1 Model Essay OCD (Chapter Summary)

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that is characterized by an individual

experiencing repeated obsessions and / or compulsions. An obsession can be identified by recurrent and
persistent thoughts, impulses or images that cause anxiety and distress. Compulsion is a repetitive
behavior or mental act that the person feels driven to perform in response to an obsession. Maudsley’s
Obsessive Compulsive Inventory is a psychometric test which can be used to access OCD behavior.
OCD can occur at any age but often before the age of 40. In men, OCD may set in during late
adolescence and early twenties for women.

It has been thought that there are five main categories of OCD; checking, contamination or mental
contamination, hoarding, ruminations or intrusive thoughts and symmetry and orderliness. A person that
has OCD for checking has the compulsive need to check to prevent harm or damages. This behavior is
carried out multiple times which can take a toll on the patient’s daily life. Contamination OCD is the
need to be clean at all times to prevent illness or death. An example of a case in which the patient was
suffering from OCD was a case study by Rappaport (1989) on a patient named Charles. Charles had
contamination OCD where he would take showers for more than 3 hours because he could not get rid of
the ‘sticky-ness’. Meanwhile, mental contamination OCD is when a person feels internally unclean due
to critical or abusive remarks by others. Hoarding OCD is the inability to discard unwanted or useless
possession. The house of an OCD patient with hoarding issues is normally cluttered. Ruminations are
repetitive thoughts that are unproductive while intrusive thoughts are thoughts are that are repetitive,
disgusting, horrific and repugnant in nature. The last type of OCD is symmetry and orderliness. These
people are obsessed with organizing and they spend a lot of time arranging things into symmetry.

Based on the biological model, it has been found that genetic component plays a part in OCD. Slater and
Shields (1969) found that identical twins were more likely to show anxiety than non-identical twins.
DNA samples from patients with OCD were examined and the results suggests that OCD may be
associated with a rare combination of two mutations within the human serotonin transporter gene
(hSERT), resulting in a significant lower amount of serotonin available in the synapse. Since serotonin
is the chemical in the brain that sends messages between brain cells and is thought to be involved in
regulating everything from anxiety to memory. An imbalance in serotonin levels would cause
miscommunication between the frontal lobe and the deeper parts of the brain responsible for the
repetitive behaviour. Medication can be prescribed to overcome OCD and it usually takes the form of
antidepressants, Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac. Medication may
reduce anxiety enough for a person to start and succeed in therapy.

OCD can also be explained through cognitive-behavioral model. Under the cognitive component, it is
explained that OCD patients feel an inflated sense of responsibility and misinterpret these thoughts as
being important. Aaron Beck explains the type of cognitive errors that an OCD patient have such as
catastrophic misinterpretation, black and white thinking, memory problem and hyper vigilance. Beck
explains that these patients are bias to these thoughts and only interpret thoughts that support their
negative thinking. Under the behavioral component, OCD is explained base on the principles of
conditioning. Classical conditioning by Ivan Pavlov explains that OCD is due to specific behaviors
being associated with bad events. Cognitive-Behavioural Therapy (CBT) can be used to treat this
disorder, which aims to enable the person to become their own therapist and to provide patients with the
knowledge to continue working towards complete recovery from OCD. It has two elements, the
cognitive therapy, which looks at how the patient thinks. This includes identifying and modifying
patterns of thought that causes anxiety, distress and compulsive behaviour. The behavioural therapy,

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2 Model Essay OCD (Chapter Summary)

looks at how this affects what the patient does, is aided with Exposure and Response Prevention (ERP)
and flooding. ERP describes the obsessions and compulsions and ranks them from most severe to least
severe. Therapists start from small exposure exercises and build up to much more difficult ones. In
helping patients, they are taught deep breathing and Progressive Muscle Relaxation (PMR) techniques.
Flooding happens when the person with OCD is immersed in the situation they fear the most and is left
in that situation until the anxiety becomes less bothersome.

Lastly, Freud suggested that OCD develops because of a person’s fixation arising from unconscious
conflicts experienced during the anal stage of development. This could happen when the child becomes
overly-gratified, suggesting that the child did not advance through the stages smoothly and an
unconscious conflict develops. These conflicts arise when an unconscious wish (usually related to a
sexual urge) is at odds with socially acceptable behavior. The unconscious conflict between the id and
the ego leads to obsessive thoughts and compulsive actions. The ego then defends itself by Reaction
Formation, a defensive process that involves displacement and substitution that provides immediate
relief, for instance, transferring the conflict to something more manageable like washing, checking or
hoarding. Freud proposed that obsessions are defense mechanisms that serve as ways of occupying the
mind and displacing more threatening thoughts. This can be treated by using psychoanalysis, revealing
the contents of the unconscious through free association and dream analysis. The therapist is there to
help the patient understand the origin of their feelings during their childhood which involves an
emotional release, catharsis.

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