Obsessive Anxiety Disorder - Obsessive Compulsive Disorder

Obsessive anxiety disorder is defined as an extremely serious anxiety related condition, where an individual experiences frequent intrusive thoughts that cannot be repressed, often then followed by compulsive repetitive actions to alleviate the anxiety caused by the thoughts and significantly interferes with everyday normal life (OCD UK.org, n.d.).

It’s not known what exactly causes OCD to develop for example personality, stress, genes, brain changes, life changes, and ways of thinking are all thought to play a part. Its estimated around 1 in 50 people male or female will suffer at some point in their life, Different treatments have been developed over the years to try and cure the disorder but it remains to this day still an extremely difficult disorder to treat (RCPSYCH, 2014).

 Sigmund Freud (1856 – 1939) who interpreted obsessions and compulsions as unconscious conflict and dominated early OCD treatments with his talking therapies however these were unsuccessful treating the disorder, Behaviourists dissatisfied with the Freudian theories believed that obsessions and compulsions were caused by fear, avoidance and conditioned responses which resulted in exposure and response therapies. Cognitive behavioural therapy was then developed from behavioural and cognitive approaches to challenge and change the thoughts and behaviours and remains the most common form of treatment for OCD today.

Freud’s psychodynamic approach believes that OCD sufferers become fixated in the anal psychosexual stage of personality development as a child therefore obsessions and compulsions are ego defence mechanisms of unconscious conflict that they may be trying to repress. Freud (1909) supported his theory with the case study ‘rat man’ Freud deduced that his unconscious mind wanted to hurt his father thus developing defence mechanisms in the form of compulsions. From a psychodynamic approach there is some evidence that childhood trauma can cause OCD although this can be explained via a behavioural and cognitive approach as well, however there is limited case studies to generalise it to a wider population.

Psychoanalysis treatments include ink blots, dream analysis and free association with a therapist which are insight oriented therapies, designed to bring unconscious thoughts to consciousness in order to deal with repressed thoughts and memories, this treatment has been largely discounted due to its expensive and lengthy process which can last several years and the patient must be highly motivated, it’s also difficult to compare success rates as it lacks any empirical evidence to support the theory.

The cognitive approach believes that OCD sufferers have faulty ways of thinking at an extreme level, sufferers cannot ignore the thoughts and develop compulsions to neutralise them. Rachman (2004) case study shows how OCD sufferers develop hypervigilance and Sher et al (1983) study also found that OCD sufferers showed memory deficiency, consequently supporting the cognitive approach to OCD. The cognitive theory is reductionist as it focuses on faulty thinking although it does combine behavioural strategies in treatments and explains why those with poor memory may be susceptible to OCD.

Cognitive therapy treatment involves working with a therapist with the aim to identify, challenge and change the faulty thoughts to more accurate and positive ones. Studies show the most effective treatment is cognitive behavioural therapy which also addresses the behaviours as well as the thoughts by completing behavioural experiments to determine if their thoughts are accurate and rational. Studies also show that it can also change the activities in the brain and as such retrain the brain to a new way of thinking.

For cognitive therapy to work patients must be motivated and willing to discuss their obsessions and compulsions therefore a good relationship is essential with their therapist. Empirical evidence backs up the theory with reliable and accurate studies such as Wilhelm et al (2005) found the therapy significantly successful in 15 patients over a period of 14 week using only cognitive therapy, treatment however is reductionist as it concentrates on internal cognitions, however when combined with behavioural therapy it counteracts this limitation. Sufferers may also relapse once treatment has been completed but cognitive behavioural therapy has addressed this issue by teaching coping methods for the future.

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