OCD: Obsessive-Compulsive Disorder

[Juan and Yenan]

OCD: Obsessive-Compulsive Disorder
By Apostle Dr. Yenan Y. Perez

Obsessive-Compulsive Disorder is an Axis I Disorder of the section of Anxiety Disorders in the DSM-IV, which is characterize by obsession (which cause marked anxiety and distress) and/or by compulsions (which serve to neutralize anxiety) (DSM-IV 429).

The essential features of Obsessive-Compulsive Disorder are recurrent obsessions or compulsions that are severe enough to be time consuming or cause marked distress or significant impairment. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. The disturbance is not due to the direct physiological effects of a substance (ibid 456-7).

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) defines obsessions as “persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. The intrusive and inappropriate quality of the obsession has been referred to as ‘ego-dystonic.’ This refers to the individual’s sense that the content of the obsession is alien, not within his or her own control, and not the kind of thought that he or she would expect to have. However, the individual is able to recognize that the obsession is the product of his or her own mind and are not imposed from without” (ibid 457). Whereas, compulsion is defined as “repetitive behaviors or mental acts, the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification in most cases, the person feels driven to perform the compulsion to reduce the distress that accompanies an obsession or to prevent some dreaded event or situation” (ibid 457).

The Diagnostic Criteria of OCD are:
Numeration is 300.3 Obsessive-Compulsive Disorder can be specified with poor insight (Diagnostic Criteria, 217-18).
 Either obsession or compulsion
 At some point during the course of the disorder, the person has recognized that the obsession or compulsions are excessive or unreasonable.
 The obsession or compulsion cause marked distress, are time consuming, or significantly interfere with the person’s normal routine, occupational functioning, or social activities or relationships.
 If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it.
 The disturbance is not due to the direct physiological effects of a substance or a general medical condition.


What causes Obsessive-Compulsive Disorder?

Research suggests that OCD involves problems in communication between the frontal part of the brain (the orbital cortex) and deeper structures (the basal ganglia).
-Orbital cortex: is related to cognition and memory, in the prefrontal area the ability to concentrate and attend elaboration of thought. Is the “gatekeeper”; judgment inhibition, and is related to personality and emotional traits (Brain Function).
-Basal ganglia: is a collection of nervous tissue under the cerebral cortex on each side of the brain. Is responsible for maintenance of proper muscle tone (Basic Physiology, 7).

These brain structures use the chemical messenger serotonin. It is believe that insufficient levels of serotonin are prominently involved in OCD.
-“Serotonin fibers arise from the raphe nuclei in the brainstem (nerve pathway of cerebral hemispheres) and project throughout the brain and spinal cord. It appears that these pathway effect food intakes, regulation of body weight, reduce aggression and impulsivity, decrease depression, and effect sexual arousal and sleep” (Basic Physiology, 9).

-Drugs that increase the brain concentration of serotonin often help improve OCD symptoms.

Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in those who improve after taking a serotonin medication or receiving cognitive-behavioral psychotherapy (OCD foundation).

According to Freud, in his theory of development, psychic structures known as the id, the ego, and the superego evolve as part of an effort to control the instincts of pleasure. The id pushes the person to gratify sexual and aggressive needs; it obeys the “pleasure principle.” The impulse of the id is usually unconscious, but when this impulse appears in the consciousness, it becomes part of a “primary process thought,” a primitive way of thinking that consists of fantasies, images of immediate gratification, dreams and others creative products. As a child develops, id impulses pass through five stages of psychosexual development (Hogan & Smither 52-53).

The ego is that part of the psyche responsible for self-preservation and for dealing with the demands of reality whose primary job, according to Freud, is to satisfy the id in an efficient and dependable manner. The ego controls the id primarily through repression and anxiety. In circumstances involving repression, the ego simply drives id impulses out of awareness and then concentrates on thoughts that are incompatible with the repressed impulse. Although repression is closely related to anxiety, it is the second that prompts the ego to control the id (ibid 55-57).

