Obsessive Compulsive Disorder (OCD) is an anxiety disorder that affects a significant number of people throughout the world. Like all mental illnesses, OCD presents challenges to diagnose and to treat effectively.
Clinicians, including nurses, have the task of dealing with this disorder on a daily basis. Specific strategies need to be devised and employed that would further an understanding of the disorder, a knowledge of the best treatment practices and procedures to follow in either administering or recommending treatment.Armed with such strategies clinicians would therefore be able to provide the best possible alternatives for patients, ensuring that the disorder is managed in the best possible way. Definition of OCD The American Psychiatric Association (APA) in its 1994 publication of Diagnostic and Statistical Manual of Mental Disorders classifies OCD as an anxiety disorder (as cited in Gournay, Curran & Rogers, 2006, p. 60). Obsessive Compulsive Disorder (OCD) refers to a condition in which persons demonstrate an abnormal degree of obsession or compulsion in relation to specific daily activities.
Obsessions are persistent thoughts or mental images while compulsions are recurrent behaviors that are performed specifically as a result of obsessions. The British National Institute for Health and Clinical Excellence (NICE) issued guidelines in 2005 in which it provided a definition for obsession as ‘An unwanted and intrusive thought, image or urge that repeatedly enters the person’s mind. ’ They further define compulsions as ‘Repetitive behaviours or mental acts that a person feels driven to perform.These can either be overt or observable by others … or covert’ (as cited in Gournay, et al, 2006, p. 60). Everyday life experiences usually reveal some amount of obsession or compulsion for normal functioning persons.
Mothers, for example, constantly check their newborns. These everyday behaviors, aside from being annoying, do not affect normal activities to a great extent. In some instances, as with the newborn, such types of compulsions are necessary, excusable and natural and therefore do not cause considerable distress.The distinction between these behaviors and the behaviors associated with OCD is in the frequency with which they are carried out, the motivations behind the behaviors and the level of anxiety that is tied to the obsessive thought or compulsive behavior (Gournay et al, 2006, p. 60). OCD is present when the behaviors reach the extent of preventing the individual from functioning properly in normal everyday activities.
Obsessions usually cause a great amount of distress and anxiety for the individual and as a result actions (compulsions) are performed to diminish the anxiety caused by the obsessive thoughts or images.According to Stein (2002) persons with the disorder are constantly aiming to stabilize the anxiety they experience as a result of obsessions. For these individuals the ‘intrusive thoughts or images’ usually cause an increased amount of anxiety. To achieve equilibrium such individuals perform ‘repetitive or ritualistic actions’ to decrease the amount of anxiety they experience (p. 397).
It must, of course, be noted that persons with OCD usually attempt to resist the behaviors and thoughts. Gournay et al observes these individuals are continually aiming to address the disorder by either suppressing or ignoring it.Geffken, Storch, Gelfand, Adkins and Goodman (2004) observe that persons experiencing obsessive compulsive disorders usually acknowledge that the occurrence of the thoughts and behaviors is abnormal because of the frequency with which they occur and therefore often make a conscious effort to avoid situations that would trigger the thoughts or behavior. A further note, as highlighted by Stein (2002), is that the compulsions themselves, even though they represent behaviors, do not necessarily have to be observable but could also take the form of mental rituals (p.
397).The American Psychiatric Association specifies the conditions under which individuals may be diagnosed with OCD. First there must be the presence of the obsessions or compulsions as discussed above. Additionally these mental processes or behaviors must take up a significant amount of time, specified as more than an hour each day (as cited in Geffken et al, 2004, p. 46). It is important to discern the distinction between the obsessive and compulsive behaviors demonstrated by persons with OCD as being significantly different from delusions that are evidenced in various psychotic and personality disorders.
Indications of OCD Leckman et al (1997), in discussing the occurrence of symptoms in individuals with OCD, notes that there are numerous ways that the disorder is manifested. No two persons may demonstrate exactly the same manifestations. Furthermore the type of intrusive thoughts or ritualistic behaviors often bears some relation to the personality and socialization and experiences of the individual. Gournay et al (2006) suggest that certain personality characteristics may predispose certain individuals developing OCD.Persons with OCD are usually very self conscious and hold very high ideals for themselves. Additionally they tend to be concerned about having order and focus in their lives in respect to their goals and personal possessions.
There is also the tendency towards a very rigid outlook on life would. A further attribute of persons with OCD is their preoccupation with safety and danger. Generally an individual with OCD has either one or more of the personality characteristics just discussed. In fact it is highly irregular for such persons to demonstrate none of these personality traitsAccording to the National Institute of Mental Health OCD is demonstrated in persons feeling compelled to perform a certain ritualistic behavior or being persistently faced with mental thoughts or images. Some individuals may be obsessed with germs or dirt and therefore tend to wash their hands repeatedly. This category of OCDs is referred to as the washers.
Other individuals may constantly feel the need for reassurance or to check things repeatedly. This group is referred to as checkers (NIMH , 2006).
