Research Paper on "Obsessive Compulsive Disorder in Adults & Children"

Research Paper 6 pages (1856 words) Sources: 6

[EXCERPT] . . . .

Obsessive-Compulsive Disorder, or OCD, is a neurobehavioral disorder in which the patient feels a strong need to control their environment (Yaryura and Neziroglu, 1997). In the process of trying to gain this control, patients have forceful, repetitive and generally unwanted thoughts and participate in mental and/or motor activities which they have troubles resisting (Yaryura and Neziroglu, 1997). This paper will begin by discussing what symptoms are linked to OCD, what could be the possible causes and how OCD is treated. The paper will then go on to discuss what can be implied from the culture, race, gender and age range of Obsessive-Compulsive Disorder patients.

The basic symptoms that patients with Obsessive-Compulsive Disorder tend to experience are obsessions, compulsions, doubting, hyper-vigilance and the feeling that they need to control the world around them. Of these obsessions and compulsions are the most common and prevalent. Obsessions occur when a patient experiences obsessive thoughts that they cannot stop and interfere with their normal thought patterns. The obsessive thoughts experienced can be many things, but some of the most common thought patterns deal with contamination, religion, sex and morbidity. Many patients experience doubt with their obsessive thoughts. The patients believe, yet do not believe in their obsessions. When a patient experiences a compulsion, they experience a strong ideational or motor pressure that is against their will. This pressure is only relieved if the patient completes the act or thought process. An ideational compulsion occurs when a patient feels pressured to complete an act in their own mind. Motor compulsions, on the other hand, occur when the patient feels pressured to actually physically complete a task. Motor compulsions can also be subdivided into aggressive, physiological, bodily movement and ceremonial. Compulsions may be done repetitively, they may or may not have a purpose, or they may be done in order to avoid some disastrous event. If the patient does not go through with the act, they may develop anxiety that does not leave them until it is carried out. There are also some secondary symptoms that can be found when looking at OCD patients. These include sexual anxiety disturbances, anger, depression, and phobias. (Yaryura and Neziroglu, 1997)

There are two trains of thought when discussing the possible causes of Obsessive-Compulsive Disorder. It is generally believed to be either a psychological problem or a problem with an abnormality in the brain. Those that believe that OCD is a psychological disorder believe that OCD is caused when the patient believes that they are personally responsible for the obsessive thoughts that they experience. In order to stop this feeling of responsibility, the patient acts on their compulsions. Those that believe that OCD is caused by an abnormality in the brain, on the other hand, believe that the thoughts and actions carried out by OCD patients may show a problem in an essential pathway of the brain. This pathway is a loop that involves the orbital-frontal cortex (OFC), the head of the caudate nucleus, and the thalamus. The OFC is the part of the brain that realizes when something is not the way it is supposed to be, the thalamus directs signals from one part of the brain to another part where it can be interpreted, and the caudate nucleus is in between these two regulating the signals sent between them. The caudate nucleus normally stops any 'worry' signals sent from the OFC to the thalamus, thereby preventing the thalamus from becoming overactive. In patients with OCD, however, it is believed that the caudate nucleus is unable to stop these 'worry' signals. As a result, when the thalamus becomes overactive and sends strong signals back to the OFC, the OFC responds by increasing compulsive behavior and anxiety. An imbalance in the neurotransmitter, also known as the brain chemical serotonin, could also be to blame. Neurotransmitters travel from one cell to another over fluid-filled gaps called synapses. Serotonin is believed to be involved in the regulation of everything from anxiety to sleep. When it is released from a cell the serotonin enters another cell through a part of the cell membrane known as a receptor. In patients with OCD it is believed that some receptors might block the serotonin from entering the cells, leading to a deficiency of the neurotransmitter in important parts of the brain. ("Causes of OCD," n.d.)

