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    Nancy’s paranoid morning routine

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    It was 9:30 a. m. , and Nancy, a 36-year-old attorney, had arrived late for workagain. Nancy knew she needed to catch up on her legal assignments, but afamiliar worry nagged at her. No matter how hard she tried, Nancy could notdislodge the thought that she had left a pot burning on the stove. The image ofher home engulfed in flames was so vivid she could almost smell the smoke.

    Nancytried to shut the thought out of her mind, reassuring herself that she hadturned the gas jet off. But even remembering her hand touching the cool stoveburner-a precaution she took whenever she left the house-still left herwondering whether she had checked carefully enough. The pot and stove were notall that had been on Nancy’s mind that morning. For Nancy, leaving the houseentailed a time-consuming routine designed to ensure that no major or minordisaster-such as a fire, burglary, or household flood-would strike while she wasaway. Like a pilot preparing for take-off, she would spend more than an hourchecking and rechecking that all appliances were turned off, all water faucetsshut, all windows closed, and the doors to the house securely locked. Except fornecessities such as work, Nancy avoided going out because it meant performingthis arduous routine.

    But even these measures were not enough to keep her fromworrying. A few weeks earlier, Nancy had hit on the idea of documenting thateverything was safe before she left home. Now, sitting at her desk, she pulled acompleted checklist from her purse and reviewed it to see if the “stove andoven” item and been marked off. At first, she felt relieved to see that itwas. But then a new thought struck: What if this wasn’t today’s checklist?Panic overtook reason. Nancy dialed the local fire department and asked thattruck be sent to investigate a fire at her house.

    (Goodman, 1994, pp 103, 104)The first modern description of OCD was provided in 1838 by Jean-EtienneDominique Esquirol, a French psychiatrist. Esquirol called the disorder thefolie de doute, or doubting madness, and suspected it was rooted in a physicalproblem in the brain. During much of the 1900’s, psychoanalytic theoriesdominated the study of OCD. Many psychoanalytic theorists believed OCDoriginated from conflicts early in a child’s development over such issues astoilet training.

    (Goldman, 1994, p. 104) Researchers theorize that an antibodymay actually cause OCD. The antibody called D8/17, is produced to fightstreptococcus bacterium that causes rheumatic fever. However D8/17 may attackhealthy cells in the brain’s basal ganglia region, which helps control basicmovement sequences, such as walking or eating. (Klobuchar, 1998, p. 266) Theobsessions or compulsions must cause marked distress, be time consuming (takemore than 1 hour per day), or significantly interfere with the individual’snormal routine, occupational functioning, or usual social activities orrelationships with others.

    Obsessions or compulsions can displace useful andsatisfying behavior and can be highly disruptive to overall functioning. Becauseobsessive intrusions can be distracting, they frequently result in inefficientperformance of cognitive tasks that require concentration, such as reading orcomputation. In addition, many individuals avoid objects or situations thatprovoke obsessions or compulsions. Such avoidance can become extensive and canseverely restrict general functioning. (Diagnostic and Statistical Manual ofMental Disorders, 1994). Symptoms of OCD include repetitive, ritualizedbehavior, such as counting, hoarding objects, or handwashing; obsessive fear ofthreats, such as germs; or a fear of committing violent acts.

    (Klobuchar 266)The American Psychiatric Association classifies OCD as an anxiety disorder. People with OCD suffer from persistent and disturbing thoughts, images, orimpulses, called obsessions. They relieve the anxiety caused by their obsessionsthrough compulsions-repeated behaviors that they feel driven to perform. (Goodman, 1994, p.

    104) The DSM-IV defines obsessions as recurrent thoughts,images, or impulses that are anxiety-provoking and are perceived as intrusive orsenseless. (Gragg ; Francis, 1996, p. 1) The intrusive and inappropriatequality of the obsessions has been referred to as “ego-dystonic. ” Thisrefers to the individual’s sense that the content of the obsession is alien, notwithin his or her own control, and not the kind of thought that he or she wouldexpect to have. However, the individual is able to recognize that the obsessionsare the product of his or her own mind and are not imposed form without (as inthought insertion). (Diagnostic and Statistical Manual of Mental Disorders,1994).

    Obsessions typically fall within seven major categories. i. e. Contamination obsessions, which typically involve excessive concerns aboutgerms, disease, and cleanliness.

    Somatic obsessions, which are persistent,repetitive thoughts about physical concerns. Children may experience intrusivethoughts that they have a tumor or that they are developing sensory impairments. Sexual/Aggressive obsessions typically involve recurrent thoughts or images thatone has committed an unacceptable sexual or aggressive thought or act in thepast or is likely to do so in the future. Hoarding obsessions are worries thatthings should not be thrown away just in case they might be needed later. Doubting obsessions are incessant worrying that one will be responsible for aterrible consequence resulting from one’s failure to fulfill an obligation orcomplete a task correctly. Religious obsessions typically involve thoughts aboutcommitting or having committed an immoral act or sin.