Repression and anxiety are the defense mechanisms causing obsession and compulsion symptoms.
The superego is the voice of conscience, and it encompasses the rules, values, and demands of a child’s parents. Superego development begins with the process of identification. According to Freud, once the superego develops, it prevents us from directly recognizing or expressing sexual and aggressive desires. The superego controls these impulses by pushing the ego with guilt.

According to Freud, the primary means by which we conceal our intentions from ourselves is through defense mechanisms. Freud considered two defense mechanisms particularly important (Ibid).
1. Projection, which involves blaming others for one’s own sexual and aggressive desires.
2. Reaction formation, that turns id impulses into their opposite.

Christian Psychology
From a Christian Psychological perspective, people who suffer from OCD have problems in their temperament inclusion and/or cognitive area. Their obsession is a defense mechanism to repress emotions, urges, and desires that are condemned, from the conscious level of the mind. The obsessive thought are created to combat the anxiety that create repressed feeling and emotions that are trying to come to awareness. The ego through obsessive thoughts avoids the self effort of trying to bring into awareness feelings and emotions long repressed.

The ego feels threaten every time these feelings and emotions, urges and desires try to press to surface. The ego experience anxiety and/or destructive guilt, thus, combat the anxiety with obsessive thoughts. These thoughts create more anxiety, and destructive guilt, as a result, compulsion as a way of releasing anxiety and/or guilt. The compulsive acts relieve momentarily, but do not end the problem. The expectations are distorted, thus, reality feels frustrated, and more guilt is manifest, consequently false repentance as a way of avoiding responsibility. The obsessive thinking pattern begins again, keeping the individual trap in a cycle where the ego is in charge and lead by the father of the lies.


Traditional Treatment
The traditional treatment for OCD is educating the patient and family about OCD as a medical illness. During the last 20 years, two treatments for OCD have been developed: cognitive-behavioral psychotherapy (CBT) and medication with a serotonin reuptake inhibitor (SRI). Treatment is developed in different stages (OCD Foundation):
 “Acute treatment phase: Treatment is aimed at ending the current episode of OCD.”
 “Maintenance treatment: Treatment is aimed at preventing future episodes of OCD.”
 Education: helping patients and families learn how best to manage OCD and prevent its complications (Ibid).
 Psychotherapy: Cognitive-Behavioral psychotherapy (CBT) is the psychotherapeutic treatment of choice for children, adolescents, and adults with OCD. In CBT, there is a logically consistent and compelling relationship between the disorder, the treatment, and the desired outcome. CBT helps the patient internalize a strategy for resisting OCD that will be of lifelong benefit. The BT in CBT stands for behavior therapy. Behavior therapy helps people learn to change their thoughts and feelings by first changing their behavior. Behavior therapy for OCD involves exposure and response prevention (E/RP) (OCD Foundation).
 Medication: Medication with a serotonin reuptake inhibitor is helpful for many patients. Generally, it appears that for most people high dosages of drugs are required to obtain anti-obsessional effects. The studies done to date suggest that the following dosages may be necessary: Luvox (up to 300 mg/day), Prozac (40-80 mg/day), Zoloft (up to 200 mg/day), Paxil (40-60 mg/day), Celexa (up to 60 mg/day), and Anafranil (up to 250 mg/day) (Ibid).

Some disorders that closely resemble OCD and may respond to some of the same treatments:

 Trichotillomania (compulsive hair pulling).
 Body dysmorphic disorder (imagined distortions in the body as ugliness).
 Habit disorders, such as nail biting or skin picking.
 Impulse control problems, such as substance abuse, pathological gambling, or compulsive sexual activity, are not related to OCD in any substantial way.

OCD is not the same as to have Obsessive Compulsive Personality Disorder (OCPD). Despite its similar name, OCPD does not involve obsessions and compulsions, but rather is a personality pattern that involves a preoccupation with rules, schedules, and lists; perfectionism; an excessive devotion to work; rigidity; and inflexibility (Ibid).



