Compulsion

The main concern of psychiatrists and therapists who treat people with compulsions is the role they play in a mental illness called obsessive-compulsive disorder (OCD). Compulsions need to be distinguished from obsessions in order to understand how they interconnect with compulsive behavior and reinforce this debilitating illness.

In psychiatric literature, compulsions are defined as repetitive behavior, such as hand washing, counting, touching, and checking and rechecking an action (like turning the light off and on again and again to be sure it is off or on). Performing the specific act relieves the tension of the obsession that the light may not be on or off. The person feels no pleasure from the action. On the contrary, the compulsive behavior and the obsession cause a great deal of distress for the person.

Compulsive behavior also needs to be distinguished from excessive or addictive behaviors where the person feels pleasure from the activity, such as in compulsive eating or compulsive gambling.

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder is classified as an anxiety disorder. Other anxiety disorders are panic attacks, agoraphobia (the fear of public places), phobias (fear of specific objects or situations), and certain stress disorders. This illness becomes increasingly more difficult to the patient and family because it tends to consume more and more of the individual's time and energy . While a person who is suffering from an obsessive-compulsive disorder is aware of how irrational or senseless the fear is, he or she is overwhelmed by the need to carry out compulsive behavior in order to avoid anxiety that is created if the behavior is not carried out.

Therapists categorize compulsions into motor compulsions and ideational or mental compulsions. A motor compulsion involves the need to use physical action. Touching or hand washing would be classified as motor compulsions. An ideational compulsion involves thinking processes. Examples of ideation or mental compulsions are counting, following a ritualized thought pattern, such as picturing specific things, or repeating what someone is saying in the mind.

Obsessive-compulsive personality disorder

People with personality traits, like being a perfectionist or rigidly controlling, may not have OCD, but may have obsessive-compulsive personality disorder. In this illness, the patient may spend excessive amounts of energy on details and lose perspective about the overall goals of a task or job. They become compulsively involved with performing the details but disregard larger goals.

Like obsessive-compulsive disorder, obsessive-compulsive personality disorder can be time-consuming. The compulsive personality may be able to function successfully in a work environment but may make everyone else miserable by demanding excessive standards of perfection.

Treatments for obsessive-compulsive illnesses

The problem for treatment of obsessive-compulsive illnesses must follow careful diagnosis of the specific nature of the disorder.

Methods used to treat these illnesses include a careful physical and psychological diagnosis, medications, and therapies. Besides the compulsive behavior symptoms a person with OCD exhibits, he or she may also have physical symptoms, such as tremors, dry mouth, stammering, dizziness, cramps, nausea, headaches, sweating, or butterflies in the stomach. Since these and the major symptoms are found in other illnesses, a careful diagnosis is important before treatment is prescribed.

In behavior therapy, the patient is encouraged to control behavior, which the therapist feels can be accomplished with direction. The patient is also made to understand that thoughts cannot be controlled, but that when compulsive behavior is changed gradually through modified behavior, obsessive thoughts diminish. In this therapy, patients are exposed to the fears that produce anxiety in them, called flooding , and gradually learn to deal with their fears.

Cognitive therapists feel it is important for OCD patients to learn to think differently in order to improve their condition. Because OCD patients are rational, this type of therapy can sometimes be useful. Most professionals who treat obsessive-compulsive illnesses feel that a combination of therapy and medication is helpful. Some antidepressants, like Anafranil (clomipramine) and Prozac (fluoxetine), are prescribed to help alleviate the condition.

When patients exhibit compulsive slowness, prompting and shaping techniques are used. Persons who are compulsively slow work with a helper who prompts them along gradually until they can perform actions in a more reasonable time frame, such as reducing a two-hour morning grooming period to half an hour. The shaping aspect is the reduction of time.

Resources

books

Amchin, Jess. Psychiatric Diagnosis: A Biopsychosocial Approach Using DSM-III-R. Washington, DC: Psychiatric Press, 1991.

Baer, Lee. Getting Control. Boston: Little, Brown, 1991.

Green, Stephen A. Green. Feel Good Again. Mt. Vernon, NY: Consumers Union, 1990.

Jamison, Kay Redfield. Touched with Fire. New York: Free Press, 1993.

Neziroglu, Fugen, and Jose A. Yaryura-Tobias. Over and Over Again. Lexington, Mass: D.C. Heath, 1991.

Vita Richman

KEY TERMS

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Anxiety disorder

—An illness in which anxiety plays a role.

Behavior therapy

—A therapeutic program that emphasizes changing behavior.

Cognitive therapy

—A therapeutic program that emphasizes changing a patient's thinking.

Compulsive behavior

—Behavior that is driven by an obsession.

Diagnosis

—A careful evaluation by a medical professional or therapist to determine the nature of an illness or disorder.

Flooding

—Exposing a person with an obsession to his or her fears as a way of helping him or her face and overcome them.

Ideational or mental compulsions

—Compulsions of a mental nature, such as counting or repeating words.

Motor compulsions

—Compulsions where a specific, ritualized act is carried out.

Obsessive-compulsive disorder

—A mental illness in which a person is driven to compulsive behavior to relieve the anxiety of an obsession.

Obsessive-compulsive personality disorder

—The preoccupation with minor details to the exclusion of larger issues; exhibiting overcontrolling and perfectionistic attitudes.

Prompting and shaping

—A therapeutic technique that involves using a helper to work with a person suffering from compulsive slowness.