Obsessive-compulsive disorder essay
According to the description given in the ICD-10, obsessive-compulsive disorder is a mental disorder, the main features of which are recurring obsessive thoughts and compulsions (rituals). In a broad sense, the core of OCD is the obsessional syndrome, which is a state with predominance of feelings, thoughts, fears, memories in the clinical picture occurring against patients’ wish, but with awareness of their abnormality and critical attitude towards them (Abramowitz 13). Despite the understanding of the unnatural and illogical nature of obsessive thoughts and states, patients are powerless in their attempts to overcome them (Abramowitz 14-17; Benito and Storch 288-90).
Compulsions may be the rituals designed to relieve anxiety, such as washing hands to fight impurity and to prevent infection. Attempts to ward off undesired thoughts or impulses can cause severe internal struggle followed by intense anxiety (Abramowitz 25-27). To identify obsessive-compulsive disorder the so-called Yale-Brown scale is applied (Benito and Storch 289).
Obsessive-compulsive disorder usually begins at the age between 10 and 30 (Benito and Storch 291). However, the first visit to a psychiatrist is usually made only between 25 and 35 (Abramowitz 31). The time between the beginning of the disease and the first consultation can be up to 7.5 years; the average age of hospitalization is 31.6 (Abramowitz 32-34). In general, the prevalence of OCD in the population is high enough. According to some reports, it is determined by the index of 1.5% (meaning new cases of the disease), or 2-3% if including the episodes of exacerbations observed throughout life (Benito and Storch 292). The patients suffering from obsessive-compulsive disorder make 1% of all patients treated at psychiatric institutions (Fineberg et al. 123). It is believed that men and women are affected almost equally (Abramowitz 20).
Currently, specific etiologic factors causing OCD are not identified. There are though several reasonable hypotheses (basing on Abramowitz 2006, and Benito and Storch 2011): biological (diseases and functional features of brain, autonomic nervous system functioning specificities, disturbances in neurotransmitter metabolism, genetic factors, the theory of PANDAS-syndrome), psychological (different accentuations of personality or character, exogenously-traumatic family, sex, or professional activity factors, sociological (micro- and macro factors), and cognitive theories (strict religious upbringing, environment simulation, inadequate response to specific situations).
Despite the fact that OCD represents itself a complex group of symptom clusters, treatment principles for them are generally similar. Basing on Fineberg et al., the most reliable and effective method is surely drug therapy, which most often involves serotonergic antidepressants, anxiolytics, beta-blockers, reversible MAO inhibitors, and triazole benzodiazepines. Effective results are also demonstrated by cognitive- behavioral therapy, thought stopping method, psychoanalytic psychotherapy, and physiotherapy (Fineberg et al. 138; Abramowitz 66-69).
In milder forms OCD usually proceeds favorably, on an ambulant level. Regression of symptoms occurs in 1-5 years from the date of manifestation (Benito and Storch 294). More severe and complex OCD, such as phobias of infection, contamination, sharps objects, contrasting views, numerous rituals, on the contrary, can become resistant to treatment or manifest a tendency to recur with conserved disorders despite active treatment (Benito and Storch 295). Further negative dynamics of these states indicates the gradual complication of the clinical picture of the disease overall. In general, Abramowitz (55) marks that chronization is the most characteristic of OCD; episodic manifestation of the disease and full recovery are relatively rare.
At the same time, neuroses are not usually accompanied by temporary disability. Furthermore, the study of cognitive function came to the conclusion that there are insignificant neuropsychological differences between people with OCD and healthy participants in case of controlling confounding factors (Benito and Storch 293). Moreover, OCD patients are mostly people with a high level of intelligence, especially verbal; according to various sources, frequency of OCD patients with high IQ is 12% to 28.53% (Abramowitz 40). The prevalence of OCD is also associated with level of education. The frequency of the disease is lower in those who graduated from higher educational establishment (1.9%) than in those who did not go to college (3.4%). However, among those who graduated from the university, the incidence is higher in those who graduated with a degree (ratio is respectively 3.1% to 2.4 %) (Abramowitz 41-42). At the same time, the majority of patients with moderate disease severity cannot fully work or study, and if they do, their efficiency is low enough (Benito and Storch 291). In general, only 26% of patients with obsessive-compulsive disorder can work full-scale (Fineberg et al. 136). Therefore, we suppose that in cases of prolonged neurotic states a medical control commission decides whether it is appropriate to change the conditions of work and study (light mode, reduced work or school day, work in a small group).
