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Obsessive Compulsive Disorder |
Overcoming Anxiety (Home) > Obsessive Compulsive Disorder Obsessive Compulsive Disorder: Anxiety Treatment and SymptomsObsessive-compulsive disorder (OCD) is a common, chronic, and disabling disorder characterized by obsessions and/or compulsions. These symptoms are ego-dystonic and cause significant distress to patients and their families. Up until the early 1980s, OCD was considered a rare, treatment-refractory, chronic condition, of psychological origin. Since then, however, several researchers have reported that the prevalence of OCD is around 2% in the general population and it is almost equally distributed between males and females. An overview of the development of the OCD entity during the last 100 years is useful for understanding the history of psychiatry in general and of OCD in particular. The famous case history of the Rat Man, an early twentieth-century description of a case of ‘‘obsessional neurosis’’, constitutes one of the earliest detailed descriptions of what is today termed OCD. This young man was treated by Freud due to distressing obsessive thoughts: he developed fears that his loved ones would suffer various punishments or mishaps because of his actions. Due to his repetitive thoughts, he had the urge to commit certain acts (compulsions) in order to prevent harm to his relatives and friends (such as moving a rock from the road in order to prevent a carriage from stepping over it). Freud proposed a relationship between the present obsession and a very early sexual experience of the patient that was coupled with fear of punishment from his father (and also with anger towards the father). Sadistic feelings were the basis of the symptoms, together with fears of punishment, and the present disorder was a repetition of past experiences. Once the basis of the Rat Man’s neurosis was understood, the analysis moved on smoothly and the neurosis cleared completely. Unfortunately, the patient was killed in combat during the First World War. Since this description, psychiatry has significantly progressed with regard to therapy, research methodology and the etiology of mental disorders. Notwithstanding Freud’s critical contributions, modern psychiatry is now far more evidence-based and it seems that the pendulum has swung from ‘‘psychological’’ psychiatry to ‘‘biological’’ psychiatry. This is reflected in the use of large double-blind placebocontrolled studies and sophisticated modern techniques which include specific pharmacological and behavioral challenges, intracellular transduction, candidate genes and functional brain imaging, replacing open studies and single case reports.
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