demanding assurances
compulsive smokers
compulsive shoppers
compulsive talkers
compulsive telephone talkers
compulsive power and status seekers
The "I must know" compulsive
bowel and bladder rituals
bedtime rituals
Social Checking (to call excessively, or "checking in", "to be within reach and let us know")
exhibitionism
preoccupation with part of body
miscellaneous compulsions - need to tell, ask, or confess, measure
obesity (compulsive eating)
alcoholism (compulsive drinking)
anorexia (compulsive noneating)
alcoholic (compulsive drinker)
repeating rituals (going in / out doors, up / down from chair, etc.)
The ability of individuals to recognize that the obsessions or compulsions are excessive or unreasonable occurs on a continuum. In some individuals with Obsessive Compulsive Disorder, reality testing may be lost, and the obsession may reach delusional proportions (e.g., the belief that one has caused the death of another person by having willed it). In such cases, the presence of psychotic features may be indicated by an additional diagnosis of Delusional Disorder or Psychotic Disorder not otherwise specified. The specifier with poor insight may be useful in those situations that are on the boundary between obsession and delusion (e.g., an individual whose extreme preoccupation with contamination, although exaggerated, is less intense than in a Delusional Disorder and is justified by the fact that germs are indeed ubiquitous).
Schizophrenia are distinguished from obsessions and compulsions by the fact that they are not ego-dystonic and not subject to reality testing. However, some individuals manifest symptoms of both Obsessive-Compulsive Disorder, Depression and Schizophrenia and warrant all diagnosis. - (Is it even possible to have any more than that?)
Joan Arehart-Treichel., 1980
The Mental Disorder Biotypes
Mental disorders - abnormal thoughts, emotions, and behaviors-would be expected to have strong personality inputs. And indeed they do.
Suicides, schizophrenics, some criminals, persons subject to severe depressions, and child abusers often had a traumatic childhood, leading to loneliness and unhappiness, and perhaps to helplessness and hopelessness. They usually become disordered in the wake of one or more especially traumatic events. Each mental disorder personality is nonetheless unique. Mental disorder biotypes, with the exception of criminals, tend to suppress their distress with obsessive-compulsive behaviors, to the point that they are often too good for their own advantage.
Manic depression is so severe that it creates a temporary psychosis, frequently requiring hospitalization until the attack is past. Persons subject to this kind of depression are often subject to pathological "highs," or manias, as well. Between depressions and manias, however, manic-depressives tend to be pretty normal psychologically
Mental disorder biotypes tend toward nervousness and tension-especially in the face of stress-and toward anxiety and depression.
(Making the Diagnosis)
Do habits or thoughts get in the way of your work life, social life, or private life?
A thought or a habit is only considered an obsession or a compulsion if a person cannot stop it, if it gets in the way of their life in an important way, or, if a great deal of time and energy is spent fighting the thought or habit. Clinically, obsessions and compulsions range from mildly interfering to extremely incapacitating.
"Divided Consciousness
Multiple Controls in Human Thought and Action
Ernest R. Hilgard., 1977
Dreams
Dreams are the hallucinations of the normal. The dream was, as Freud said, "the royal road to the unconscious." Whether Freud was althogether right, he was certainly right in part. The dream, remembered, it qualifies as hallucination; furthermore, it has a spontaneous or nonvoluntary quality about it that distinguishes it from ordered rational thinking. In that sense it can be placed among dissociated experiences.
In another sense dreams do not belong among dissociations because the dream is more closely related to repressed experiences in the unconscious. That the hidden control processes that regulate dreaming are not directly recoverable and are known only by their derivatives indicates that they should be assigned to a deeper unconscious rather than to the more readily recoverable dissociations.
Hypnotic influences on Dreaming
pg .92 CH. 5
Dreams, Hallucinations. and Imagination
Treatment of the Obsessive Personality
"Leon Salzman, M.D."
Copyright 1985, 1980
The obsessive-compulsive neurosis is one of the most difficult and frustrating therapeutic problems a therapist faces.
They still don't understand why these defensive techniques develop in one individual and not in another, or why in some they are extremely incapacitating while in others they are adaptive, economical, and productive. Ultimately potentionaly refusal to acknowledge the reality limitations of being human will lead the individual to deny all reality and become psychotic.
("out-of-awareness" ideas and impulses)
Such manifestations might indicate neurosis.
Freud describes the condition masterfully in the following way: *"Obsessional neurosis is shown in the patients being preoccupied with thoughts in which he is in fact not interested, in his being aware of impulses in himself which appear very strange to him in his being led to actions the performance of which give him no enjoyment but which it is quite impossible for him to omit. The thoughts (obsessions) may be senseless in themselves, or merely a matter of indifference to the subject; often they are completely silly, and invariably they are the starting-point of a strenuous mental activity, which exhausts the patient and to which he only surrenders himself unwillingly.
"Certainly, this is a crazy illness, what is carried into action in an obsessional neurosis is sustained by an energy to which we probably know nothing comparable in normal mental life. The whole position ends up in an ever-increasing degree of indecision, loss of energy and restriction of freedom. At the same time, the obsessional neurotic starts off with a very energetic disposition, he is often extraordinarily self-willed and as a rule he has intellectual gifts above the average. He has usually reached a satisfactorily high level of ethical development."
