Category Archives: Obsessive Compulsive Disorder (OCD)

History of OCD: from Medieval to Current Times

Obsessive Compulsive Disorder (OCD) can be grouped together with mental illness in general, as well as with specific sub-domains of mental illness.  However, OCD has unique characteristics that differentiate it from typical aspects of other mental illnesses, and have also, at times, given it the social conceptualization of personal idiosyncrasy and/or a problem with self-control.  The history of OCD is characterized by evolving notions of human nature, spirituality, medicine, and philosophy, and reflects themes experienced at the large social level.  A number of well-known individuals throughout the last few centuries, including Martin Luther (the leader of the Protestant Reformation in Europe), Charles Darwin (Evolution of the Species), Howard Hughes (whose life story was told in the movie The Aviator), and Katherine Hepburn, all are now considered to have suffered from OCD.   Additionally, the spectrum nature of OCD has led it to be classified at various times as a number of distinct, unrelated conditions.

In the pre-Renaissance world (prior to the 14th century) the belief was widely held that mental illnesses were caused by demons or supernatural forces.  “Scruples” was one term that was used to refer to the manifestations of OCD.  The ensuing treatment often involved the church, in which people sought the help and advice of clergy, and included things like exorcisms and other types of religious rituals.  During the European Renaissance (1300’s – 1500’s), society started to move away from these ideas.

During the Age of Enlightenment (starting in the 1600’s), clergy and other thinkers developed specific recommendations for the treatment of OCD, including not trying to suppress distressing thoughts, keeping oneself occupied with daily activities, and maintaining the company of others.  The beginnings of a type of behavioral therapy for OCD emerged around this time through autobiographical and self-help writings from current thinkers, including Richard Baxter.  The Roman Catholic Church also developed a system of recommendations that posited that OCD could only be treated by absolute adherence to the advice of one’s spiritual adviser.  Obedience became a dominant theme in the church’s recommendations for OCD treatment.

In the 1700’s, treatment of OCD shifted away from the church and became more medicalized, although physicians did not have many tools for treating OCD. This reflected a shift in societal consciousness towards rationalism and positivism and away from pure faith in the established spiritual systems.  Physicians used the same standard medical treatments that were applied to a broad array of medical conditions at the time, including bloodletting, laxatives and enemas to get rid of “bad thoughts”.  This time period was largely negative in the life experience of OCD sufferers, as medical practice was ill equipped to deal with psychological conditions and the era witnessed an increase in the institutionalization of OCD sufferers in insane asylums.  Institutionalization was a trend that continued with increasing prominence through the 1700’s, 1800’s, as OCD during this time period was conceived of as a type of insanity.  In the late 1800’s, a consensus was reached in the medical community that OCD was not a type of insanity, and it became less common to institutionalize OCD sufferers.

The growth of pharmaceutical treatment of OCD grew during the 1900’s, as the medical community and growing interest in psychological analysis debated the causes, nature, treatments, and outcomes of OCD.  Treatment with bromides, opium, and morphine became more common, although treatments during this time period were largely experimental and based on the hunches of individual physicians, who wrote about their experiences.  An emergent discussion about OCD as a neurological disease also began during this time period.

During the 1900’s, the emerging predominance of the psychoanalytic paradigm popularized by Freud came to view OCD symbolically, as representations of conflicts in primal urges experienced by patients.  Psychologists in the tradition popularized by Freud posited talk therapy as the appropriate treatment for OCD.  The psychoanalytic approach to OCD, and  the Freudian view of connection with basic primal conflicts, clashed with the ideas of the church, which maintained an emphasis on “scruples”.

Also during the latter part of the 1900’s, behavioral psychology began to take over as the dominant paradigms in the conceptualization, study, and treatment of OCD.  Behaviorists  moved away from talk therapy and came to view behavioral therapy as the appropriate treatment for OCD.  Exposure and Response Prevention (ERP), a treatment rooted in the behaviorist tradition, is still the dominant treatment used for OCD today.

Over the course of the history of OCD, understandings and treatment of OCD have largely stemmed from and reflected the state of societal consciousness, and philosophical and cultural developments at the social level.  As dominant views in society have shifted, so has the approach to psychological conditions such as OCD.  The history of OCD is reflective of the history of mental illness in general, as well as the evolving societal view about religion, medicine, rationalism, and the nature of human beings.

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Effects of Sertraline?

Sertraline (Zoloft) is often the first choice treatment for OCD. However, new research suggests that Sertraline affects the brains of depressed and non-depressed people differently, and may lead to opposite structural changes in the brain. This is important because Sertraline is prescribed for a wide variety of conditions, ranging from bulimia to hot flashed to sexual dysfunction, as well as for patients who suffer from OCD but are not depressed.

In a study comparing the effects of Sertraline on the brain of depressed and non-depressed primates, researchers at the Wake Forest Baptist Medical Center found that, in depressed primates, Sertraline use was associated with an increase in size of the anterior cingulate cortex over the courser of treatment, while a decrease in size of this brain region was observed in non-depressed subjects. This region of the brain is important and interconnected with areas involving memory, learning, spatial navigation, emotion and motivation.

This study has implications for the widespread use of Sertraline and calls for further study to address the effects of Sertraline in non-depressed individuals. It should be noted that the observation of these changes was not associated with observable negative effects in the primate subjects, and, as with any study, results should be understood within the broad scientific context that characterizes scientific inquiry. An exploratory study, it is possible that future human studies of this nature will fail to find the same effect in humans, or that such an effect is meaningful in terms of associated effects.

