Psychopathology
Obsessions in Psychology
By Pierre Khazen
Introduction:
An Obsessional-Compulsive Disorder is a disabling disorder. Obsessions are viewed as a syndrome in their own right. Meyer (1966) reported a successful behavioural treatment for obsessions by creating Psychological Models to obsessions and suggesting effective behavioural treatments. Models of compulsive behaviour suggested that ritualistic behaviours are a learned avoidance. Meyer’s concern was the issue of avoidance in obsessional disorders by noting that it was crucial to prevent this avoidance behaviour instantly by making sure that such rituals did not happen within or between treatment sessions. His approach was cognitive saying that we need to invalid expectations of harm deriving from obsessions and the need to be exposed gradually to the obsessional situations but this is secondary as the most important was preventing ritualizing.
On the other hand, Rachman, Hodgson, Marks (1971) presented treatment based on exposure to feared situations as a main treatment.
In the end, the two approaches were used together to create very good behavioural treatment of exposure and response prevention. In 1988, Salkovskis added that obsessional thoughts are exaggerations of normal cognitive functioning.
Definition of an Obsession:
Obsessions are defined as unwanted and intrusive thoughts, images and impulses. A person who experiences them finds them repellent, illogical, unacceptable, and hard to get rid of. A big number of triggering stimuli could create obsessions. When an obsession happens, a person feels uncomfortable, anxious and the need to neutralize or put right such obsession. Neutralizing is usually expressed by compulsive behaviour and some times with a subjective feeling of resisting to do compulsive behaviour. Compulsive/neutralizing behaviours are often done according to strange "rules" that if such ritualizing was not done, then anxiety would increase. Neutralizing includes change of mental activities by thinking intentionally another thought when an obsessional thought strikes. Add to that, patients develop avoidance behaviours such cases which could trigger those thoughts/behaviours. Patients generally consider their obsessional thoughts and behaviours as senseless or exaggerated.
Clinically, obsessional-compulsive phenomenon was split to two:
1. Obsessional thoughts which are compulsive behaviour free (Obsessional ruminations).
2. Obsessions plus overt compulsions (Obsessional ritualizing).
The Psychological model of obsessions stresses the importance of overt and covert compulsions which are called neutralizing behaviours. So obsessions are involuntary intrusive thoughts, images, and compulses which lead to anxiety while neutralizing is voluntary behaviour to decrease such anxiety or "risk of harm". Covert neutralizing behaviour is similar to obsessional thoughts because both are thoughts but the difference is their essence as it is a serial of intrusion-neutralizing-intrusion-neutralizing-intrusion….. so the function of both is different. Their target is relaxation and this may intensify if a thought happened.
The nature of obsessional thoughts, impulses and images is often of repugnant subjects in a personal manner. In case an intrusive unacceptable thought happened, the more as it is, the more a person feels uncomfortable. Many patients with obsessive-compulsive disorder, share a similar stream regarding future harm and the need to stop it and usually a try to do so.
To give examples of obsessions and compulsive behaviour:
Obsession – Comb of hairdresser had an AIDS virus on it; Compulsive Behaviour – Call doctor, check body for signs of AIDS, wash hair and hands, clean thoroughly things people touch.
Obsession – I will do some thing bad to my child; Compulsive Behaviour – Avoids being by herself with her child, hides knives and plastic bags.
Obsession – I will scream and swear; Compulsive Behaviour – Make sure I control my behaviour, avoidance of social events, ask people if my behaviour was ok.
Obsession – I will rape a woman; Compulsive Behaviour – Tries to prevent thoughts of sex, will not be alone with a woman.
As we can see, there are different categories of obsessions including violence, sex, death, social, religion, contamination, orderliness and this is just a short list.
Content of the Psychological Model of Obsessive-Compulsive Disorder:
Obsessions are mainly featured by:
Avoiding objects or situations that trigger obsessions.
Obsessions.
Compulsive behaviours and thought rituals.
Such avoidance does not help and in fact, it may trigger or worsen obsessions and in response, rituals happen. Rituals refer to characteristic obsessional behaviours, especially when they are repetitive and the belief that such rituals would lead to anxiety relief or decreased. As a result, obsessions remain, rituals become wide, and patients neutralize before the obsession happens and by doing so, prevent its event. The above model is the basis as to how we assess and treat patients with obsessional disorder. The way to treat patients who suffer from obsessions is by exposing them to the feared stimuli, encourage them to behave in a way which would not prevent this exposure, reappraise their fear in order they would know that things they fear do not happen virtually.
This article will be continued till subject of obsessions is covered as follows:
1. Introduction
2. Definition of an Obsession
3. Content of Psychological Model of Obsessive-Compulsive Disorder
4. Assessments and Interviews before Treatment
5. Treatments for Obsessions with Overt Compulsive Behaviour
6. Other Available Treatments
7. Results of a Treatment
Terms:
* Obsession = thought
* Neutralizing = compulsive behavior = ritualizing.
* Obsession/thought leads to neutralizing/compulsive behaviour/ritualizing leads to avoidance behaviour leads to anxiety.