Abnormal behavior was often thought to be caused by a disorder of the bodily humors, hereditary factors, or invasion of witches or other ungodly creatures.
The obsession is a persistent, ritualized thought pattern, whereas the compulsion is a persistent ritualized behavior pattern.
Obsessive character structures were described by Freud as orderly, stubborn, and parsimonious; others have described them as being obstinate, orderly, perfectionistic, punctual, meticulous, parsimonious, frugal, and inclined to intellectualism and hair splitting discussion. Pierre Janet described such people as being rigidly, inflexible, lacking in adaptability, overly conscientious, loving order and discipline, and persistent even in the face of undue obstacles. They are generally dependable and reliable and have high standards and ethical values. They are practical, precise, and scrupuluos in their moral requirements. Under conditions of stress or extreme demands, these personality characteristics may congeal into symptomatic behavior that will then be ritualized.
When present, the rituals are dramatic and pathogmonic. The combination of character traits described above is also easily identified. As the purpose and adaptive functions of the variety of personality traits and the ritual are better understood, it will be seen that they all subserve the need of achieving control of oneself and the environment. Such bizarre behavior has great meaning to the person. A concept of an "unconscious" and the notion that ideas and feelings outside of immediate awareness are possible and can nevertheless significantly influence behavior.
The term obsessive neurosis refers to a wide variety of phenomena that may be manifested at any time in a person's life. It refers to thoughts, feelings, ideas, and impulses that an individual cannot dispel in spite of an inner desire to do so. The compelling nature of the activity even though it may be illogical, undesirable, and unnecessary - is the central issue. Generally such thoughts or feeling are alien to the individual's usual attitudes and are experienced as being somewhat strange, even outrageous, sometimes disgusting and at times, frightening. Their presence is embarrassing and quite distressing. It is an intriguing development - particularly in the face of current notions of free will and freedom of choice - because despite all the wishes, desires, and active opposition of the person, he is forced by some internal pressure to concern himself with a variety of experiences that may be distasteful or frightening. It is considered a neurosis rather than traits or personality manifestations when it becomes disruptive and unproductive and produces anxiety not relievced by the compulsive rituals designed to alleviate that anxiety. The distress can be severe enough to immobilize the individual and impair all his functioning.
What extraordinary phenomena obsessions and compulsions are! Ideas, thoughts, or insistent demands for action that are entirely alien to his conscious mind or his moral or ethical standards - like an army of psychic demons or sophisticated electronic rays from outer space overcome an individual. He can neither expel nor terminate the thoughts, and all conscious efforts to do so only aggravate and enhance these intruders. In fact, invasion by demons was the explanation for this phenomenon for many years, until Freud first suggested an explanation based on the recognition of unconscious feeling and attitudes which reside in the individual himself rather than forces which intrude from the outside. During the christian era, prior to Freud's formulations, such experiences were viewed as possession states in which devilish, anti-God forces overcame and took hold of a person's being and controlled his thoughts and behavior. Yet in spite of the adhesive persistence of thoughts, some rarely get carried into action, since they are defenses or distractions and ways of avoiding confrontation with more threatening ideas or attitudes that will humiliate and totally undermine the individual's security. These intrusive thoughts and obsessive ideas are defined as "ideas, emotions and impulses which occupy consciousness, irrespective of the subjects desire, intruding themselves at inopportune times and occupying consciousness to the exclusion of other ideas. Compulsions, which are aspects of the same dynamic issue but manifested in action, are defined as behavior which is compelled by unkown sources and while the individual is fully aware of how foolish, inappropriate and illogical these ideas and actions are, he cannot alter them."*
Whether they are present, stored in an area of the mental apparatus called the unconscious, or simply outside the immediate fringe of awareness and subject to focal attention by some mysterious process in the individual, obsessional ideas can exert profound effects on behavior by demanding full attention all the time in the most severe cases or by distracing usual activities by an insistent intrusiveness in other cases. The obsessional individual cannot identify the source without help or guidance, since the thoughts are alien, unacceptable, and grossly discordant with his public personality patterns of thinking, and behaving. He therefore describes them as outside of his own self and as unwelcome intruders into his functioning.
So overpowering are these tendencies that no act of will, determination, or effort can terminate them, nor can drugs, electroshock treatment, or lobotomies - even though these treatment modalities can reduce some of the anxiety that accompany these thoughts. Only an investigation of the origin of these forces, coupled with a commited intention to change, will reduce or eliminate them. Although behavior-modification techniques may alter some of the compulsive behavior phenomena, they cannot influence the underlying personality structure that requires such drastic security measures.
Overpowering feelings, thoughts or pressures to think or behave in ritualized ways are consistent and dramatic features of human behavior. These persistent feelings are called obsessions, and when they are expressed in behavioral acts, they are called compulsions, clearly, the same psychic mechanisms are at work, manifesting themselves in either action or thought. Such obsessions can get bad enough that the individual is unable to proceed with his daily living. Such rituals are terminated by fatigue or when the ludicrousness of the process becomes apparent to the individual. If the rituals are prematurely terminated or prevented from being expressed, severe anxiety or panic may ensue.
