Psychology

Obsessive Compulsive Disorder or OCD is a disorder in which the patient feels compelled to perform an activity such as washing or rubbing in a repetitive manner. These activities serve to reduce the anxiety felt by the patient and when the activity is not done, the patients anxiety increases. The paper describes the research conducted upon OCD and the most commonly used treatment.

It was found that most people with OCD do not know the treatment for OCD. Surprisingly, even health professionals are not fully aware of the treatment for OCD. Researchers have come to the conclusion that CBT has shown the most improvement in patients.

Obsessive Compulsive Disorder or OCD is a compulsive disorder in which the patient is forced to respond to a particular thought process by doing a particular task again and again in order to reduce their anxiety. It is fairly common in the population and is known to be present among most people to a small degree. But when the disorder moves on to dominate a persons mind completely it takes the form of a disease that has to be treated.

Lewin et al. (2005) pointed out that OCD was most prominent in children and adolescents. OCD for children is usually a means to fill up some other deficiency which could be familial, social or academic. If OCD is not treated in children, they carry it forward to their adulthood (Lewin, Storch, Merlo, Adkins, Murphy, Geffken, 2005).

OCD can be both harmless and harmful. In some people it remains an obsession to do certain things at certain times whereas in other people it turns itself into a disorder. Lewin et al. (2005) explain the term OCD by dissecting it into three parts. Obsession is a thought process which keeps occurring to the patient to do a particular task and when the required task is not done, the anxiety of the patient increases. Compulsion, on the other hand, is the execution of the task again and again to reduce the anxiety (Lewin et al., 2005).

The author here tries to explain the process or the development of OCD. OCD begins as a thought process to complete a particular activity. These activities are usually harmless to begin with washing hands, rubbing or tapping on something. It would probably start sometime in early childhood when a child would feel like tapping on wood. Then the same thought slowly becomes an obsession, it can go in such manner every time the child passes the dining table hisher mind asks him to tap on it. The child would do the harmless activity once and maybe continues doing it in future. Then would come a time when if he or she would not tap on the wood, heshe would start to feel nervous or anxious. In this way, a simple thought can easily turn into an obsession. This was a simple example there could be many different ways in which people could start displaying OCD and following it.

A child displaying OCD would never think about it as though it were a problem. For a childs simple mind it would only be a small game that heshe would be playing. The implication and understanding that it was actually a disorder would only come when the child grew up, but by then the person would be so used to it that not doing the activity would just add to hisher anxiety. Hence, Lewin et al. (2005) stress the fact that OCD should be treated in childhood (Lewin et al., 2005).

Lewin et al (2005) say that Cognitivebehavioral therapy (CBT) and pharmacotherapy with serotonin reuptake inhibitors are the treatment to use when dealing with pediatric OCD. In a recently conducted trial, it was found that CBT was showing marked improvement in children with OCD. On the other hand, another study has shown that pediatric OCD treatments have not been long-lasting (Lewin et al., 2005). Franklin, Abramowitz, Bux Jr., Zoellner, and Feeny (2002) believe that the treatments that have been suggested till now have had no proper backing from researchers. Without any proof of the superiority of the treatments like CBT etc, psychologists have had to depend on their own logic and belief in treating patients with OCD (Franklin, Abramowitz, Bux Jr., Zoellner, and Feeny, 2002).

This kind of double and conflicting information can only lead to more confusion to the doctors and the patients. The most important part in any disorder is the treatment of the patient, without a provable treatment, the treatment of OCD can become more complicated.

Another major hurdle in the treatment of OCD according to Lewin et al. (2005) is that the numbers of medical health professionals trained in CBT are very less (Lewin et al., 2005). Hence, even though treatment is available and can be used to benefit a number of patients, there has not been proper utilization of the treatment. .

For those children having treatment refractory pediatric OCD Lewin et al (2005) suggest Intensive CBT or I-CBT. The only difference between CBT and I-CBT is that I-CBT is more frequent and lasts longer than CBT. It has proven to be more beneficial to children and adults than CBT (Lewin et al., 2005).

During the I-CBT sessions, Lewin et al. (2005) says the children are first made to answer a test which gauges their level in the OCD. They are then explained what is obsession and compulsion. The children are engaged in activities which increase their anxiety to do the compulsion and then they are asked not to succumb to the activity (Lewin et al., 2005).

