OBSESSIVE COMPULSIVE DISORDER
Introduction:
Obsessive compulsive disorder is a neurotic condition classified under stress
related disorder.
Definition
An obsession is defined as
A. An idea, impulse or image which intrudes into the conscious awareness
repeatedly.
B. It is recognized as one’s own idea, impulse or image but is perceived as
egoalian.
C. It is recognized as irrational and absurd.
D. Patient tries to resist against it but is unable to.
E. Failure to resist, leads to marked distress.
A compulsion is defined as
A. A form of behavior which usually follows obsession
B. It is aimed at either preventing or neutralizing the distress or fear arising out of
obsession
C. The behavior is not realistic and is either irrational or excessive
D. Insight is present, so the patient realizes the irrationality of compulsion
E. The behavior is performed with a sense of subject compulsion
Etiology
I. Psychodynamic theories
a. Isolation of affect
b. Undoing
II. Behavioral theories
III. Biological theories
Book Pictures Patient Pictures
Types I. Washers Washers
II. Checkers This is the commonest type. Here
III. Pure obsession the obsession is of contamination with
IV. Primary obsessive slowness dirt, germs, body excretions and the
like. The compulsion is washing of
hands or the whole body, repeatedly
many times a day.
Clinical o Obsession of contamination with o Obsession of contamination with dirt.
Features dirt, germs, body excretions and the o The compulsion is washing of hands
like. or the whole body, repeatedly many
o The compulsion is washing of times a day.
hands or the whole body,
repeatedly many times a day.
o It usually spreads on to washing of
clothes, washing of bathroom,
bedroom, door knobs and personal
articles gradually
Psycho- Sigmund freud found obsessions and Same as described in book picture.
pathology phobias to be psycho genetically
related.
Isolation of affect
By this defense mechanism, ego
removes the affect from the anxiety
causing idea. The ideas are thus
weakened, but remains still in the
consciousness. The affect however
becomes free and attaches itself to
other neutral ideas by symbolic
association. Thus, these neutral ideas
become anxiety provoking and turn
into obsessions.
Diagnostic History collection History collection
Evaluation Mental status examination Mental status examination
Psychoanalysis Psychoanalysis
Treatment Anti anxiety drugs Anti anxiety drugs
Psycho- Anti depressants Anti depressants
pharmaco Anti psychotic drugs Antipsychotic drugs
-logy
Psycho- Psychoanalysis Psychoanalysis
therapy Aversion therapy Aversion therapy
Individual counseling Individual counseling
Token economy Token economy
ECT Recommended in case of drug ECT not given.
resistance.