In the presence of obsessions a person is overwhelmed with persistent thoughts that cannot be extruded, eliminated, or denied, and they may interfere with his functioning in ways that completely tie up his living and prevent him from performing or pursuing other reasonable tasks and goals that are essential to his well-being. The awareness of the nature of the demands that are being made and the inability to be free to choose or to alter such demands are paramount features of this disorder. Obsessions and compulsions interfere and, at times absolutely prevent choices because their imperious demand, the source of which the individual cannot identify, must be acknowledged and pursued. These intrusive thoughts, which are clearly unsolicited, can determine and influence one's behavior. They are the clearest evidence of the presence of what is called the unconscious, or the out-of-awareness elements in human mentation and activity.
The obsessive-compulsive aspect of human behavior becomes a disorder only when it is excessive and becomes the dominating feature in a person's living. Prior to a scientific understanding that allowed for a rational explanation, abnormal behavior was often thought to be caused by a disorder of the bodily humors, hereditary factors, or an invasion of malevolent or ungodly forces.
Obsessional persons may be bright, capable of understanding complicated, highly technical issues, or philosophically astute with high I.Q.'s and still incapable of alternating trivial, nonsensical items of thought or behavior. Such persons strive to achieve; they often claim an omniscience and omnipotence of superhuman proportions, the amount that enables one to function without undue anxiety to that which pervades a person's living, whether or not it impedes that living or impairs his performance, if it does that it is called neurotic.
The obsessional demand for guarantees does not indicate a higher virtue or a more dedicated conviction; rather it shows an unwillingness to face life with all its possibilities. The existential dilemma which has confused our generation deals precisely with this matter. To be happy, one must risk unhappiness; to live fully, one must risk death and accept its ultimate decision.
There is some validity to the idea that a neurosis may protect the individual against a psychotic breakdown, since the longer one has managed to function effectively with a neurosis the less likely is a psychotic breakdown to occur in later years, when the demands on one's living have lessened. This is not always true, however, in the obsessional neurosis - when aging is accompanied by the actual lessening on one's physical and mental capacities - a fact the obsessional cannot accept. The accompaniments of aging, with it's biminution of psychological and physical capacities, can and do aggravate the obsessional disorder.
A predominantly obsessional illness can become, particularly in the later years, an involutional depression or a schizophrenic illness with delusions and hallucinations. Usually such people may have been functioning successfully until the crisis of aging overtook them. This would suggest that neurosis does not neccessarily ward off a psychosis.
Obsessive Compulsive Disorder
"By Roy C.
Copyright1993, 1999 by Obsessive Compulsive Anonymous World Services, Inc.
OCD is a chronic illness like cancer, chemical addiction or clinical depression in that it is often progressive and usually not curable, but it is treatable, and with treatment people with OCD can live full, healthy lives.
When the person attempts to resist a compulsion, there is a sense of mounting tension that can be immediately relieved by yielding to the compulsion. In the course of the illness, after repeated failure at resisting the compulsions, the person may give in to them and no longer experience a desire to resist them. Complications include Major Depression and the abuse of alcohol and anxiolytics.
National Institute of Mental Health
Obsessive-Compulsive Disorder
Decade of the Brain
Printed 1991, Revised 1994, Revised September 1996
Obsessions - These are unwanted ideas or impulses that repeatedly will up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.
Compulsions - Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.
Insight - Most People with OCD show a range of insight into the senselessness of their obsessions. Often, especially when they are not actually having an obsession, they can recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity.
Resistance - Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers' lives, making it impossible for them to continue activities outside the home.
Long-Lasting Symptoms - OCD tends to last for years, even decades. The symptoms may become less severe from time to time, and there may be long intervals when symptoms are mild, but for most individuals with OCD, the symptoms are chronic.
OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Co-existing disorders can make OCD more difficult both to diagnose and to treat.
A person with OCD has obsessive and compulsive behaviors that are extreme enough to interfere with everyday life. People with OCD should not be confused with a much larger group of individuals who are sometimes called "compulsive" because they hold themselves to a high standard of performance and are perfectionistic and very organized in their work and even in recreational activities. This type of "compulsiveness" often serves a valuable purpose, contributing to a person's self-esteem and success on the job. In that respect, it differs from the life-wrecking obsessions and rituals of the person with OCD.
Research into treatment for OCD is ongoing in this area - neurosurgery, a new approach to treatment - refractory OCD. In the very few centers where neurosurgery has been performed as a clinical procedure, candidiates are generally restricted to those who have failed to respond to conventional treatments, including behavior therapy and pharmacotherapy.
In addition to research into treatment modalities, NIMH researchers are conducting studies into possible linkage of OCD to some autoimmune diseases. (Diseases in which infection-fighting cells, or antibodies, turn against the body, trying to destroy it).
Ancedotal reports of the successful use of electroconvulsive therapy (ECT) in OCD have been published over the past several decades. Most often, the benefit from ECT has been short lived, and this treatment is now generally restricted to intances of treatment-resistant OCD accompanied by severe depression.
Individuals with OCD are protected under the Americans with Disabilities Act (ADA). Among organizations that offer information related to the ADA are the ADA Information Line at the U.S. Department of Justice, (202) 514-0301, and the Job Accommodation Network (JAN), part of the President's Committee on the Employment of People with Disabilities in the U.S. Department of Labor. JAN is located at West Virginia University, 809 Allen Hall, P.O. Box 6122, Morgantown, WV 26506, telephone (800) 526-7234 (voice or TDD), (800) 526-4698 (in West Virginia).
