The focus of the study is on the sub-optimal response to obsessive-compulsive disorder (OCD) among patients showing an obsession with fear and anxiety. People suffering from the disorder reflect certain characteristics. The characteristics include: fear of harming others; fear of contamination or dirt; fear of embarrassment; fear of committing a mistake; fear of harboring sinful thoughts; obsession with exactness; and excessive doubts or need for constant assurances.
Also, a number of several compulsions characterize the disorder. Such characteristics are reflected when patients shower or wash hands frequently. They also decline shaking hands. Often, they check such items as safes, locks or stoves. Sometimes, they collect or hoard valueless items.
Based on the literature review, OCD is a condition that has affected society for a long time. Several studies have shown the prevalence of the condition, as well as its negative effects. In addition to a diagnosis of the condition, screening statements are given to distinguish between the victims and healthy persons.
Key Questions Considered
- Does obsessive-compulsive disorder (OCD) pose a health concern?
- What is the incidence of the disorder?
- What are the probable approaches that can be used in controlling the disorder?
In the past, obsessive compulsive disorder was viewed as a rare concern/condition. Just like with any other anxiety disorder, it was commonly held that patients suffering from the ailment preferred to keep their problems private (Abramowitz, 2009). Many obsessions are based on irrationalities, an aspect that explains why sufferers are often frightened or embarrassed to reveal their tribulations (Beyette & Schwartz, 1997). In part, the embarrassment and other frustrations could explain why the disorder was given less attention. Thus, the magnitude as well as the incidence of the disorder remained unclear.
Victims of the disorder depict thoughts or conducts that are guided by either compulsions or obsessions (Beyette & Schwartz, 1997). The two aspects could be present separately or jointly. One factor that characterizes the disorder is that it can be found in different cultures, societies, occupations, and so on (Abramowitz, 2009). Before developing any intervention, it is commendable to note that compulsions or obsessions are part of people’s daily lives. This view is held in reference to the notion that each person has entertained fanciful or irrational ideas at least once in their lifetime. When a person is under a delusion, they are likely to engage in an unacceptable or irrational behavior. Whenever one is troubled by conscience bordering on guilt or perfectionism, it is very easy to presume that one is suffering from the disorder (Abramowitz, 2009). Thus, when developing interventions, it is desirable that a separation or a distinction should be drawn between temporary hysteria and long-term compulsions and obsessions.
Causes of OCD
In the past, obsessions were presumed to be caused by development-based factors (Baer, 2002). Due to the perception, the treatment approaches bordered on psychoanalytical theories (Baer, 2002). After some time, physicians began holding the view that OCD was attributable to some slight structural and chemical variations in the brain (Osborn, 1999). The variations do not directly lead to abnormalities. Instead, they offer a basis upon which OCD develops.
Apart from the structural and chemical deviations, genetics has been cited as a possible influential factor in the emergence of OCD (Osborn, 1999). Although there is no conclusive evidence to link the disorder to genetics, people with parents suffering from the illness stand a higher probability to fall victims to it. Another contributing factor is environmental. People who grow in disturbing environments are more likely to suffer from the disorder than those from a peaceful environment. Despite the number of factors associated with the problem, no single factor could be assumed to be a cause.
Review of Literature
The Epidemiological Catchment Area study (Karno et al., 1988) was the main epidemiological research that centered on investigating obsessive-compulsive disorder. The study was based on a representative sample collected nationally. The sample was also based on a reliable diagnostic criterion. According to the study, obsessive-compulsive disorder had become the fourth most occurring psychiatric disorder. By virtue of being among the most prevalent health problems, conducting further studies on the disease assumes an added dimension. Results based on a cross-national study (Weissman et al., 1994) which employed similar methods established that the prevalence of the condition did not vary considerably across different populations.
