The Perfectionist's SanctuaryIsm::PerfectionismO.C.D.
This man, diagnosed as having obsessive-compulsive disorder, shows the driven quality of the thoughts and rituals seen in people with this condition. While the specific features of the condition vary from case to case, they have in common recurrent obsessions or compulsions that are severe enough to be time consuming (that is, they take more than one hour a day) or cause marked distress or significant impairment. Obsessive people are unable to get an idea out of their minds (for example, they are preoccupied by sexual, aggressive, or religious thoughts); compulsive people feel compelled to perform a particular act or series of acts over and over again (repetitive hand washing or stepping on cracks in the sidewalk, for example).
Obsessions usually involve doubt, hesitation, fear of contamination, or fear of one’s own aggression. The most common forms of compulsive behavior are counting, ordering, checking, touching, and washing. A few victims of obsessive-compulsive disorder have purely mental rituals; for example, to ward off the obsessional thought or impulse they might recite a series of magic words or numbers. About 25 percent of people with an obsessive-compulsive disorder have intrusive thoughts but do not act on them. The rest are both obsessive and compulsive; compulsive behavior without obsessional thoughts is rare (Skodol, 1989).
Compulsive rituals may become elaborate patterns of behavior that include many activities. For example, a man requires that his furniture never be left an inch out of place, and feels a need to dress and undress, brush his teeth, and use the toilet in a precise, unvarying order, all the time doubting whether he has performed this sequence of actions correctly, and often repeating it to make sure. Some theorists believe that compulsive behavior serves to divert attention from obsessive thoughts. In any case, compulsive rituals become a protection against anxiety, and so long as they are practiced correctly, the individual feels safe.
Therapists say there are enormous differences between healthy people with compulsive streaks and those suffering from obsessive-compulsive disorder. Truly obsessive-compulsive people often have family histories of psychiatric difficulties, suggesting a genetic component to the disorder. They are wracked by self-doubt and often are unable to make even simple decisions.
By contrast, healthy people with a few compulsive tendencies tend to work efficiently and organize their daily activities to avoid confusion. They also take pride in their ability to control their emotions--an impossibility for those with obsessive-compulsive disorder. Although obsessive-compulsive people are wracked by guilt over their strange behavior’s effects on their families, they continue because they believe their compulsive acts keep themselves and their families safe.
The exact incidence of obsessive-compulsive disorder is hard to determine. The victims tend to be secretive about their preoccupations and frequently are able to work effectively in spite of them; consequently, their “problems” are probably underestimated, Obsessive-compulsive disorder is more common among upper- income, somewhat more intelligent individuals. It tends to begin in late adolescence and early adulthood, and males and females are equally likely to suffer from it. A relatively high proportion of obsessive-compulsive individuals--some surveys report up to 50 percent--remain ‘unmarried.
Recent studies have found the lifetime prevalence of obsessive-compulsive disorder in the United States and Canada to be approximately 2.3—2.6 per 100 people with the age of onset occurring in the twenties (Robins & Regier, 1991; Weissman et al., 1994). While this figure is lower than for phobias and generalized anxiety, it is higher than for panic disorder and several other diagnostic groupings. As public awareness of the prevalence of obsessive-compulsive disorder increases, the social stigma associated with it may decrease and encourage those who suffer from it to seek professional help.
The most common features of obsessive-compulsive disorder are the following:
The language used by those with an obsessive-compulsive disorder conveys their exaggerated attention to details, their air of detachment, and the difficulty they have in making a decision:
Obsessional thoughts often seem distasteful and shameful. Their content generally involves harming others, causing accidents to occur, swearing, or having abhorrent sexual or religious ideas. The person with these thoughts is often very fearful that he or she might act on them and as a result spends a great deal of time avoiding these situations or checking that everything is all right.
Depending on the situation and the nature of the obsession, the obsessive individual may feel some pride in his or her unwillingness to make a premature decision, or may feel self-contempt when indecisiveness prevents action and allows others to win acclaim. The founder of evolutionary theory, Charles Darwin, is an example of an obsessive person. Only when Darwin faced the possibility of prior publication by a colleague was he able to overcome his obsessive indecisiveness and put On the Origin of Species into the hands of a publisher.
The variety of obsessive-compulsive rituals and thoughts is practically unlimited, but investigators have identified four broad types of preoccupations: (1) checking, (2) cleaning, (3) slowness, and (4) doubting and conscientiousness. The following statements illustrate each type.
When the compulsive rituals or obsessive thoughts begin to interfere with important routines of daily life, they become significant problems that require professional attention. Their bases frequently are not well understood, but because all of us have had some persistent preoccupations with particular acts and thoughts, their interfering effects can easily be appreciated. Obsessive-compulsive preoccupations--checking details, keeping things clean, and being deliberate--often increase during periods of stress. They can have undesirable effects when speedy decisions or actions are required.
Attempts to find out what obsessive-compulsive individuals are afraid of usually fail. Many clinicians believe that fear of loss of control and the need for structure are at the core of the obsessions and compulsions. Whether the disorder reflects the impact of environmental factors or heredity, its incidence is greater among members of some families than among the general population.
A common feature of psychotic behavior is irrational thought, but an obsessive-compulsive person is not considered to be psychotic since he or she is usually aware of the irrationality. In some cases, however, the border between obsessive-compulsive disorder and true psychosis is imprecise.
People who suffer from obsessive-compulsive disorder are cautious. Like victims of phobias and other anxiety disorders, they unreasonably anticipate catastrophe and loss of control. In general, victims of phobias fear that might happen to them, whereas victims of obsessive-compulsive disorders fear what they might do. There are mixed cases; for example, fear of knives might be associated with the obsessional thought that one will hurt someone if one picks up a knife, and fear of elevators might be brought on by a recurrent impulse to push someone down the shaft. An obsessional thought about shouting obscenities during a sermon might lead the victim to avoid attending church, just as a phobia about the sound of church bells would. Normally, the object of a phobia can be avoided while an obsession cannot be, but again there are mixed cases; a dirt phobia may be as intrusive as an obsession, because dirt is everywhere.
Obsessive thoughts and compulsive rituals shade into phobias to the extent that anxiety accompanies the thoughts or rituals and there is avoidance of situations that evoke them. For example, someone who has a washing ritual will try to avoid dirt, much as a person with a dog phobia avoids dogs. Clinical workers often observe that both obsessive-compulsive and phobic individuals have an unusually high incidence of interpersonal problems. The two disorders differ in that the obsessive-compulsive person’s fear is directed not at the situation itself but, rather, at the consequences of becoming involved with it--for example, having to wash afterwards. Another difference is that obsessive-compulsive persons develop a more elaborate set of beliefs concerning their preoccupying thoughts and rituals than phobics do about their fears. Cognitions seem to play a larger role in obsession-compulsion than in phobia. This point is illustrated by the case of a 40-year- old man with a checking compulsion.
Source: OCR of this text was performed from Irwin G. Sarason & Babara R. Sarason's book entitled: "ABNORMAL PSYCHOLOGY: The Problem of Maladaptive Behavior (Eighth Edition)"; Chapter 7: Anxiety Disorders: OCD; pp. 193-195.
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