The Pharmaceutical Research and Manufacturers Association publishes a directory of indigent programs for those who cannot afford medications. Physicians can request a copy of the guide by calling 800-762-4636 (800-PMA-INFO).
September 1999 ?Revised
What Causes OCD?
There is growing evidence that OCD represents abnormal functioning of brain circuitry, probably involving a part of the brain called striatum.
Anxiety Disorders
What Are the Different kinds of Anxiety Disorders?
F Key Saver
Diagnostic and Statistical Manual of Mental Disorders
Fourth Edition
Published By The American Psychiatric Association Washington, DC
The most common obsessions for obsessive compulsive disorder are:
repeated doubts
compulsive gambling
compulsive masterbation
repeat peculiar acts
hoarding
{endless rearranging objects in an effort to keep them in precise alignment with each other}
mentally repeating phrases
listmaking
checking
hand-washing
having to count over and over to a certain number
touching
fear of harm to oneself or loved ones
intrusive sexual thoughts
recurrent blasphemous images
hoarding useless materials
screaming obscene words at inappropriate times or places
compulsive avoidance (phobias)
compulsive eating
compulsive drinking
compulsive stealing (kleptomania)
stripping clothes off (e.g., where people can see you)
thought
perfectionist
bad habit
contamination
a need to have things in a particular order
aggresive or horrific impulses
sexual imagery
ordering / arranging compulsions, packing and unpacking a suitcase, rearranging drawers
Mental Acts -- (e.g., praying, counting, repeating words silently) -- {the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification}
requesting or demanding assurances
compulsive smokers
compulsive shoppers
compulsive talkers
compulsive telephone talkers
compulsive power and status seekers
The "I must know" compulsive
bowel and bladder rituals
bedtime rituals
Social Checking (to call excessively, or "checking in", "to be within reach and let us know")
exhibitionism
preoccupation with part of body
miscellaneous compulsions - need to tell, ask, or confess, measure
obesity (compulsive eating)
alcoholism (compulsive drinking)
anorexia (compulsive noneating)
alcoholic (compulsive drinker)
repeating rituals (going in / out doors, up / down from chair, etc.)
The ability of individuals to recognize that the obsessions or compulsions are excessive or unreasonable occurs on a continuum. In some individuals with Obsessive Compulsive Disorder, reality testing may be lost, and the obsession may reach delusional proportions (e.g., the belief that one has caused the death of another person by having willed it). In such cases, the presence of psychotic features may be indicated by an additional diagnosis of Delusional Disorder or Psychotic Disorder not otherwise specified. The specifier with poor insight may be useful in those situations that are on the boundary between obsession and delusion (e.g., an individual whose extreme preoccupation with contamination, although exaggerated, is less intense than in a Delusional Disorder and is justified by the fact that germs are indeed ubiquitous).
Schizophrenia are distinguished from obsessions and compulsions by the fact that they are not ego-dystonic and not subject to reality testing. However, some individuals manifest symptoms of both Obsessive-Compulsive Disorder, Depression and Schizophrenia and warrant all diagnosis. - (Is it even possible to have any more than that?)
Multiple Controls in Human Thought and Action
Ernest R. Hilgard., 1977
Dreams
Dreams are the hallucinations of the normal. The dream was, as Freud said, "the royal road to the unconscious." Whether Freud was althogether right, he was certainly right in part. The dream, remembered, it qualifies as hallucination; furthermore, it has a spontaneous or nonvoluntary quality about it that distinguishes it from ordered rational thinking. In that sense it can be placed among dissociated experiences.
In another sense dreams do not belong among dissociations because the dream is more closely related to repressed experiences in the unconscious. That the hidden control processes that regulate dreaming are not directly recoverable and are known only by their derivatives indicates that they should be assigned to a deeper unconscious rather than to the more readily recoverable dissociations.
Hypnotic influences on Dreaming
pg .92 CH. 5
Dreams, Hallucinations. and Imagination
Treatment of the Obsessive Personality
Dreams are the hallucinations of the normal. The dream was, as Freud said, "the royal road to the unconscious." Whether Freud was althogether right, he was certainly right in part. The dream, remembered, it qualifies as hallucination; furthermore, it has a spontaneous or nonvoluntary quality about it that distinguishes it from ordered rational thinking. In that sense it can be placed among dissociated experiences.
In another sense dreams do not belong among dissociations because the dream is more closely related to repressed experiences in the unconscious. That the hidden control processes that regulate dreaming are not directly recoverable and are known only by their derivatives indicates that they should be assigned to a deeper unconscious rather than to the more readily recoverable dissociations.
Hypnotic influences on Dreaming
pg .92 CH. 5
Dreams, Hallucinations. and Imagination
Treatment of the Obsessive Personality
Copyright 1985, 1980
The obsessive-compulsive neurosis is one of the most difficult and frustrating therapeutic problems a therapist faces.
They still don't understand why these defensive techniques develop in one individual and not in another, or why in some they are extremely incapacitating while in others they are adaptive, economical, and productive. Ultimately potentionaly refusal to acknowledge the reality limitations of being human will lead the individual to deny all reality and become psychotic.
("out-of-awareness" ideas and impulses)
Such manifestations might indicate neurosis.