The I-CBT sessions tell the children that the compulsive habit that they have acquired is harmful to them. Before coming to the I-CBT sessions, most children would be unaware that they have any problem. For them, as mentioned before, it could be something very unimportant or negligible. Once they know that they have a disorder, they would be more adept at trying to cure themselves. And the fact that it is coming from a health professional usually helps them accept that they have a problem. It is more applicable to adults who might be reluctant to believe that they have a problem. In the session, as has been mentioned before, the children are made to do tasks that would cause them to go into the compulsive activity zone. And then they are asked not to engage in the particular compulsive activity. Once they are able to refrain from doing the compulsive activity the first time, the children would feel more relaxed and realize that they do not always have to finish the compulsion to reduce their anxiety.

For example, let us look at a boy who has to tap any wooden object every time he goes by it. In this case, he would be made to pass a wooden object a number of times through the day to increase his anxiety. The first time he passes by, he will know that he is being watched and has been told not to tap the wood, so he passes by without carrying through his compulsion. Next time he passes by again, it will be easier to fight the compulsion. The more times the child passes by the wood and does not tap it, he will start to feel more confident and more relaxed.

This does not mean that the disorder will be completely cured, there might be times when the child might give in and tap the wood but these will be few as compared to the childs previous history. And at the end of the sessions the participant will be asked to remain in contact via either some other clinic or via the telephone.

Even though a few studies have shown that CBT has been very helpful in treating OCD, there is research being conducted to find better medication. Franklin et al. (2002) conducted a study to determine whether CBT was to be used with any other additional medication or should be used alone. The results showed that there was a very small difference between the two groups only CBT and CBT plus some extra medication. The patients both showed significant progress at the end of the session (Franklin et al., 2002).

These kinds of conflicting data can be very confusing. If the data had shown that either one was more beneficial than the other one then there would have been some kind of conclusion drawn. But here the data seems to suggest that whether more medication is used or not, CBT has a substantial effect on the patients mental health. On the other hand, the data also seems to point out that extra medication has no effect at all on the patients mental health.

Franklin et al. (2002) also add that the study is incomplete as they have not yet received the follow-up data. They still have to see if the people who had showed improvement have lapsed back into OCD (Franklin et al., 2002). An important part of a study is whether the disorder has returned back. The results of the follow-up need to be studied to see if any group is going into relapse.

Almost all studies and researchers have concentrated on the patients and their mental distress. But the family of the patient also suffers just as badly as the patient. They are in a more distressing position of not being able to do anything to help the patients. A number of researchers have also blamed parents and relatives for OCD. Rachman (1976) says that most OCD patients are those whose parents are overcontrolling and critical (cited in Cooper, M., 1996).

Cooper (1996) conducted a survey on relatives of OCD patients. These were the people who were involved or living with an OCD patient. Most of them were depressed and wanted to find a way to deal with the disease. They had all at one time or the other tried some therapy or medication to deal with OCD. Some had found these therapies and medication a little helpful while others had not. The most disturbing behavior of OCD patients as told by the families was the depression that the patient faced. This depression not only caused pain to the patients but also caused anxiety to their families. A large number of OCD patients were unemployed causing an additional burden on their relatives (Cooper, 1996).

Being unemployed due to a disease can be a major irritant for any person. But when a person is already suffering from a disorder and is co-dependent emotionally on hisher relations, not having a job can only serve to increase the stress.

The situation with OCD is found to be stressing not just to the patients but also to the families. The treatment for OCD is also quite unclear. Though some researchers believe that CBT is the best option, others are not so sure. Such kind of conflict of opinions between health professionals can lead to more stress to the OCD patients. And even when the treatment is chosen, there are very few health professionals who are trained in CBT.

OCD is more common than it was a decade before, probably because of more information and understanding on the subject. The treatment of OCD is a much debated topic among health professionals but it is a topic which requires a solution. But right now, the most important thing to be concentrated upon is that health professional need to be trained in the use of CBT. There is an urgent need to give training to health professionals in CBT, so that the maximum number of patients can be treated. The information on the treatment also needs to be made easily available in order to make sure that OCD patients are detected and treated in an early stage.