The three main treatments used for patients with Obsessive-Compulsive Disorder are CBTs, pharmacotherapies, and SSRIs. CBTs, usually used in combination with a pharmacotherapy, are meant to identify what triggers the patient's obsessions and compulsions. From that, personalized exposure and response prevention (ERP) strategies that can be used while not in therapy can be designed for the patient. The ultimate goal of the CBT/pharmacotherapy combination is for the patient to not feel anxiety or compelled to go through with their compulsive behaviors when they are confronted with stimuli that appear threatening to them. Pharmacotherapies that prevent the reuptake of serotonin are drugs that prevent the reuptake of serotonin in pre-synaptic cells increase the amount of serotonin in synapses. It is believed that the pharmacotherapies influence the cortico-striato-thalamo-cortical circuit, a circuit which is believed to control obsessions and compulsions, especially in the caudate nucleus. SSRIs, which include fluoxetine, fluvoxamine, sertraline and paroxetine, have proven to be effective at controlling OCD symptoms. (Kalra and Swedo, 2009)

Society's thoughts in regards to mental illness in general are often determined by religious and superstitious beliefs, moral codes, cultural knowledge and economic factors and all these thoughts vary from culture to culture (Yaryura and Neziroglu, 1997). An OCD patient's symptoms can often take on features of their culture (Pallanti, 2008). Not only do things like religion have an effect on how something may be viewed, but when it comes to Obsessive-Compulsive Disorder, religion may also help develop obsessive-compulsive patterns in OCD patients (Yaryura and Neziroglu, 1997). This is because of the obsessive and ritualistic behaviors that are experienced when a patient follows their religious beliefs and practices (Yaryura and Neziroglu, 1997). These behaviors can easily become a part of their OCD behaviors. However, the epidemiology of OCD is fairly consistent in different countries and cultures and it has been proven that cultural variation has very little influence on the lifetime prevalence rates of OCD (Pallanti, 2008). It would seem that the disorder is more rooted in neurobiology than it is in the culture of a patient (Pallanti, 2008). Racial and ethnicity differences also do not appear to have an impact on the prevalence of OCD in a patient (Greenberg, 2011).

While differences in culture and in race may not have an impact on Obsessive-Compulsive Disorder, gender does. Male patients with OCD and female patients with OCD differ in terms of the clinical presentations and the course of their case of OCD. In general, males are more likely than females to have an early onset of OCD. In fact, they are more likely to have a childhood onset of the disorder than females are. Males are also more likely to have a chronic course with the disorder. Not only that, but they are also more likely than females to have a comorbid tic disorder, Attention Deficit Disorder or some kind of hyperactivity disorder to go along with their Obsessive-Compulsive Disorder. (Dickel et al., 2006)

As stated previously, when it comes to the age of Obsessive-Compulsive Disorder patients, males are more likely than females to be diagnosed with the disorder during childhood. Once puberty is hit, the ration of male vs. female OCD patients switches to predominantly females. Gender ratios are not the only differences in child OCD patients vs. adult OCD patients. Children with OCD differ from adult patients in symptom presentation, patterns of comorbidity, sex distribution (as already discussed), degree of insight, and etiopathogenesis. Symptom presentation and comorbidities among children with OCD are more likely to include simple tic-like compulsions, comorbid tics and ADHD. Just as boys are more likely to be affected by OCD in childhood, they also have a higher prevalence of compulsions not following obsession. Boys are also more likely to have a greater genetic contribution to OCD. (Kalra and Swedo, 2009)

Common obsessions and compulsions are similar among child and adult OCD patients. Obsessions among children often include a preoccupation with contamination, harming themselves or others, symmetry and a fear that something bad will happen if they do not complete one of their rituals in just the right way. Compulsions that are common among children with OCD include washing, checking and ordering rituals. Both adults with OCD and children with OCD often have other psychopathologies. Although adults are usually stuck with their Obsessive-Compulsive Disorder, those patients that have OCD onset in childhood, may have it remit as they enter into adulthood. Some factors that are believed to affect whether or not OCD persists from childhood into adulthood include the age at which the OCD appears, the necessity of in-patient care and the duration of the disorder. (Kalra and Swedo, 2009)

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