Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD)

 Definitions & clinical picture:

The characteristic features of obsessive compulsive disorder (OCD) are the presence of obsessions and compulsions which interfere with the patient’s ability to cope with their daily life.

Obsessions: are unpleasant or distressing thoughts, images or impulses that come to mind over and over again despite conscious efforts to stop them. We all become preoccupied by particular thoughts at times, or have the experience of an irritating tune running again and again through the mind. These normal thought processes are distinguished from obsessional thoughts because it is possible to distract oneself by thinking or doing something else, and because the thoughts do not interfere with normal functioning. In OCD obsessional thoughts are rarely this innocuous. Common themes for the thoughts include violence, sex, contamination and blasphemy. Obsessional images may be of violent or gory scenes that come vividly to mind again and again, and cannot be ignored or suppresses. An obsessional impulse might be a recurrent impulse to hurt someone, usually someone the sufferer would not consciously wish to hurt. For example, a man might have the obsessional impulse to stab his wife, despite having no wish to harm her and finding the impulse distressing. It is uncommon for people to act on obsessional impulses. It is important to distinguish obsessional thoughts from thought insertion, a first rank symptoms of schizophrenis, in which the patient believes they are experiencing thoughts that are not their own. In contrast, obsessional thoughts are always recognized as arising from the patient’s own mind (ego-syntonic vs. ego-dystonic).

Compulsions: are the behavioural counterparts of obsessions, with a strong urge to perform an action or complex serious of actions (overt or covert) repeatedly, even though they are recognized as unnecessary. Compulsions can often be resisted for a short periods, but that can only be relieved by performing the compulsive act. Compulsions can take very many forms, but the commonest are:

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