Anxiety Obsessive Compulsive and Related Disorders

The DSM-IV and the DSM-V have been criticized for creating too many diagnostic categories between psychopathology and normal psychological phenomena. Both emphasize the difficulties of drawing a precise distinction between normality and psychopathology. The DSM-IV defines mental disorders as A) a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual, B) is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom, C) must not be merely an expectable and culturally sanctioned response to a particular event, D) a manifestation of a behavioral, psychological, or biological dysfunction in the individual, and E) neither deviant behavior nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual.

The DSM-V definition of mental/psychiatric disorder is A) a behavioral or psychological syndrome or pattern that occurs in an individual, B) the consequences of which are clinically significant distress or disability, C) must not be merely an expectable response to common stressors and losses or a culturally sanctioned response to a particular event, D) that reflects an underlying psychobiological dysfunction, E) that is not solely a result of social deviance or conflicts with society, F) that has diagnostic validity using one or more sets of diagnostic validators, and G) that has clinical utility. Both provided distinct details of mental disorder. However, it is still unclear as to what kinds of disorder are classified as a mental disease and what their differences are. This paper will delve into what a mental disorder is, in association with specific disorders such as anxiety, obsessive compulsiveness, and other related disorders.

Obsessive-Compulsive Disorder:
An obsession is the persistent thought, urge, or image that is experienced repeatedly, feels intrusive, and causes anxiety. A compulsion is the repetitive and rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxiety. One survey was conducted with the aim to identify areas with the help of expert consensus or disagreement, to help steer research efforts toward the DSM-V classification of obsessive-compulsive disorder (OCD). Therefore, a worldwide survey among OCD experts was conducted using the email addresses of 303 corresponding authors of papers on OCD published between 1996 and 2006. The survey asked questions regarding the classification of OCD and how to improve it via email to the experts. Regarding whether OCD should be removed from the current category of anxiety disorders, approximately 60 percent agreed, and 40 percent disagreed. The survey also revealed that if a new OCD Spectrum Disorders category is created, the expert consensus is to keep it narrow and only include Body Dysmorphic Disorder (72% agree), Trichotillomania (70% agree), and possibly Tic Disorders (61% agree) and Hypochondriasis (57% agree).
Another cognitive assessment of Obsessive-Compulsive Disorder (OCD) wanted to emphasize the importance of cognitive contents - specifically, beliefs and appraisals - as well as cognitive processes in the etiology and maintenance of OCD. The decision was made to develop measures of the relevant cognitive contents and processes using several scales that had been developed, though many remain unpublished and a large number overlap among these measures. Various methods of assessment are reviewed, including idiographic methods, information processing paradigms, and self-report measures. In summary, consensus ratings indicate that six belief domains are likely critical in OCD: inflated responsibility; over-importance of thoughts; excessive concern about the importance of controlling thoughts; overestimation of threat; intolerance of uncertainty; and perfectionism.

Moving on, OCD and OCD-related disorders are common in Western society. They usually first manifest in childhood or adolescence, and women are diagnosed more frequently than men at a ratio of 2:1. To be classified as someone with OCD, an individual must experience recurring obsessions, compulsions, or both that consume a significant amount of time, and cause significant distress or impairment. For most sufferers, adherence to set routines during everyday activities can be comforting; indeed, forty percent report becoming irritated if they must depart from these routines.

Freud posited that OCD is played out in overt thoughts and actions. Specifically, he suggested that “Id impulses” equate to obsessive thoughts and “Ego defenses” correspond to counter-thoughts or compulsive actions. OCD, he proposed, is related to the anal stage of development; people who suffer from it typically have periods of intense conflict between the "id" and the "ego".

Notwithstanding, not all psychodynamic theorists agree. Psychodynamic therapies aim to uncover and overcome underlying conflicts and defenses through free association and interpretation. In contrast, behaviorists focus on explaining and treating compulsions rather than obsessions; they use exposure and response prevention, a type of treatment where a client is exposed to anxiety-inducing thoughts or situations and then prevented from performing compulsive acts.

According to cognitive theorists, everyone experiences repetitive, unwanted, intrusive thoughts. People with OCD, however, may blame themselves for these otherwise normal (though repetitive and intrusive) thoughts, fearing that terrible consequences could result. These individuals often hold exceptionally high standards of conduct and morality, equating thoughts with actions and fearing the harm they could bring. Furthermore, they believe that people should have perfect control over their thoughts and behaviors.

Therapy may also include psychoeducation, and efforts to help the client identify, challenge, and change distorted cognitions. Research suggests that a combination of cognitive and behavioral models often proves more effective than either intervention alone.
The biological perspective of OCD involves abnormal serotonin activity and abnormal brain structure/functioning. OCD is linked to brain structures such as the orbitofrontal cortex, caudate nuclei, thalamus, amygdala, and cingulate cortex. Researchers suggest that some of these structures may be too active in people with OCD, and some research provides evidence that these observations may be linked. Serotonin, along with other neurotransmitters (glutamate, GABA, and dopamine), plays a key role in the operation of the orbitofrontal cortex and the caudate nuclei. Abnormal neurotransmitter activity could contribute to the improper functioning of the circuit. Some biological therapies suggest that the use of serotonin-based antidepressants can help rebalance the brain circuitry. On average, these antidepressants bring improvement to 50-80 percent of those with OCD. However, a relapse can occur if the medication is suddenly stopped. The most effective research suggests that combination therapy (medication and cognitive behavioral therapy approaches) may be the most helpful.