Freud describes the condition masterfully in the following way: *"Obsessional neurosis is shown in the patients being preoccupied with thoughts in which he is in fact not interested, in his being aware of impulses in himself which appear very strange to him in his being led to actions the performance of which give him no enjoyment but which it is quite impossible for him to omit. The thoughts (obsessions) may be senseless in themselves, or merely a matter of indifference to the subject; often they are completely silly, and invariably they are the starting-point of a strenuous mental activity, which exhausts the patient and to which he only surrenders himself unwillingly.
"Certainly, this is a crazy illness, what is carried into action in an obsessional neurosis is sustained by an energy to which we probably know nothing comparable in normal mental life. The whole position ends up in an ever-increasing degree of indecision, loss of energy and restriction of freedom. At the same time, the obsessional neurotic starts off with a very energetic disposition, he is often extraordinarily self-willed and as a rule he has intellectual gifts above the average. He has usually reached a satisfactorily high level of ethical development."
Abnormal behavior was often thought to be caused by a disorder of the bodily humors, hereditary factors, or invasion of witches or other ungodly creatures.
The obsession is a persistent, ritualized thought pattern, whereas the compulsion is a persistent ritualized behavior pattern.
Obsessive character structures were described by Freud as orderly, stubborn, and parsimonious; others have described them as being obstinate, orderly, perfectionistic, punctual, meticulous, parsimonious, frugal, and inclined to intellectualism and hair splitting discussion. Pierre Janet described such people as being rigidly, inflexible, lacking in adaptability, overly conscientious, loving order and discipline, and persistent even in the face of undue obstacles. They are generally dependable and reliable and have high standards and ethical values. They are practical, precise, and scrupuluos in their moral requirements. Under conditions of stress or extreme demands, these personality characteristics may congeal into symptomatic behavior that will then be ritualized.
When present, the rituals are dramatic and pathogmonic. The combination of character traits described above is also easily identified. As the purpose and adaptive functions of the variety of personality traits and the ritual are better understood, it will be seen that they all subserve the need of achieving control of oneself and the environment. Such bizarre behavior has great meaning to the person. A concept of an "unconscious" and the notion that ideas and feelings outside of immediate awareness are possible and can nevertheless significantly influence behavior.
The term obsessive neurosis refers to a wide variety of phenomena that may be manifested at any time in a person's life. It refers to thoughts, feelings, ideas, and impulses that an individual cannot dispel in spite of an inner desire to do so. The compelling nature of the activity even though it may be illogical, undesirable, and unnecessary - is the central issue. Generally such thoughts or feeling are alien to the individual's usual attitudes and are experienced as being somewhat strange, even outrageous, sometimes disgusting and at times, frightening. Their presence is embarrassing and quite distressing. It is an intriguing development - particularly in the face of current notions of free will and freedom of choice - because despite all the wishes, desires, and active opposition of the person, he is forced by some internal pressure to concern himself with a variety of experiences that may be distasteful or frightening. It is considered a neurosis rather than traits or personality manifestations when it becomes disruptive and unproductive and produces anxiety not relievced by the compulsive rituals designed to alleviate that anxiety. The distress can be severe enough to immobilize the individual and impair all his functioning.
What extraordinary phenomena obsessions and compulsions are! Ideas, thoughts, or insistent demands for action that are entirely alien to his conscious mind or his moral or ethical standards - like an army of psychic demons or sophisticated electronic rays from outer space overcome an individual. He can neither expel nor terminate the thoughts, and all conscious efforts to do so only aggravate and enhance these intruders. In fact, invasion by demons was the explanation for this phenomenon for many years, until Freud first suggested an explanation based on the recognition of unconscious feeling and attitudes which reside in the individual himself rather than forces which intrude from the outside. During the christian era, prior to Freud's formulations, such experiences were viewed as possession states in which devilish, anti-God forces overcame and took hold of a person's being and controlled his thoughts and behavior. Yet in spite of the adhesive persistence of thoughts, some rarely get carried into action, since they are defenses or distractions and ways of avoiding confrontation with more threatening ideas or attitudes that will humiliate and totally undermine the individual's security. These intrusive thoughts and obsessive ideas are defined as "ideas, emotions and impulses which occupy consciousness, irrespective of the subjects desire, intruding themselves at inopportune times and occupying consciousness to the exclusion of other ideas. Compulsions, which are aspects of the same dynamic issue but manifested in action, are defined as behavior which is compelled by unkown sources and while the individual is fully aware of how foolish, inappropriate and illogical these ideas and actions are, he cannot alter them."*
Whether they are present, stored in an area of the mental apparatus called the unconscious, or simply outside the immediate fringe of awareness and subject to focal attention by some mysterious process in the individual, obsessional ideas can exert profound effects on behavior by demanding full attention all the time in the most severe cases or by distracing usual activities by an insistent intrusiveness in other cases. The obsessional individual cannot identify the source without help or guidance, since the thoughts are alien, unacceptable, and grossly discordant with his public personality patterns of thinking, and behaving. He therefore describes them as outside of his own self and as unwelcome intruders into his functioning.