Another research by Nelson and Rice (1997) focusing on community studies indicated that regardless of the concerns on the validity of earlier studies in reference to diagnosing obsessive-compulsive disorder, it emerged that the condition was highly uncommon among adults, as confirmed by Bebbington (1998), and children (Zohar, 1999).
The ratio of men to women suffering from obsessive-compulsive disorder has also been the same. This is a contrast to other mood and anxiety disorders. In regard to the other conditions, it is often established that the prevalence is higher among females than males (Bebbington, 1998). The distribution of age among victims of obsessive-compulsive disorder revealed a bimodal distribution. For some patients, the condition started at puberty. In regard to juveniles, the condition was more prevalent among males, as established by Eichstedt and Arnold (2001).
There is a consistency between epistemological studies and clinical work which reflected that obsessive-compulsive disorder is associated with a high level of comorbidity (Hollander et al., 1997). The studies also proved that obsessive-compulsive disorder patients showed impulsive characteristics, such as increased suicide attempts and childhood conduct disorder (Hollander et al., 1997).
Even though cases of acute obsessive-compulsive disorder are well documented, the condition remains generally chronic (Skoog & Skoog, 1999). Another study has indicated that obsessive-compulsive disorder is related to direct and indirect consequences in terms of costs (Dupont et al., 1995). The state of affairs is further compounded by the problem of under-diagnosis, low recognition, as well as inappropriate treatment. Moreover, patients are unwilling or unable to seek help. As one study found, the lag period between the onset of the condition and the making of a correct diagnosis was 17 years (Hollander et al., 1997).
A large number of patients often hide their symptoms (Newth & Rachman, 2001). Concealing any symptoms is highly detrimental to society, since the extension of treatment is curtailed. This underscores the value of sensitizing people on the condition and asking care providers to screen their patients on a routine basis. The guiding tools should be used. Such tools include measurement scales or obsession and compulsion questions.
In assessing obsessive-compulsive disorder, there should be a concerted focus on the psychiatric history, as well as an examination. The critical aspects would be centered on tracing the symptoms, in addition to allowing a differential diagnosis, to identify the condition. Obtaining a general medical history of the patients in question could also be critical in coming up with appropriate procedures to help the victims.
Treatment of the Condition
Questionnaires are helpful in discerning the disorder. Such questionnaires as the Yale-Brown Obsessive Compulsive Scale (YBOCS) are useful in diagnosing OCD, as well as in tracking any progress attributable to the treatment (Colas, 1998).
The Cognitive behavioral therapy (CBT) has been found to be effective when dealing with disorders of this nature (Colas, 1998). Under the therapy, a patient is exposed to a situation which triggers obsessive thoughts. From such exposure, the patient will be able to gradually learn how to put up with anxiety by resisting the temptation to behave compulsively. Combining the CBT and the medications mentioned above would be more helpful than adopting any given approach separately.
Psychotherapy is also helpful in providing effective approaches to reducing stress and anxiety. In addition, the approaches are instrumental in the pursuit of inner peace, as they allow for the resolution of inner conflicts.
It is critical to note that OCD is a chronic illness that has long-term effects (Colas, 1998). The severe symptoms are often followed by instances of improvement. In practice, however, patients suffering from the disorder do not experience a totally symptom-free spell. Nevertheless, it is notable that patients report improvements upon receiving treatment.
OCD is associated with long-term complications that emerge out of compulsions and obsessions (Wilson & Veale, 2005). By way of illustration, washing hands repeatedly is likely to lead to skin breakdown. Nevertheless, it should be understood that the disorder does not lead or progress to another disease. It is advisable to seek help from health care providers whenever the symptoms associated with the disorder appear to disrupt daily lives or social relationships of the victims. Regarding prevention, it should be understood that no possible solution exists, although taking the highlighted interventions presents an avenue to redress the problem.
Cognitive behavioral therapy (CBT) has been shown to be the most effective type of psychotherapy for this disorder (Wilson & Veale, 2005). The patient is exposed many times to a situation that triggers obsessive thoughts and learns gradually to tolerate the anxiety and resist the urge to perform the compulsion. Medication and CBT together are considered to be better than either treatment separately at reducing symptoms.
