Obsessive-compulsive disorder (OCD) is usually grouped with anxiety disorders. In recent years it has been increasingly treated with antidepressant medications. OCD consists of two components - obsessive thinking and compulsive actions. It's possible to get the diagnosis without having both components. Here's how I think about OCD:
This type of paranoia is not as out-of-touch with reality as paranoid schizophrenia. It is actually the extreme end of thinking too much about things. If you think and think and think about something, you eventually think things are happening that are not really happening. Reducing or managing the stress can eliminate the paranoia in most cases.
OCD is presently treated with antidepressant medications and cognitive-behavioral psychotherapy. Some research suggests that outcomes are better if both of these techniques are employed. The disorder was not always understood in this way. Consider this excerpt from the 1970 edition of Hinsie & Campbell's Psychiatric Dictionary:
Psychoanalytically, obsessive-compulsive neurosis is interpreted as a defense against aggressive and/or *** impulses, particularly in relation to the Oedipus complex. The initial defense is to the anal-sadistic level, but the impulses at this level are also intolerable and must be warded-off - by reaction formation, isolation, and undoing.
I don't understand it completely either. The modern DSM-IV defines OCD in the following way:
Either obsessions or compulsions:
Obsessions as defined by:
If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e. g. , preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with *** urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder). The disturbance is not due to the direct physiological effects of a substance (e. g. , a drug of abuse, a medication) or a general medical condition.
(American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition. Washington, DC, 1994)
So far this sounds reasonably straightforward. It gets more complex. For starters some compulsive behaviors have their own diagnosis. Trichotillomania is the name for compulsive hair-pulling. To make things even more interesting there is another disorder with a name that is confusingly similar to OCD. Obsessive-compulsive personality disorder could be thought of as a milder, but more longstanding version of OCD - but that's not quite right.
Obsessive-compulsive personality disorder looks entirely different from OCD at first glance. The DSM-IV describes it this way:
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
(American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, 1994)
When we call someone “anal" (short for “anal-retentive") we are referring to this disorder, rather than OCD. Like all personality disorders, this can be thought of as an extreme exaggeration of a certain personality style. We all know someone who is somewhat like this. It's only a personality disorder when it is so extreme that it gets in the way.
If you look hard you can see why these disorders have similar names. Both involve the tendency to obsess and to act compulsively. OCD is an illness that can develop at different points in life. Obsessive-compulsive personality disorder must have begun by early adulthood. It refers to a deeply imbedded personality style, rather than to a set of acute symptoms that get in the way.
Having some obsessive-compulsive personality traits can pay off. Students and employees who are “excessively devoted to work and productivity to the exclusion of leisure activities and friendships" can be very productive. This productivity is rewarded by good grades, pay raises, and advancement at work. Other aspects of life can suffer, however, if things are not in balance.
Psychotherapy and medications are used to treat OCD and trichotillomania. Psychotherapy can also be helpful to treat Obsessive-compulsive personality disorder, (with medications sometimes used as an adjunct). If these symptoms sound like your life, and if they are getting in the way, consider consulting a mental health professional in your area.
With Much Love,
Out of Darkness & Into the Light
43 Oakwood Ave. Suite 1012
Huron Ohio, 44839
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