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Germ Phobias

Germ phobias are exaggerated and often debilitating fears of germs.  These fears are  part of the anxiety spectrum and often are symptoms of OCD, although they can also exist on their own.  Germ phobias often manifest with both obsessive and compulsive components.  When a person suffers from germ phobias, he or she obsesses about germs in the environment and/or on the body and will spend large amounts of time compulsively cleaning the surfaces and objects that are the focus of the contamination fears.  The compulsive cleaning is a ritualistic attempt to relieve the anxiety caused by the obsession over germs.  Often, germ phobias entail a sense of loss of control over the safety of the environment in terms of hygiene and a fear of contamination.  These phobias and related compulsions are often connected with a sense of shame or embarrassment, as the person suffering often realizes at some level that the obsessions and behaviors are unreasonable yet are unable to control them. Continue reading Germ Phobias

Compulsive Behaviors Related to OCD

Definition of Compulsions and Compulsive Behaviors

Compulsive behaviors are actions that are performed persistently and repetitively without necessarily resulting in any reward or positive effect.  Compulsive behaviors are usually not pathological in and of themselves, but are characterized by the fact that they are typically not related to the purpose to which they seem to be intended.  Compulsions can also refer to mental behaviors that fit the same characteristics.  Compulsions have a variety of causes, including religious ritualistic behaviors, anxiety, physiological dysfunction, and mood disorders.  One of the most common causes of compulsions is Obsessive Compulsive Disorder (OCD).  This can feel similar to a skip in a record player, where the person is fraught with an irresistible urge to repeat again and again the same behavior until something releases her or him from the skip. Continue reading Compulsive Behaviors Related to OCD

Promising Treatment for OCD and Depression

A significant number of people who suffer from Obsessive Compulsive Disorder (OCD) also suffer from depression.  While the exact mechanics are not fully understood, It is believed that OCD often increases depressive symptoms, sometimes leading to major depression, although OCD can exist in non-depressed individuals as well.  Similarly, depression can involve OCD components, as well as lead to their manifestation over time. When OCD and depression occur together, it can be more challenging to decide how to best treat the patient.  Seratonin-Reuptake Inhibitors (SRI´s) may or may not be totally effective at controlling both the OCD and the depression at a given dose, and, at the same time, it is often desirable to make the medication regimen as simple as possible.  The effects of some medications, when taken simultaneously, counteract or exacerbate the effects of another leading to undesired effects, and sometimes a single medication would be effective for both OCD and depression, but at different doses.  This presents a complex situation for assessing which treatment of combination of treatments will work best in a given patient´s situation. Continue reading Promising Treatment for OCD and Depression

Be like water

One metaphor OCD sufferers can use is that of a brick versus water.  When we engage in our rituals and  obsessions, it is all driven by the impulse to control.  When we do this, we are represented by the brick, that doesn´t bend, melt, bond or adapt.  If we keep hitting something with a brick, either we will eventually break the thing, or we will break the brick.  However, in contrast, a helpful metaphor for OCD sufferers to visualize is to be like water.  Water doesn´t stay or stick, resist, insist, or stop at impediments or obstacles.  It simply flows towards the gradient.  When we engage in our rituals, we are attempting to control reality with behavioral or mental bricks.  However, we cannot hit reality, and we cannot control it, and the brick simply breaks us down emotionally.  When we try to resist the OCD compulsions and obsessions head on, we are also using the brick mentality.  What we need is to be like water, and use a water mentality.  Let it flow.  The obsessions can come and the obsessions can go, the compulsions can come and the compulsions can go.  We need to release attachment and control and let our lives flow.

Thoughts on security

As OCD sufferers, one of the core conflicts that we suffer from is the struggle with control vs. risk.  We are driven to compulsive behaviors or thoughts because we, in our exaggerated perception of risk as well as of our own obligation towards it, feel an overwhelming need to carry out those actions because the OCD makes us think that, in doing so, we can exert some control over external events that will prevent danger or “bad things” from happening.  To this issue, I, as an OCD sufferer, have found the following quote by Hellen Keller an extremely deep reaching concept for meditating on when I am most in need:

“Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing.” –Helen Keller, published in 1957 in The Open Door.

We as OCD sufferers really deal with the same conflict that all of humanity faces; the struggle with the fact that bad things might happen and we have little, if any, control over any of it.  The only difference is that, because of OCD, we have a mistaken belief that we can superstitiously control these potential bad events through actions and rituals, and because of OCD, we cannot push this conflict into the background of our awareness, like others can, but instead feel it as the most glaring element of our environment, staring us in the face constantly.  The fundamental precept to remember is that this idea of security, or that security can be attained, through whatever medium it might be, is just a superstition.  Security cannot be attained by OCD rituals or by excessive amounts of money or friends or knowledge….most events that happen in life are out of our control, and we are not responsible for them.  If we stop washing our hands 20 times every half hour and our mother suffers a stroke, it is not because we stopped washing our hands.  We sometimes wonder with envy how others that we know are able to so freely go about their lives without the crippling sense of responsibility and guilt that we mistakenly project onto our rituals.  The fact is that the same physical laws apply to OCD sufferers as they do to everyone else, and security is mostly a superstition.  Knowing this doesn’t solve the other problem presented by OCD which is the lack of ability to let go, but it is a step in the right direction.  Until tomorrow….

Be like water

As one of the fundamental characteristics of OCD is that sufferers are driven to compulsive actions based on a belief that, by undertaking those actions, they can somehow exert control over events that happen in the outside world in order to avoid danger or “bad things” happening, a quote by Hellen Keller speaks quite aptly to this internal conflict that we as OCD sufferers experience about security and danger, risk and control and, as an OCD sufferer, I have found it most helpful for meditating on when I am suffering:

“Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing.” — Helen Keller