OCD is treatable using medications and/or therapy (Wilson & Veale, 2005). Selective Serotonin Reuptake Inhibitor is a common antidepressant used in suppressing the illness. In given instances, Selective Serotonin Reuptake Inhibitor is combined with clomipramine. The drugs include:
- Citalopram (Celexa)
- Fluvoxamine (Luvox)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
In the event that Selective Serotonin Reuptake Inhibitor does not work, a physician would consider prescribing an older antidepressant known as tricyclic (Wilson & Veale, 2005). Although the older drug is more effective, it is less preferable due to its negative side effects. The effects include:
- Difficulties in starting urination
- Decline in blood pressure whenever emerging from a sitting position
- Dry mouth
Traditionally, psychodynamic and psychoanalytic psychotherapy was the primary psychological approach that was used in resolving the disorder. While it is suggested that the approach helps in reducing the problem, the extent to which patients adjust their obsession and compulsive behaviors remains unclear. The psychoanalytic and psychotherapy approaches entail engaging patients with the aim of resolving conflicts that emerge from sub-consciousness or unconsciousness on the part of the patients.
Group therapy is also a psychotherapy approach that entails a therapist’s working with a number of people concurrently (Yalom & Lesczc, 2005). The therapy approach is available across locations such as hospitals, private therapeutic practices, community centers, and mental health clinics. Sometimes, the therapy is used alone, although, in most instances, it is integrated into comprehensive treatment regimes that include medication and individual therapy.
Group therapy is based on a number of principles. Irvin D. Yalom has outlined the major principles of the approach. The first principle centers on instilling hope into a group. Groups undergoing the treatment have patients at different stages of the treatment plan. Thus, relatively new members need to see the progress that is being registered. The second principle is based on universality. Under this principle, it is observed that being one among many people helps victims to comprehend that the issues they are facing are not isolated or unique to one individual. The third principle rests on imparting information. As members of a group, patients are accorded an opportunity to share their experiences among themselves. This aspect helps patients along their recovery path(Yalom & Lesczc, 2005).
The fourth element is altruism(McDermut et al., 2002). In reference to this element, group members (OCD victims) are encouraged to share both strengths and weaknesses. Such sharing is significant as it helps members in the pursuit of a common goal. The final principle is based on existential factors. Under the principle, when working within a group, support and guidance are obtainable. In the process, group therapy assists victims in exercising responsibility by understanding that they are primarily in charge of their own lives. This translates into taking caution while acting and making choices.
The work of group therapy is based on the number of people taking part. Groups generally have seven to twelve people. However, a group may have three or fifteen individuals. The groups may meet once or twice every week. During group sessions, the members are given opportunities to share their experiences. The nature of sessions depends on the goals that the group seeks to achieve, as well as the preferred style of the psychologist in charge. Group therapy has been found to be effective in some situations and ineffective in others (Yalom & Lesczc, 2005).
The best reason why group therapy is preferred is because it allows people to learn from the success of others. Group members who successfully cope with their problems could serve as role models to new entrants. This holds true, since seeing that somebody goes through the therapy sessions successfully is critical as it persuades other patients of the usefulness of participating in such endeavors.
The group therapy approach is also cost-effective(Kanas, 2005). This is because a therapist is able to focus on more than one case at a time. In a group session, several patients are dealt with at the same time. The patients contribute to the costs of the fees charged. Hence, the approach is cost-effective. It is also suggestive that group therapy offers a safe haven to patients. This is because the setting of group therapy allows patients to behave in a usual way, since the members have no fears. Thus, they do not reserve certain behaviors.
Group therapy allows a therapist to understand differences in responses of patients. It, thus, enables a therapist to see how a person handles social situations. Using such information, a therapist is able to select the best alternative to employ in order to solve the patients’ issues.
