OCD

Introduction

OCD is classified as an anxiety disorder and is defined as the presence of recurrent obsessions (persistent thoughts, impulses or images) or compulsions (repetitive behaviour or thought patterns induced in an attempt to reduce anxiety) that are excessively time-consuming or cause marked distress or significant function impairment. These persons are aware that their symptoms are excessive (DSM-IV, 1994) and often experience these as egodystonic thoughts or behaviour.

Obsessive-compulsive disorder is a widely prevalent condition that was documented as early as the 15th century (Kramer and Sprenger, 1980). In an early description of the disorder, William Shakespeare recounts what might be viewed as a classic description of a compulsive washer, Lady Macbeth:

A different type of obsessive-compulsive symptom emerges from contemporary reports about the 18th century literary figure Dr. Samuel Johnson. Johnson made “extraordinary gestures or antics with his hands when passing over the threshold of a door,” and he refused to step on cracks between paving stones and touched every post he passed while walking, going back if he happened to miss one.

A more modern public figure with OCD was the legendary Howard Hughes. From childhood, Hughes was obsessed with avoiding germs. He devised a system of “insulations” of papers towels and tissues for protection and demanded that everything be brought to him wrapped in these materials. He also insisted that doors and windows be sealed to prevent germs from entering his home. Ultimately, Hughes was overwhelmed by these efforts and ended his life in filth and neglect (Sasson et al., 1997).

Although the most prevalent obsession is concerned with contamination, as was the case with Lady Macbeth and Howard Hughes, the content of the obsessions adapt with the changing times to thoughts about leprosy, cholera, tuberculosis, syphilis, and, more recently, AIDS.

This disease has recently been highlighted in the film “As good as it gets” for which Jack Nicholson won an Academy Award for his portrayal of an author with OCD. His obsessions ranged from contamination to checking and habitual rituals. For these sufferers such symptoms lead to a great deal of suffering, while these and other unusual habits lead to a certain isolation from society.

These examples illustrate that the distress, dysfunctionality and pain associated with OCD are due, in large, to the egodystonic nature of the disorder. Patients know very well that their obsessions and compulsions do not make sense and they make some attempt to resist them at some point during the course of their illness. However, the urge to carry them out is often overwhelming. This discrepancy between the knowledge that such obsessions and compulsions are irrational and the overwhelming urge to perform them contributes to the immense anxiety associated with the disorder.