Environmental Influences
However, there are scientific speculations that link some environmental traits to the disorder. Greenberg (2009) asserts that OCD can be an outgrowth produced by environmental stress influenced primarily by dysfunctional parents. This assertion is based on studies that have shown a great correlation between dysfunctional family settings and the occurrence or likelihood of occurrence of the disorder. Other environmental predisposing factors that have been linked to the disorder include post-traumatic stress and abuse behaviors in homes. It is important however to assert the claim made in study 1 that scientifically, the strongest identified cause of the disorder is biological and has to do with the structure of the brain and especially low levels of the hormone serotonin.
The manner in which the various environmental influences leads to the disorder are not exactly clear though there are explanations that may be reliable in supporting the environmental influence. The immediate environment of an OCD patient normally consists of the family. The normal development of a child in a great way depends on the availability of a conducive environment in which the mental, social and emotional facets are allowed to flourish. In the absence of these, there is an increased likelihood that one or several facets of the child may malfunction. For instance, a child who grows up in an abusive environment may develop fear, anxiety ands worry from a tender age and if these responses are interpreted by the brain as usual, the child may develop chemical imbalances in the brain which leads to the performance of out of the ordinary things. Since the development is gradual, the child carries on the worry circuits in his development. Of important to note is the likely chemical imbalance or misinterpretation that may be induced in the brain during development. When the child grows, the brain is not be able to control or direct normal and expected biological responses. Due to the pace at which the condition develops, it is not easy for parents or those within the environment to note the trend and normally, they will reinforce the worry by reprimanding the child when he appears to be doing repetitive things. As indicated in study 1, the condition is a series of repetitive actions induced by a worry circuit that makes the patient feel that he must do something to repel the worry (Kaplan, 1998).
In addition to the family, the extended social environment of a child that includes of peers and friends may also play a part in reinforcing the condition if the environment is one characterized by fear, suspense, suspicion and threats. Researchers however emphasize the role of dysfunctional families as being more influential in the occurrence of the condition.
In regard to the combined effect of genetic and environmental influences, researchers view the two as being instrumental in the condition formation. Note that the condition can be recognized early if the environment is friendly and peaceful. In an abusive environment and in cases where there are likely traces of genetic traits of the disorder, the condition can be accelerated both by the environment building up on the already established genetic weakness in the brain.
Psychosocial treatment
Research done by different bodies such as NIMH and other organizations that have focused on both clinical and animal research have obtained some information that indicates that OCD can be treated using either pharmacotherapy or by using behavioral approach (CAMH, 2009). It is however to be appreciated that both of the approaches do not provide absolute cure though they are credited as being able to control the tendencies and symptoms. When most effective, they are able to restore normality in the lives of the patients.
Behavioral therapy, referred in some quarters as traditional psychotherapy aims at helping the patient understand and develop insight into the ailment. If poorly reinforced, traditional therapy does very little in treating obsessive compulsive disorders cases. The most preferable and behavioral therapy for OCD is a specific behavioral response referred to as exposure and response prevention. This approach, unlike the traditional behavioral therapy has been rated as efficient in treating OCD. In the approach, the patient is voluntarily and deliberately exposed to the feared idea or object. This can be done either directly by exposing the person to the real object or indirectly through imagination (Greenberg, 2009). During exposure, the patient is bound to experience the compulsion to respond using the normal behavior and at this point, the therapist uses all means to prevent or discourage the patient from indulging on the compulsion. The technique is also referred to as systematic desensitization (Psychcentral, 2009).
In the case under study, Maria can be treated psychosocially by exposing her to a lot of dirt. For instance, she can be made to touch muddy water or other equally dirty places and then be encouraged to refrain from washing the hands. The idea in this approach is to inhibit the hormonal responses that are triggered by the mental stimulus of seeing the object that cause the compulsion.
For this therapy to work, the patient should first be made aware of her ailment so that she becomes a willing participant of the treatment process. For patients who can understand the biological disposition of their problem, it would be important to take them through the mental processes that occur once the object or situation that stimulates their compulsions is seen or experienced. For Maria, it would be important to explain to her how her brain responds when she sees dirt. The idea would be to prepare her mind to engage in responses that would counter the original and usual response of wanting to wash her hands every time. As seen in case 1, the hormonal imbalance in the levels of serotonin must be countered with an equally strong hormonal release of another hormone which communicates a different response. For instance, by making her touch dirt and not wash her hands, the brain would start releasing a hormone that communicates a claim that dirt has no harm and this would counter the strength of the compulsion response. By denying the patient to engage in the compulsion, the patient gradually lessens her anxiety from the obsession and compulsion (Psychcentral, 2009). This helps the patient go for long without repeating the compulsive behavior for long periods of time.