The Behavioral Therapy
The behavioral therapy is another psychological treatment framework. The therapy applies to the treatment of such issues as phobias, depression or undesirable attributes. There are several alternatives from which to choose. The alternatives include intense discussion sessions that seek to establish the root cause of an issue before devising an appropriate strategy to counter the concern. Another option entails finding a practical approach to the issues. The behavioral therapy is more appropriate for those people who seek practical solutions than those intending to establish root causes of problems.
The behavioral therapy is based on the notion that behavior is learned. Thus, if a person has developed destructive behavior, a way to undo the learned behavior should be sought. As an illustration, if a person responds to a problem by drinking, the best approach would entail replacing drinking with a stress-combating activity. The activities might be exercising or meditating.
The behavioral school proposes two important processes that assist in comprehending how people learn due to environmental aspects. The two processes are operant and classical conditioning. In operant conditioning, learning is based on the outcomes of behavior, while in classical conditioning, learning is due to association (Baum, 2005).
The behavioral perspective remains ingrained in the field of scientific methodology. This view rests on the idea that in understanding behavior, the school heavily relies on using the method of observation (Baum, 2005). As such, objectivity prevails. Also, it is worth noting that the behavioral school does not support the notion that individuals have a free will. Instead, the environment affects behavior. Behavior, thus, follows the stimulus-response stream.
Cognitive psychology is based on the idea that when one wants to understand human behavior, then figuring out the processes that take place in the minds of people is desirable (Gazzaniga, 2010). As such, students of psychology examine cognitive processes or mental acts, which determine knowledge acquisition. The cognitive approach is associated with mental functions that include attention, perception, and memory. In its simplest form, the cognitive school looks at human behavior as being similar to that of computers. The similarity is based on processing of information. For instance, human brains process and store information just the same way computers do. This establishment has prompted psychologists to claim that human brains encode, store, and retrieve information. As such, the cognitive approach is largely a scientific perspective that includes lab experiments in studying human behavior.
Cognitive therapy is a type of psychotherapy that was introduced by Aaron T. Beck. This therapy is among therapeutic approaches within cognitive behavioral therapies. The therapy endeavors to assist patients in overcoming hardships using identification (Hofmann, 2011). Therapists identify and change the dysfunctional thinking, behavior, as well as emotional responses reflected by people. Therapists focus on helping victims to alter their beliefs, develop skills, and identify warped thinking in regard to others in various ways. Thus, the therapy approach is geared towards behavior change (Gerstein et al., 2013).
For the cognitive therapy to work effectively, cooperation between the therapist and the patient is critical (Robertson, 2010). The patient is largely required to alter their views on testing. This is because the cognitive therapy may entail testing the assumptions that victims make in order to establish the levels of distortion that they hold. In most cases, distorted views are unrealistic and remain unhelpful. It is only after questioning the distorted views that the reversal process begins. As cognitive therapists hold, a list of errors is likely to lead to depression. Such lists are based on arbitrary inferences, over-generalization, magnification of negatives, minimization of positives, and selective abstraction (Beck, 2008).
After identifying the characteristics and available treatment options, the therapeutic approach based on some of the characteristics is proposed. The approach involves characteristics, interventions, and expected outcomes.
General Handling of the Concerns
The identified characteristics among the patients must be handled. A primary characteristic is that they fear harming others. Although harming other people is indefensible, unfounded fears are unwelcome. Hence, restoring the normal reasoning of the patient could prove helpful.
Also, it has become apparent that the patients harbor fears of contamination or dirt. This aspect must be dealt with decisively. Contamination poses health risks. However, fearing it does not solve any problem. An approach to dissuade a patient from holding fears is necessary. The patient needs to be informed on how to handle such situations.