Treatment for OCD from A Christian Perspective

From a Christian Perspective OCD is a problem in the cognitive area, and a manifestation of represed emotions. To treat OCD we need to work with Cognitive Behavioral Therapy. In the cognitive area we will work planting the word of God, new values and beliefs. From the behavioral aspect the client will act based in the word and not in his feelings, focusing in the actualizing tendencies of the client temperament. It is my opinion that we also need to work with the affectus liberating repressed memories and emotions; this can be done trough regression and/or music therapy. Trough Prayer Therapy we can bring the client to experience repentance and forgiveness and break the cycle of destructive guilt and false repentance. We need to develop the therapeutic process based in the Stages of Change, walking with the client through the changing process of: pre-contemplation, contemplation, preparation, action, and maintenance.



References
Brain Function. About Brain Injury: A Guide to Brain Anatomy, Function and Symptoms. http://www.waiting.com/brainfunctwo.html. 6/3/03
Basic Physiology of Psychoactive Drugs. The Chemical Synapse. http://ist-socrates.berkeley.edu. 8/21/03
Diagnostic Criteria from DSM-IV-TR. Washington, DC. American Psychiatric Association. 2000.
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Washington, DC. American Psychiatric Association. 2000.
Hogan Robert & Robert Smither. Personality Theories. Cambridge, MA. Westview Press. 2001.
Obsessive-Compulsive Foundation (OCF) at [e-mail]. Jenike Michael A. M.D. Havard Medical School Chairman, OC Foundation Scientific Advisory Board [e-mail] Copyright 2004.


Rev Yenan Silen-Perez (c) 2005-2008 all rights retained

Note: This writing is an abstract and do not intent to substitute your medical treatment as is best always consult with your doctor, counselor, or spiritual leader. Never self medicate yourself.

Apostle Dr. Yenan is available for seminars, conferences and/or preaching. Please feel free to contact us at: [e-mail]

[Apostle Dr. Lee Ann Marino]

Thank you for this information! We can all benefit from learning more about these disorders as diagnosed in general psychiatry and a Christian approach to treatment.

[Juan and Yenan]

There is genetics and inheritance, that is carry through a family and reinforced by family dynamics. Represion and Anxiety is a defense mechanism that is used to deal with Obsession and Compulsion, to confront the thinking processess. Guilt manifest when experincing this thinking process which increase OC. False repentance is the innability of the person to heal themelves, and part of the defense mechanism to keep the thought process of OC in control. Mostly, these dynamics are unconscious. When expose to Christ revelation the mind can learn new ways of organizing and processing thoughts. Christ can heal genetic and cancel inheretance generations of OCD because in Christ we are new, completely. However, is a process of healing that can be gradual. I recommend that you read Prophet Joe Blog, he is a teacher and an experienced Spiritual healer that can help much in understanding the process of healing, through Christ.

I come from a family of people diagnosed with moods disorders as Depression and Bipolar. Personally, I suffered depresion since I was a little girl and later was diagnosed as Bipolar. Was treated for 15 years as Bipolar, my family was diagnosed with mood disorders and OCD, but when Christ came to be the center of our lifes we were all healed.

Susan Frigge said:

This post hits very close to me as my husband has been diagnosed with OCD. My oldest son who is twelve has it, but has the offcial diagnosis of "mood disorder" since he was eleven. One of our daughters, who is seven, is exhibiting all the signs as our son. She is too young to get an official diagnosis. I don't believe though as this post says that it is always a manifestation of repressed emotions, destructive guilt & false repentance. My reasoning -- my husband was adopted at 6 months old, before that living in a foster home until the adoption was complete. Two and a half years ago his biological sister got in touch with him and has told us that their biological mother was bi-polar & manic depressive and the sister also exhibits the symptoms of bi-polar. So without being raised with that family, my husband still has similiar symptoms. (We have realized he has had symptoms since childhood even though he was diagnosed at age 38.) So, I believe that sometimes it is inherited and is there from birth. I also say this because we have two children that exhibit the same symptoms as their father and have been since they have been very small children. Those two children of ours also were both born with a disease in their intestines (verses our other two children who were not and don't exhibit OCD symptoms), which I believe is directly related to having OCD. Worry and stress do effect the digestive system in very adverse ways. My husband has had bowel problems since he was a child. I believe that our two children were struggling with worry and stress even in the womb. So how could they as unborn babies have repressed emotions, destructive guilt & false repentance?