Obsessions are repetitive thoughts that are involuntary, unsettling, alien to the self, and cannot be dismissed with conscious effort. Compulsions, on the other hand, are involuntary repetitive actions that are often made to banish obsessive thoughts. Such obsessions are also extremely meaningless and even absurd to the person himself ( Rabavilas & Hodgson, 1976). The person tries to ignore or suppress such impulses, thoughts or fantasies. However, the more he tries to get these thoughts out of his head, the more they come to the person’s mind. Such impulses and thoughts are tried to be neutralized with another thought or behavior. Any behavior that is persistent, repetitive, seemingly purposeful, or stereotyped (e.g., washing hands, checking) or mental acts (e.g. counting, saying certain words silently) is defined as a compulsion.
Compulsions are aimed at relieving the distress caused by the obsessions or avoiding the fearful event or situation. However, compulsions do not provide pleasure or satisfaction. Initially, the person resists not fulfilling the obsession with which he was urged to do. However, the tension created by the obsession is overcome, even for a short time, by the realization of the compulsion. These obsessions and compulsions waste a significant portion of the person’s time (takes more than an hour a day).
Obsessions have four main symptom groups:
(a) Contamination: It is the most common. (The person constantly thinks that urine, feces, dust or germs will be transmitted. He believes that this contamination is transmitted from person to person, from object to object. He tries to clean up or try to avoid them to reduce the distress caused by this situation).
(b) Doubt: The person believes that he did not do some work, forgot or neglected it. (She can’t be sure that she has closed the door, turned off the stove, so her compulsions to control begin). He tries to control the stove, the tap, the door many times.
(c) Thoughts of sexual or offensive action: (Thoughts that they will harm, kill, or sexually harass the child).
(d) Symmetry – Prescriptiveness: It is in the form of wanting some situations to be in a certain order. (Placing the items on the table in a certain order, noticing the slightest change in this order and restoring it).” (Nemiah, 1985, p: 21)
Obsessive Compulsive Disorder can occur at any age, but the risk is higher between the ages of 09-25. Obsessive Compulsive Disorder, which occurs in childhood or adolescence, is usually seen together with tic disorders. Obsessive Compulsive Disorders that appear in adulthood respond better to treatment and are more common in women. It is estimated to affect 1-3% of the world population.
According to the data of the American Institute of Mental Health, one out of 50 adults suffers from Obsessive Compulsive Disorder in a given year. Its incidence is approximately 4 times lower in children.
In the calculations based on the 12-month period in the Turkish Mental Health Profile Report, the prevalence was found to be 0.5%. It is observed that most of the patients with Obsessive Compulsive Disorder have either another anxiety disorder or depression. The difference between obsessions and compulsions distinguishes phobic disorder from obsessive compulsive disorder. In phobia, the dimension that can be seen as an obsession, that is, an obsessive fear of an object and situation, as well as a compulsion, that is, avoidance of the feared object and situation, is typical. Thyricotillomania (hair-pulling disease), dysmorphophobia, hypochondriasis also have similar features with obsessive compulsive disorder. In cases of thyricotillomania, there is an unstoppable hair-pulling and pulling behavior. Hair pulling is a behavior that is resistant enough to cause regional baldness on the scalp. In hypochondriasis, the person thinks that he or she has a disease. Even if proven otherwise, he does not give up on this obsession.
Different Theories and Treatment Approaches
A systematic review of the OCD literature has shown that treatment approaches based on psychodynamic theories have not been adequately tested in controlled studies. In addition, comparisons between the psychodynamic approach and behavioral interventions have not been conducted.
Data collected from a small number of studies of psychodynamic treatments have consistently yielded poor results in OCD-affected patients. Better results have been obtained with behavioral interventions that include types of exposure (eg, systematic desensitization, paradoxical intent, satiation) and blocking of OCD symptoms (eg therapy with impulsive stimuli, thought arrest).
Studies examining variables related to maintenance of therapy and prognosis have revealed some specific applications for how to manage behavioral treatment for OCD. The best results to date have been produced by combining exposure and ceremonial prevention targeting both obsessions and compulsions. This conclusion is supported by multiple case studies and more than thirty group studies conducted over the past two decades on exposure and ritual prevention variables. The combined behavioral strategy produced positive results, consistent with improvement in OCD symptoms ranging from 65% to 85%.
Gains in OCD symptoms appear to generalize to uninterrupted OCD improvement in OCD symptoms. These significant improvements in both obsessions and compulsions have been achieved with relatively fewer treatment sessions ranging from 10 to 20 for 45-90 minutes over 4 to 12 weeks. Exposure for 45-90 minutes has been shown to be most beneficial in many studies. A gradual hierarchy of exposures severity can increase treatment participation and adherence, and incorporating imaginary exposure can significantly increase long-term benefits and prevent recurrence of symptoms. Clinical experience advocates the most strictly supervised ceremonial prevention management the patient can handle to achieve maximum benefit from treatment. Clinical experience also indicates that although efficacy has been demonstrated for many patients, they prefer therapist-controlled exposure and ritual avoidance to self-directed treatment.
Exposure and ceremonial prevention have been shown to be appropriate for adolescents as well as adults, and no specific approach is required for age, gender, marital status or educational level. No specific therapy appears to be necessary for depressed and anxious patients unless it is severe enough to warrant a concomitant diagnosis such as major depression or generalized anxiety disorder. OCD symptom characteristics (duration, severity, form) were generally not predictors of therapy outcomes, while some personal variables (low motivation, high reactivity, personality traits) were associated with poorer outcomes. Although there is limited information on family support, the above findings suggest that therapy progresses more satisfactorily when family members are plausibly tolerant of their distressed relatives. Although spousal support in therapy does not affect the outcome of therapy, it can be beneficial to give the therapist the power to have the patient follow procedures of exposure and ritual avoidance.