The third characteristic that must be handled is based on the realization that the patients fear embarrassing situations or committing a mistake. In conducting any affair, the chances of being embarrassed remain real. However, just as mentioned above, fear is destructive as it does not help patients. Instead, fear contributes to the deterioration of people’s health. Thus, the only empowerment is to encourage the patients to be positive about whatever they are doing. In case of a failure, the patient should be assured that there is always a second chance to excel or to improve.
Some other characteristics include:
The patient fears harboring sinful thoughts.
The patient has excessive doubts.
The patient needs constant assurances.
The patient showers or washes hands frequently.
The patient refuses to shake hands.
The patient checks such items as safes, locks or stoves.
The patient collects or hoards valueless items.
Although these characteristics are closely associated, dealing with patients that have them requires a similar approach as outlined above. The main idea lies in empowering the patients to be able to face life more boldly than they could at the moment. Those who hold fears based on their economic status need to be taught entrepreneurial skills or be accorded opportunities to earn a living or deal with emerging issues.
The diagnostic approach to understanding OCD is to assess the patient’s symptoms. Specifically, the time taken by the patient to perform routine tasks is an indicative diagnosis of the disorder. Thus, a nurse examining the patient would have to consider the following statements.
Therapeutic Nursing Approach to the Obsessive-Compulsive Neurosis; OCD
Desired Outcome: After the nursing intervention, patients are expected to show low levels of anxiety or compulsion. They should be at ease or relaxed.
Stressor Identified: The patients give responses that are uncommon among healthy people (Wilson & Veale, 2005). In most instances, they demonstrate high levels of obsession and fear. The victims seem uncertain about the future and tend to show less optimism about life in general.
The Interventions: The nurses will consider exclusive time with the affected patients. The critical factor is to offer emotional support to the patients. Exploring the patients’ feelings is necessary in reference to diagnostic examinations. The diagnostic approach to understanding OCD is to assess the patient’s symptoms. Specifically, the time taken by a patient to perform routine tasks is an indicative diagnosis of the disorder.
Also, such patients could be facing insecurity at their job stations. Hence, addressing the concern could entail teaching the patients entrepreneurial skills. Encouraging the patients to look for different opportunities would also constitute another approach to redressing the situation.
Another option could entail discussing with the patient the manner in which some past situations were dealt with. This approach is crucial in the pursuit of answers to underlying problems or aspects which were unaddressed in the previous occasions. Through the identification of the factors, appropriate mechanisms are developed.
Treating the whole person would be crucial in helping the patients to overcome any form of resistance. In executing this, employing a holistic approach that incorporates the spirit, body, and mind is advocated. Using such an approach is significant as it enhances the manner in which a patient handles problems that arise out of the diagnosis.
Desired Outcome: The patients are expected to understand the treatments that are availed in controlling the health problem.
Stressor Identified: A patient encounters problems in order to understand the diagnostic measures taken. This is necessary for a successful intervention, since a patient who does not understand the diagnostic approach may refuse to cooperate.
The Intervention: In such a development, the nurse should consider providing truthful as well as accurate information in reference to the problem facing the patient. The nurse must also inform the patient regarding the prevention or treatment measures that are being undertaken in order to solve the problem. As Wilson & Veale (2005) observed, informing patients about their problems empowers them in a manner that enhances their chances of recovery.
Desired Outcome: In regard to the above intervention, the expectation is that the patient prepares for unanticipated changes that would appear as a result of the diagnosis.
Stressor Identified: Generally, some physiological aspects are likely to change. The changes are related to the diagnosis which involves a decline in the abilities of the affected patients. Specifically, the changes include forced lifestyle, body image, and physical abilities.
The Intervention: The nurse is expected to help the patient to build their self-belief in regard to overcoming resistance. The best approach would be to teach the patient how to access resources through carrying out some tasks which facilitate earning income. This approach would allow patients to overcome the feeling of hopelessness. Similarly, it is advisable to ask the patients to get involved in therapeutic practices or activities. As Davis (2008) indicated, the extension of empowerment is critical to helping families to overcome any concerns.