Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic

By David H. Barlow | Go to book overview

CHAPTER 15
Obsessive–Compulsive Disorder

Among anxiety disorders, obsessive–compulsive disorder (OCD) is often the one that generates very severe consequences. Patients who are hospitalized because of anxiety are most likely to be diagnosed with OCD. In fact, in recent years, several inpatient psychiatric units have been established around the country exclusively to treat OCD. These facilities provide specialized therapy to those who have not responded to standard pharmacological and behavioral treatments known to work for most people with this disorder. Chances are that these inpatients with severe OCD have comorbid debilitating conditions, such as major depression, other anxiety disorders, eating disorders, and personality disorders. These cooccurring conditions sometimes complicate the OCD symptoms, making it difficult for patients to respond to or even undertake standard therapies. For those with this condition, gaining control and predictability over the seemingly ubiquitous dangers in life leads them to resort to magic and rituals in vain attempts to reestablish safety or prevent a dreaded event. In OCD, danger appears in the form of a thought, image, or impulse that provokes intense discomfort. This thought or image is upsetting and is avoided, much as a person with a snake phobia avoids snakes. Usually obsessions occur many times a day, often continuously in severe cases.

The intensity, severity, and sometimes bizarre qualities of OCD are hard to appreciate without case illustrations. A 32-year-old married woman who had given birth 3 months before to her second child sought outpatient treatment when her checking of faucets, light switches, and buttons on her children's clothing increased sharply.1 In addition, she complained of several magical rituals regarding numbers, and noted that certain items of clothing and other activities had become connected in her mind to the devil. These symptoms had begun in her mid-20s before her marriage, but had worsened recently with the stress of

1This case description is adapted from Steketee, G. (1998). Judy: A compelling case of obsessive–compulsive
disorder. In R. P. Halgin & S. K. Whitbourne (Eds.), A casebook in abnormal psychology (pp. 58–71). Ox-
ford: Oxford University Press. Copyright 1998 by Oxford University Press. Adapted by permission.

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