So overpowering are these tendencies that no act of will, determination, or effort can terminate them, nor can drugs, electroshock treatment, or lobotomies - even though these treatment modalities can reduce some of the anxiety that accompany these thoughts. Only an investigation of the origin of these forces, coupled with a commited intention to change, will reduce or eliminate them. Although behavior-modification techniques may alter some of the compulsive behavior phenomena, they cannot influence the underlying personality structure that requires such drastic security measures.
Overpowering feelings, thoughts or pressures to think or behave in ritualized ways are consistent and dramatic features of human behavior. These persistent feelings are called obsessions, and when they are expressed in behavioral acts, they are called compulsions, clearly, the same psychic mechanisms are at work, manifesting themselves in either action or thought. Such obsessions can get bad enough that the individual is unable to proceed with his daily living. Such rituals are terminated by fatigue or when the ludicrousness of the process becomes apparent to the individual. If the rituals are prematurely terminated or prevented from being expressed, severe anxiety or panic may ensue.
In the presence of obsessions a person is overwhelmed with persistent thoughts that cannot be extruded, eliminated, or denied, and they may interfere with his functioning in ways that completely tie up his living and prevent him from performing or pursuing other reasonable tasks and goals that are essential to his well-being. The awareness of the nature of the demands that are being made and the inability to be free to choose or to alter such demands are paramount features of this disorder. Obsessions and compulsions interfere and, at times absolutely prevent choices because their imperious demand, the source of which the individual cannot identify, must be acknowledged and pursued. These intrusive thoughts, which are clearly unsolicited, can determine and influence one's behavior. They are the clearest evidence of the presence of what is called the unconscious, or the out-of-awareness elements in human mentation and activity.
The obsessive-compulsive aspect of human behavior becomes a disorder only when it is excessive and becomes the dominating feature in a person's living. Prior to a scientific understanding that allowed for a rational explanation, abnormal behavior was often thought to be caused by a disorder of the bodily humors, hereditary factors, or an invasion of malevolent or ungodly forces.
Obsessional persons may be bright, capable of understanding complicated, highly technical issues, or philosophically astute with high I.Q.'s and still incapable of alternating trivial, nonsensical items of thought or behavior. Such persons strive to achieve; they often claim an omniscience and omnipotence of superhuman proportions, the amount that enables one to function without undue anxiety to that which pervades a person's living, whether or not it impedes that living or impairs his performance, if it does that it is called neurotic.
The obsessional demand for guarantees does not indicate a higher virtue or a more dedicated conviction; rather it shows an unwillingness to face life with all its possibilities. The existential dilemma which has confused our generation deals precisely with this matter. To be happy, one must risk unhappiness; to live fully, one must risk death and accept its ultimate decision.
There is some validity to the idea that a neurosis may protect the individual against a psychotic breakdown, since the longer one has managed to function effectively with a neurosis the less likely is a psychotic breakdown to occur in later years, when the demands on one's living have lessened. This is not always true, however, in the obsessional neurosis - when aging is accompanied by the actual lessening on one's physical and mental capacities - a fact the obsessional cannot accept. The accompaniments of aging, with it's biminution of psychological and physical capacities, can and do aggravate the obsessional disorder.
A predominantly obsessional illness can become, particularly in the later years, an involutional depression or a schizophrenic illness with delusions and hallucinations. Usually such people may have been functioning successfully until the crisis of aging overtook them. This would suggest that neurosis does not neccessarily ward off a psychosis.
Obsessive Compulsive Disorder
"By Roy C.
Copyright1993, 1999 by Obsessive Compulsive Anonymous World Services, Inc.
OCD is a chronic illness like cancer, chemical addiction or clinical depression in that it is often progressive and usually not curable, but it is treatable, and with treatment people with OCD can live full, healthy lives.
When the person attempts to resist a compulsion, there is a sense of mounting tension that can be immediately relieved by yielding to the compulsion. In the course of the illness, after repeated failure at resisting the compulsions, the person may give in to them and no longer experience a desire to resist them. Complications include Major Depression and the abuse of alcohol and anxiolytics.
National Institute of Mental Health
Obsessive-Compulsive Disorder
Decade of the Brain
Printed 1991, Revised 1994, Revised September 1996
Obsessions - These are unwanted ideas or impulses that repeatedly will up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.
Compulsions - Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.
Insight - Most People with OCD show a range of insight into the senselessness of their obsessions. Often, especially when they are not actually having an obsession, they can recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity.
Resistance - Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers' lives, making it impossible for them to continue activities outside the home.
Long-Lasting Symptoms - OCD tends to last for years, even decades. The symptoms may become less severe from time to time, and there may be long intervals when symptoms are mild, but for most individuals with OCD, the symptoms are chronic.
OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Co-existing disorders can make OCD more difficult both to diagnose and to treat.
A person with OCD has obsessive and compulsive behaviors that are extreme enough to interfere with everyday life. People with OCD should not be confused with a much larger group of individuals who are sometimes called "compulsive" because they hold themselves to a high standard of performance and are perfectionistic and very organized in their work and even in recreational activities. This type of "compulsiveness" often serves a valuable purpose, contributing to a person's self-esteem and success on the job. In that respect, it differs from the life-wrecking obsessions and rituals of the person with OCD.
Research into treatment for OCD is ongoing in this area - neurosurgery, a new approach to treatment - refractory OCD. In the very few centers where neurosurgery has been performed as a clinical procedure, candidiates are generally restricted to those who have failed to respond to conventional treatments, including behavior therapy and pharmacotherapy.