    And lastly, a need forsymmetry and exactness. These obsessions are characterized by excessive concernabout putting objects in a specific position, scheduling events in a certainorder, doing and undoing motor acts in an exact fashion, or making sure thatthings are precisely symmetrical. (Gragg ; Francis, 1996, pp. 2,3) Theindividual with obsessions usually attempts to ignore or suppress such thoughtsor impulses or to neutralize them with some other thought or action (i.

    e. , acompulsion). For example, an individual plagued by doubts about having turnedoff the stove attempts to neutralize them by repeatedly checking to ensure thatit is off. (Diagnostic and Statistical Manual of Mental Disorders, 1994).

    TheDSM-IV defines compulsions as repeated behaviors or mental acts that a personfeels compelled or driven to perform, either in response to an obsessions oraccording to a self-imposed, rigidly applied rule. (Gragg ; Francis, 1996,p. 4) There are six major types of compulsions. The most common compulsion iswashing, bathing, or cleaning to relieve an obsessive fear of contamination fromgerms, dirt, or some imagined source. Washers may scrub their homes or batheuntil their skin is raw before they feel safe from the imagined danger. Checkersmay find themselves repeatedly driving back over a stretch of road to confirmthat they haven’t accidentally hit a pedestrian.

    (Goodman, 1994, p. 107)Washing and cleaning compulsions typically involves excessive washing andcleaning of oneself and one’s surroundings, as well as active avoidance ofobjects, places, or persons considered to be unclean. Checking compulsionstypically consists of an overwhelming urge to check and recheck objects and/oractions. Repeating compulsions involve redoing physical or mental acts a certainnumber of times or until it feels just right.

    Counting compulsions includerituals that include having special or lucky numbers that dictate the number oftimes they must do, say, or think things. Ordering compulsions are typicallyassociated with the obsessions involving the need for symmetry and exactness. Hoarding compulsions are rituals that often occur in response to hoardingobsessions, that involve the inability to throw things away or the need tocollect useless objects. (Gragg ; Francis, 1996, pp. 4-6) OCD was oncethought to be rare. It is now estimated that up to 3 percent of the U.

    S. population may suffer from OCD at some point in their lives (about 5 millionpeople). The disorder usually begins in adolescence or early adulthood, but itmay also occur in childhood. (AMI/FAMI). By definition, adults withObsessive-Compulsive Disorder have at some point recognized that the obsessionsor compulsions are excessive or unreasonable. This requirement does not apply tochildren because they may lack sufficient cognitive awareness to make thisjudgment.

    (Diagnostic and Statistical Manual of Mental Disorders, 1994) Theexact causes of OCD are still unknown. However, researchers strongly suspectthat a biochemical imbalance is involved. Alterations in one or more brainchemical systems that regulate repetitive behaviors may be related to the causeof OCD. These imbalances may be inherited. Psychological factors and stress mayheighten symptoms. (AMI/FAMI).

    We do not know why OCD bothers each person in adifferent way. It does seem that it is almost as if OCD ‘knows’ what wouldbother you the most and hones in on that. For example, if you are a particularlyreligious person you might be plagued by repugnant religious OCD thoughts thatare a lot more upsetting to you than they would be to a person with belowaverage concern about religion. (National Anxiety Association).

    It has beenhypothesized that there is a relationship between OCD and the neurotransmitterserotonin. Support for this theory is based primarily on evidence that OCDsymptoms decrease in response to treatment with medications that affectserotonin levels. (Gragg ; Francis, 1996, p. 8) In the 1960’s and 1970’s,psychiatrist announced that a drug called clomipramine (trade name Anafranil)was effective in treating OCD.

    After a nerve cells releases serotonin, itreabsorbs any serotonin not captured by an adjoining nerve cell. This process,known as serotonin reuptake, acts to recycle serotonin, making it available forlater use. Clomipramine and related drugs block the reuptake of serotonin,preventing its return to its home nerve cell. (Goodman, 1994, p. 112) In March1997, the FDA approved the use of the drug fluvoxamine maleate, or Luvox,previously approved to treat adults, prevents the neurotransmitter serotoninfrom being reabsorbed into neurons. An inadequate level of serotonin in thesynapses between neurons has been linked to several mental illnesses includingOCD.

    (Klobuchar, 1998, p. 266) Overall, my personal experience with OCD in myfamily has really opened my eyes to many issues. Although many people laughabout it, and consider OCD sufferers “crazy,” it is a very serious andailing disease. It has the potential to ruin a marriage or a family if nottreated accurately and quickly. I think that it would be an incredibly benefitfor people to take interest in this disease and other related disease, to betteraware themselves of worldly issues, that may, at one time or another, havepotential to affect their life. BibliographyDiagnostic and Statistical Manual of Mental Disorders.

    (4th ed. ). (1994). American Psychiatric Association. Francis, G.

    , ; Gragg, R. A. (1996). Childhood obsessive compulsive disorder. London: Sage Publications.

    1-6, 8Goodman, W. K. (1994). The World book health and medical annual 1994.

    Chicago:World Book. 103-104, 107 Jaffe, D. J. (1998).

    All about obsessive disorders (OCD)and mental illness. New York: AMI/FAMI Klobuchar, L. (1998). The World bookhealth and medical annual 1998. Chicago: World Book. 266 National AnxietyAssociation.

    (1992-1999). Obsessive-Compulsive Disorder. Kentucky: NationalAnxiety Association.

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