In the article titled "Understanding and Treating Obsessive and Compulsive Disorder," by Paul M. Salkovskis, he argues that developments in cognitive theory suggest that the key to understanding obsessional problems lies in the way in which intrusive thoughts, images, impulses, and doubts are interpreted. Negative interpretations typically involve the notion that one's actions, or the decision not to act, could result in harm to oneself or others. This can lead to severe consequences, such as motivating neutralizing behavior and fostering other counter-productive strategies, increasing selective attention, and creating negative moods. These can, in turn, reinforce the negative beliefs, potentially perpetuating the obsessive and compulsive problem.

Anxiety:
Moreover, what distinguishes fear from anxiety? Fear is defined as the body's response to a serious threat to one's well-being, and anxiety is the body's response to a vague sense of danger. Both have the same physiological features and prepare us for action by increasing respiration, perspiration, muscle tension, and so forth. For some people, the discomfort is either too severe, too frequent, lasts too long, or is triggered too easily. According to the DSM-V, 18 percent of adults in the U.S. population experience one of the anxiety disorders. Close to 29 percent develop one of the disorders at some point in their lives and only one-fifth of these individuals seek treatment.

The DSM-V Anxiety Disorders include generalized anxiety disorder (GAD), specific phobias, agoraphobia, social anxiety disorder, and panic disorder. General anxiety disorder (GAD) is characterized by three factors: 1) For six months or more, the person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple topics; 2) The symptoms include at least three of the following: edginess, fatigue, poor concentration, irritability, muscle tension, and sleep problems; 3) Significant distress or impairment.

GAD is most likely to develop in people facing ongoing, dangerous societal conditions, living in poverty, or facing discrimination, low income, and reduced job opportunities. According to the 2015 Children Mind Institute Children's Mental Health Report, anxiety and depression are treatable, but 80 percent of kids with a diagnosable anxiety disorder and 60 percent of kids with a diagnosable depression are not getting treatment. Based on diagnostic interview data from the National Comorbidity Survey Adolescent Supplement, an estimated 31.9% of adolescents have an anxiety disorder. Of adolescents with any anxiety disorder, an estimated 8.3% have severe impairment.

The prevalence of any anxiety disorder among adolescents is higher for females (38.0%) than for males (26.1%). The Psychodynamics Perspective explains that when childhood anxiety goes untreated, anxiety will progress to a more difficult stage. Some psychodynamic therapies include general techniques such as treating all psychological problems by free association, transference, resistance, and dreams. Object relations therapies help patients identify and settle early relationship problems.

Child Psychologist Sigmund Freud focused less on fear and more on control of the "id". Researchers have found some support for the psychodynamic perspective. They found that people with GAD are particularly likely to use defense mechanisms (especially repression). Adults who, as children, suffered extreme punishment for expressing "id impulses" have higher levels of anxiety later in life. According to the humanistic perspective, GAD arises when people stop looking at themselves honestly and acceptingly. The humanistic therapy developed by Carl Rogers, in which clinicians try to help clients by being accepting, empathizing accurately, and conveying genuineness is best to treat GAD.

According to the cognitive perspective, research supports that people with GAD hold maladaptive assumptions, particularly about dangerousness. When these assumptions are applied to everyday situations and to more events, GAD may develop.
Next, another disorder that many do not consider a disorder is worrying. In one survey, 62 percent of college students said they spend less than 10 minutes at a time worrying, and 20 percent worry for more than an hour. According to the cognitive perspective, in order to treat individuals with GAD, it is important to help them recognize their inclination to worry. Helping clients become aware of streams of thoughts, and to accept these as mind events, is called "mindfulness-based acceptance therapy". Alternatively, some of today's modern cognitive therapists specifically guide clients with generalized anxiety disorder to recognize and change their dysfunctional use of worrying. Clients are educated about the role of worrying in GAD and they are taught to observe their bodily arousal and cognitive responses across life situations and become increasingly skilled at identifying their reactions.

According to the biological perspective, the circuit in the brain that helps produce anxiety reactions includes areas such as the amygdala, prefrontal cortex, and anterior cingulate cortex. Biological theorists believe that GAD is caused primarily by biological factors. During the 1950s, benzodiazepines, such as what we know today as Valium and Xanax, were found to reduce anxiety. Neurons in our brain have specific receptors and benzodiazepine receptors ordinarily receive gamma-aminobutyric acid (GABA, a common neurotransmitter in the brain) which carries inhibitory messages. When received, it causes a neuron to stop firing. When a feedback system is triggered, the brain and body activities work to reduce excitability. Some neurons release GABA to inhibit neuron firing, thereby reducing the experience of fear or anxiety. Malfunctions in the feedback system are believed to cause GAD because of too few receptors or ineffective receptors.

In conclusion, mental disorders encompass a wide range of conditions that affect mood, thinking, and behavior. These disorders include clinical depression, bipolar disorder, dementia, attention-deficit/hyperactivity disorder, schizophrenia, autism, post-traumatic stress disorder, and more. Many people in the world may have mental health concerns from time to time, but these concerns can become a mental illness when you experience ongoing signs and symptoms or frequently feel stress to the point where it can affect your ability to properly function on a daily basis. Signs and symptoms can vary depending on the type of disorder and other factors. Mental illness can affect your thoughts, behavior, and emotions. Treatment should be considered, and it can involve talking to someone such as your doctor, therapist, or even loved ones to prevent the illness from worsening over time.

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