In addition to research into treatment modalities, NIMH researchers are conducting studies into possible linkage of OCD to some autoimmune diseases. (Diseases in which infection-fighting cells, or antibodies, turn against the body, trying to destroy it).
Ancedotal reports of the successful use of electroconvulsive therapy (ECT) in OCD have been published over the past several decades. Most often, the benefit from ECT has been short lived, and this treatment is now generally restricted to intances of treatment-resistant OCD accompanied by severe depression.
Individuals with OCD are protected under the Americans with Disabilities Act (ADA). Among organizations that offer information related to the ADA are the ADA Information Line at the U.S. Department of Justice, (202) 514-0301, and the Job Accommodation Network (JAN), part of the President's Committee on the Employment of People with Disabilities in the U.S. Department of Labor. JAN is located at West Virginia University, 809 Allen Hall, P.O. Box 6122, Morgantown, WV 26506, telephone (800) 526-7234 (voice or TDD), (800) 526-4698 (in West Virginia).
The Pharmaceutical Research and Manufacturers Association publishes a directory of indigent programs for those who cannot afford medications. Physicians can request a copy of the guide by calling 800-762-4636 (800-PMA-INFO).
September 1999 ?Revised
What Causes OCD?
There is growing evidence that OCD represents abnormal functioning of brain circuitry, probably involving a part of the brain called striatum.
Anxiety Disorders
What Are the Different kinds of Anxiety Disorders?
F Key Saver
Diagnostic and Statistical Manual of Mental Disorders
Fourth Edition
Published By The American Psychiatric Association Washington, DC
The most common obsessions for obsessive compulsive disorder are:
repeated doubts
compulsive gambling
compulsive masterbation
repeat peculiar acts
hoarding
{endless rearranging objects in an effort to keep them in precise alignment with each other}
mentally repeating phrases
listmaking
checking
hand-washing
having to count over and over to a certain number
touching
fear of harm to oneself or loved ones
intrusive sexual thoughts
recurrent blasphemous images
hoarding useless materials
screaming obscene words at inappropriate times or places
compulsive avoidance (phobias)
compulsive eating
compulsive drinking
compulsive stealing (kleptomania)
stripping clothes off (e.g., where people can see you)
thought
perfectionist
bad habit
contamination
a need to have things in a particular order
aggresive or horrific impulses
sexual imagery
ordering / arranging compulsions, packing and unpacking a suitcase, rearranging drawers
Mental Acts -- (e.g., praying, counting, repeating words silently) -- {the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification}
requesting or demanding assurances
compulsive smokers
compulsive shoppers
compulsive talkers
compulsive telephone talkers
compulsive power and status seekers
The "I must know" compulsive
bowel and bladder rituals
bedtime rituals
Social Checking (to call excessively, or "checking in", "to be within reach and let us know")
exhibitionism
preoccupation with part of body
miscellaneous compulsions - need to tell, ask, or confess, measure
obesity (compulsive eating)
alcoholism (compulsive drinking)
anorexia (compulsive noneating)
alcoholic (compulsive drinker)
repeating rituals (going in / out doors, up / down from chair, etc.)
The ability of individuals to recognize that the obsessions or compulsions are excessive or unreasonable occurs on a continuum. In some individuals with Obsessive Compulsive Disorder, reality testing may be lost, and the obsession may reach delusional proportions (e.g., the belief that one has caused the death of another person by having willed it). In such cases, the presence of psychotic features may be indicated by an additional diagnosis of Delusional Disorder or Psychotic Disorder not otherwise specified. The specifier with poor insight may be useful in those situations that are on the boundary between obsession and delusion (e.g., an individual whose extreme preoccupation with contamination, although exaggerated, is less intense than in a Delusional Disorder and is justified by the fact that germs are indeed ubiquitous).
Schizophrenia are distinguished from obsessions and compulsions by the fact that they are not ego-dystonic and not subject to reality testing. However, some individuals manifest symptoms of both Obsessive-Compulsive Disorder, Depression and Schizophrenia and warrant all diagnosis. - (Is it even possible to have any more than that?)
"By Roy C.
Copyright1993, 1999 by Obsessive Compulsive Anonymous World Services, Inc.
OCD is a chronic illness like cancer, chemical addiction or clinical depression in that it is often progressive and usually not curable, but it is treatable, and with treatment people with OCD can live full, healthy lives.
When the person attempts to resist a compulsion, there is a sense of mounting tension that can be immediately relieved by yielding to the compulsion. In the course of the illness, after repeated failure at resisting the compulsions, the person may give in to them and no longer experience a desire to resist them. Complications include Major Depression and the abuse of alcohol and anxiolytics.
National Institute of Mental Health
Obsessive-Compulsive Disorder
Decade of the Brain
Printed 1991, Revised 1994, Revised September 1996
Obsessions - These are unwanted ideas or impulses that repeatedly will up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.
Compulsions - Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.
Insight - Most People with OCD show a range of insight into the senselessness of their obsessions. Often, especially when they are not actually having an obsession, they can recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity.
Resistance - Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers' lives, making it impossible for them to continue activities outside the home.
