OCD (Obsessive-compusive Disorder) is a mental disorder that is characterized with certain repetitive routines, also referred to as “rituals” as well as repetitive thoughts. However, this condition should not to be confused with OCPD (Obsessive-compulsive Personality Disorder) since OCD is a disorder that is not compatible with the client’s concept to onseself and is ego-dystionic while OCPD is ego-syntonic.
Ego-dystonic and ego-syntonic are psychoanalysis terms that are exactly opposites. The former is attributed to impulses and behaviors that are normally not the character or personality of a person while the latter refers to ideas and instincts that are compatible with a person’s self-image. Having said this, ego-dystonic actions and thoughts result to a person feeling upset and can be distressing since it can affect the normal life of a person in a negative way.
What Causes Ego-Dystonic OCD?
Although the cause of ego-dystonic OCD is unknown, its signs and symptoms are both covert and overt. However, studies have shown that when it comes to affecting twins, cases are more evident with maternal twins as opposed to paternal twins. As for risk factors, cases have been diagnosed to stem from traumatic or stressful events in life and abuse in childhood. Moreover, infection is also considered to be a risk factor of this disorder.
- These are some of the manifestations of suffering from Ego-dystonic OCD:
- Repetitive hand-washing
- Repeatedly checking if all the doors are lock
- Cursing and using blasphemous words
- Hoarding and refusal to throw away things
- Anti-religious thoughts
- Thoughts about self-harm
- Doubts about one’s romantic partner
- Doubts about one’s sexual orientation
These are intrusive thoughts or thoughts that keep on haunting the person with the disorder in spite of the attempts to confront or avoid them. Result can be anxiety on the part of the person and so as to manage this uncomfortable feeling and reduce it, the person will turn to doing repetitive actions or what are also referred to as compulsions. Also, there are other intrusive thoughts that are not only recurring and pertaining to a person’s self-image. There are also obsessions other than oneself, such as, the Devil, God and sickness going to harm the people they love.
Other OCD sufferers experience sensations like objects growing outside their bodies or have a feeling that an inanimate object has a soul or life. Sexual obsessions can also be experienced by some clients with intrusive thoughts of sexual acts like kissing, touching, incest and kissing with parents, children, acquaintances, strangers and even animals. Although these intrusive thoughts can also be experienced by people without OCD, those who have this mental disorder treat these thoughts with extreme significance that it can be considered by the people in their circle as sexual identity crisis. And while the person with ego-dystonic OCD has to perform tasks to reduce anxiety, he or she knows that these things are irrational. OCD also accompanies doubt on the part of the person, like feelings of guilt that can end to a person criticizing oneself and self-loathing.
There are ego-dystonic OCD patients who perform rituals or compulsions because they have the feeling of obligation to do so. They also need to carry out these distorted thoughts to reduce anxiety. Some patients feel that doing all these actions will keep them or the people they love from being harmed. Moreover, no matter if the actions they do or their behaviors are not seen as conventional by others, OCDs will always rationalize their actions. An example can be a person who keeps on checking if the doors are locked on end will say that the time and effort he or she spends in doing so is less than the time and effort that will be lost if intruders will rob their house. Some of the actions that manifest compulsions are the following:
Nail biting, hair pulling, organizing things in the same way, like all the canned goods in the pantry arranged with all the labels outward and spacing the same, turning the switch on and off and repetitive hand washing to reduce the feeling that their hands are dirty.
Treatment of Ego-dystonic OCD
There are several techniques to manage this disorder with CBT or Cognitive Behavioral Therapy being the most effective and useful treatment.
Cognitive Behavioral Therapy
There are three techniques comprising CBT. These are mindfulness, cognitive reconstructing and ERP or Exposure and Response Prevention. Mindfulness-based CBT refers to making the person aware of the intrusive thoughts and avoidant behaviors he or she has but without doing anything to undoing these actions. What is important here is for the patient to acknowledge and accept these behaviors and thoughts. Cognitive reconstructing, on the other hand, refers to teaching the client skills to challenge these thoughts and avoidant actions while ERP works by exposing the client to what causes his or her anxiety with the aim to increase the level of anxiety due to exposure and overtime, anxiety will be reduced due to habituation.
For adult OCD, SSRIs or Selective Serotonin Reuptake Inhibitors are used as the second line of treatment. These are olanzapine, resperidone, clomipramine and quetiapine, among others.
In some cases, a procedure called electroconvulsive therapy (ECT) can be used if the condition is severe. Surgery is also the treatment of choice if all other treatments fail or are not effective. In the U.S. psychosurgery is not performed on an OCD client unless all treatments have failed after several attempts and medications have been given at full dosage. When it comes to CBT, this treatment should have been undergone by the client for several months already.
This is also helpful in most cases of OCD such as the sub-type Scrupulosity OCD in which it is manifested by repetitive thoughts about moral or religious beliefs. If a religious leader is aware of the OCD and have knowledge about it, he or she can counsel the client about separating his or her religious beliefs from his unwanted thoughts and behavior.