Studies in this psychosocial treatment have shown it to produce long lasting effects. It should however be noted that behavioral approach in itself is weak and its effectiveness may take long when used alone. As such, studies on obsessive compulsive disorder have suggested that the most effective treatment is one that combines both pharmacotherapy (medical) and the behavior therapy (NIMH, 2009). In addition to the therapies, the therapist should be specially trained to handle each patient uniquely since every patients condition may be a complex combination of their genetic composition as a well as myriad of other environmental influences such as abuse and dysfunctional families. The best approach when attempting behavioral approach is to start by collecting background information on the patient.
In the case study, the therapist would be able to establish that there is an apparent link to Marias genetic composition considering that her mother and her daughter had also recorded tendencies similar to those experienced by obsessive compulsive disorder patients. Upon this establishment, the therapist would be able to assert whether psychosocial or chemical treatment would be preferable. A close look at Marias family background shows that her family environment is neither dysfunctional nor abusive. In contrast, the family is well composed with close observance to religious activities and with a supporting husband. As such, clarifying her background information would reveal that her problem is not environmental. As such, her treatment would require more than a psychosocial approach and would focus more on her biological hormonal composition which would more effectively be tackled using pharmacotherapy.
According to research, the two most efficient psychosocial treatments include the already mentioned exposure and response prevention technique and cognitive therapy (Durand Barlow, 2007 p. 57). The first method becomes effective in that it effectively retrains the mind from engaging in the compulsive behavior. When a patient whose compulsion is in hand washing is asked to touch the door of a public restroom and restrained from washing the hands, the urge slowly goes away. The mind starts realizing that one does not necessarily require the ritual to be okay or to rid the anxiety. The mind is also trained to realize that one is not completely helpless but that there is some power of control over the compulsive behaviors and obsessive thoughts.
Cognitive therapy on the other hand is focused on the exaggerated sense of performing rituals and the catastrophic thoughts produced by the anxiety. In this therapy, the aim is to produce responsible and better responses to the compulsion other than the ritualistic responses the mind is used to. Cognitive therapy also focuses on how patients interpret their obsessions. For instance, for a patient who fears shaking hands, cognitive therapy would focus on asking the person why they believe that dirt would be passed to them by shaking hands. It would also go ahead to verify why the patients specifically is afraid of the contact. For instance, it would seek to ask questions such as, even if the dirt was passed on to you, how do you think it will affect you, if it does not affect others The idea in this therapy is to reinterpret the fears so that their debilitating fears can be reasoned out and hopefully be diminished. Although the results take time and efforts to achieve, there is considerable evidence that the therapies do provide relief.
The effectiveness of psychosocial therapies may vary from patient to patient. Success is influenced by several factors with the patient motivation considered a primary factor. Up to 75 of patients who have been treated using these therapies have showed improvement in their conditions during treatment (CAMH, 2009). Though the change in conditions may take some considerable time before major changes are observed, studies have recorded substantial improvement in the patients condition two to three years after treatment. The treatment is especially efficient for patients who exhibit overt compulsions with evidence showing that patients with high levels of depression and those who do not exhibit overt compulsions do not respond well to psychosocial therapy and are instead more predisposed to medical treatment.
Case study Specifics
By analyzing Marias case, the environmental influence is not clearly illustrated as influential. Her immediate nuclear family is portrayed as functional and supportive and therefore may not be a strong environmental factor in her condition. Her sons diagnosis with ADHD disorder and her daughters tendency to cut herself are more inclined to genetic causes of the disease. A such, any treatment consideration should consider this genetic background, since as it has been observed in this study, the treatment for genetic caused disorder may differ significantly with those that are environmentally influenced. Essentially, behavioral therapy is more effective in environmentally influenced cases but in this case, it would be effective to adopt both medical and behavioral therapy. The achievement of her treatment would require the family to understand her situation and if a therapist is involved, heshe should carefully help her to appreciate the treatment efforts. By appreciating the efforts, Maria would effectively be involved in her own treatment.
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