Long-Lasting Symptoms - OCD tends to last for years, even decades. The symptoms may become less severe from time to time, and there may be long intervals when symptoms are mild, but for most individuals with OCD, the symptoms are chronic.
OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Co-existing disorders can make OCD more difficult both to diagnose and to treat.
A person with OCD has obsessive and compulsive behaviors that are extreme enough to interfere with everyday life. People with OCD should not be confused with a much larger group of individuals who are sometimes called "compulsive" because they hold themselves to a high standard of performance and are perfectionistic and very organized in their work and even in recreational activities. This type of "compulsiveness" often serves a valuable purpose, contributing to a person's self-esteem and success on the job. In that respect, it differs from the life-wrecking obsessions and rituals of the person with OCD.
Research into treatment for OCD is ongoing in this area - neurosurgery, a new approach to treatment - refractory OCD. In the very few centers where neurosurgery has been performed as a clinical procedure, candidiates are generally restricted to those who have failed to respond to conventional treatments, including behavior therapy and pharmacotherapy.
In addition to research into treatment modalities, NIMH researchers are conducting studies into possible linkage of OCD to some autoimmune diseases. (Diseases in which infection-fighting cells, or antibodies, turn against the body, trying to destroy it).
Ancedotal reports of the successful use of electroconvulsive therapy (ECT) in OCD have been published over the past several decades. Most often, the benefit from ECT has been short lived, and this treatment is now generally restricted to intances of treatment-resistant OCD accompanied by severe depression.
Individuals with OCD are protected under the Americans with Disabilities Act (ADA). Among organizations that offer information related to the ADA are the ADA Information Line at the U.S. Department of Justice, (202) 514-0301, and the Job Accommodation Network (JAN), part of the President's Committee on the Employment of People with Disabilities in the U.S. Department of Labor. JAN is located at West Virginia University, 809 Allen Hall, P.O. Box 6122, Morgantown, WV 26506, telephone (800) 526-7234 (voice or TDD), (800) 526-4698 (in West Virginia).
The Pharmaceutical Research and Manufacturers Association publishes a directory of indigent programs for those who cannot afford medications. Physicians can request a copy of the guide by calling 800-762-4636 (800-PMA-INFO).
September 1999 ?Revised
What Causes OCD?
There is growing evidence that OCD represents abnormal functioning of brain circuitry, probably involving a part of the brain called striatum.
Anxiety Disorders
What Are the Different kinds of Anxiety Disorders?
F Key Saver
Diagnostic and Statistical Manual of Mental Disorders
Fourth Edition
Published By The American Psychiatric Association Washington, DC
The most common obsessions for obsessive compulsive disorder are:
repeated doubts
compulsive gambling
compulsive masterbation
repeat peculiar acts
hoarding
{endless rearranging objects in an effort to keep them in precise alignment with each other}
mentally repeating phrases
listmaking
checking
hand-washing
having to count over and over to a certain number
touching
fear of harm to oneself or loved ones
intrusive sexual thoughts
recurrent blasphemous images
hoarding useless materials
screaming obscene words at inappropriate times or places
compulsive avoidance (phobias)
compulsive eating
compulsive drinking
compulsive stealing (kleptomania)
stripping clothes off (e.g., where people can see you)
thought
perfectionist
bad habit
contamination
a need to have things in a particular order
aggresive or horrific impulses
sexual imagery
ordering / arranging compulsions, packing and unpacking a suitcase, rearranging drawers
Mental Acts -- (e.g., praying, counting, repeating words silently) -- {the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification}
requesting or demanding assurances
compulsive smokers
compulsive shoppers
compulsive talkers
compulsive telephone talkers
compulsive power and status seekers
The "I must know" compulsive
bowel and bladder rituals
bedtime rituals
Social Checking (to call excessively, or "checking in", "to be within reach and let us know")
exhibitionism
preoccupation with part of body
miscellaneous compulsions - need to tell, ask, or confess, measure
obesity (compulsive eating)
alcoholism (compulsive drinking)
anorexia (compulsive noneating)
alcoholic (compulsive drinker)
repeating rituals (going in / out doors, up / down from chair, etc.)
The ability of individuals to recognize that the obsessions or compulsions are excessive or unreasonable occurs on a continuum. In some individuals with Obsessive Compulsive Disorder, reality testing may be lost, and the obsession may reach delusional proportions (e.g., the belief that one has caused the death of another person by having willed it). In such cases, the presence of psychotic features may be indicated by an additional diagnosis of Delusional Disorder or Psychotic Disorder not otherwise specified. The specifier with poor insight may be useful in those situations that are on the boundary between obsession and delusion (e.g., an individual whose extreme preoccupation with contamination, although exaggerated, is less intense than in a Delusional Disorder and is justified by the fact that germs are indeed ubiquitous).
Schizophrenia are distinguished from obsessions and compulsions by the fact that they are not ego-dystonic and not subject to reality testing. However, some individuals manifest symptoms of both Obsessive-Compulsive Disorder, Depression and Schizophrenia and warrant all diagnosis. - (Is it even possible to have any more than that?)
When the person attempts to resist a compulsion, there is a sense of mounting tension that can be immediately relieved by yielding to the compulsion. In the course of the illness, after repeated failure at resisting the compulsions, the person may give in to them and no longer experience a desire to resist them. Complications include Major Depression and the abuse of alcohol and anxiolytics.