546 Forum 2
Obsessive Thought Disorder
John C. Thomas, Ph.D.
I. Definition
A. Obsession recurrent, persistent, unwanted thoughts, impulses or images. They are experienced as senseless and inconsistent with personal self-image. Attempts to resist these thoughts cause marked distress and interfere with daily functioning.
B. Compulsion repetitive behaviors or mental acts that have the goal to prevent or reduce anxiety or distress rather than to provide gratification.
II. Content
A. Types of Obsessions
1. Fear of bodily contamination/disease
2. Sexual perversion
3. Fantasized violence toward a loved one
4. Religious blasphemy
B. Considerations
1. Usually do not discuss the thoughts with anyone due to shame.
2. Typically wait until it is too late to get treatment.
C. Identification (ask all clients)
1. “Are you bothered by thoughts that come into your mind that make you anxious?”
2. “Are there certain behaviors or rituals you do over and over again that may seem silly to you or others but make you feel better if you do them?”
III. Compulsions
A. Uncertainty, indecisiveness, and “what if” fears often lead to rituals to neutralize thoughts (compulsion). 80% of both obsessions and compulsions; only 20% have obsessions alone.
B. Types:
1. Washers
2. Checkers
3. Groomers
4. Pathological slowness (careful not to make a mistake)
5. Religious
IV. Prevalence
A. Old data was that it was uncommon (.5 to 2.5%)
B. New data: 2.5% of general population
C. No differences due to gender
D. Age late adolescence, early 20s. Usually affects males earlier.
E. High family incidence, about 25%
V. OC Personality Disorder
A. Obsessive Compulsive Personality Disorder (OCPD) is not characterized by obsessions and compulsions. People with OCPD tend to seek perfection, are preoccupied with details, and insist others do it their way. They tend to be workaholics, indecisive, overly scrupulous, black/white thinkers, lack generosity, hoarders, and lack expression.
B. Need at least 5 for the diagnosis
C. Only 10% of OCD have the OCPD.
VI. Etiology
A. Psychodynamic
1. Linked to punitive parents in late toilet training
2. People were in treatment for years with little improvement
3. Search for early trauma is ineffective in treating disorder
B. Learning use behavior treatment
C. Cognitive very effective
D. Organic/Neurologic
E. Serotonergic Serotonin regulates the disorder. Believed to be in the frontal lobe and basal ganglia.
VII. Christian Perspectives
A. Bible directs us to control our thoughts
1. Philippians 4:8
2. 2 Peter 3:1
3. Matthew 19:20–28
B. Does a chemical/genetic predisposition preclude biblical injunction to control thoughts?
1. A predisposition does not preclude responsibility, but should promote more empathy toward the person.
VIII. Treatment
A. Education
B. Liaison
1. Must form an alliance between person and their minister to bring moral interpretations into treatment because OCD client often has standards that exceed moral standards.
2. “Is it permitted in your religion to…?”
C. Medication (best treatment)
1. SSRIs
2. Need trials up to 12 weeks
3. About 60% have meaningful response to meds.
D. Behavioral Treatment
1. As effective as medication for compulsions, but not as good for obsessions.
2. Relaxation is not effective
3. Thought-Stopping (aversive-conditioning)
4. Thought Substitution non-repetitive prayers, memorization, positive thoughts, or imagery.
5. Get them focused outward (helping others)
E. The most effective treatment is a combination of behavioral therapy and medication.
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