OCD Diagnosis Selection - Term Paper Example

? DIAGNOSIS SELECTION FROM AXIS I DISORDERS USING THREE MODELS OF PSYCHOPATHOLOGY Diagnosis Selection from Axis I Disorders Using Three Models of Psychopathology Finding the proper diagnosis is considered to be the key in finding and administering the proper cure, and this idea is universally applicable in any kind of healing or treatment. In the case of diagnosing patients known to be suffering from psychological disorders, it is important to take into consideration the various models of psychopathology to come about with the nearest, if not the exact diagnosis of the patient and its corresponding treatment. For this paper, obsessive-compulsive disorder (OCD) will be described based on various models and its diagnosis will be presented, as well as its impact on various aspects of the individual. OCD is considered to be an anxiety disorder with DSM-IV code 300.3 from the Axis I disorders of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, APA, 2000). As its name suggests, an individual with OCD tends to have recurring obsessions along with repetitive actions that cause anxiety or distress to the individual when not done, and in the process causes the said person to become too preoccupied with the act, in such a way that other aspects of life such as socialization, work, among others become greatly affected by it (Dziegielewski, 2010). Various theories are currently available and can be used in order to understand the mechanisms of the disorder using different models of approach. Three Theoretical Models of Psychopathology As of date, there are various factors identified to trigger or develop OCD among individuals. These can range from biological factors such as genetics, infections and neurological disorders, psychological factors such as behavioral and cognitive reactivity, social inhibitions and incompetence, as well as interpersonal factors such as strong, stressful, or powerful life-changing events (Dziegielewski, 2010; Stein, 2002). For this paper, OCD diagnosis will be based on three psychopathological models, starting with the biological model using a combination of neurobiological models with imaging studies, followed by the psychological model using a behavioral approach, and lastly an interpersonal model using family systems studies and approaches. Etiology of OCD According to Biological Model At present, the dominant model of OCD using a biological model is the abnormality of the cortico-striatal circuitry, with particular attention to the orbitofronto-striato-thalamic circuits (OFC) of the brain (Menzies, et al., 2008). Early studies were able to identify the association of this part of the brain with emotions and behavior when researchers observed lesions in some patients exhibiting profound behavioral changes after encountering accidents (Stein, 2002). With regards to the kind of compulsion, there has been observed reduction in regional cerebral blood flow (rCBF) in the striatum in patients exhibiting checking and ordering/symmetry compulsions, while an increase in rCBF was observed in the left OFC among patients with washing compulsions, all of which were detected using positron and magnetic resonance imaging studies comparing the brain images of normal and OCD patients (Mataix-Cols, et al., 2005). The reduction in blood flow translates to lesser oxygen and glucose in the affected areas, while an increase in blood flow to other parts cause additional hyperactivity in regions affected, creating imbalances in the different synaptic and cellular processes and abnormal activation of some parts of the brain (Dziegielewski, 2010; Menzies, et al., 2008). It is possible that due to the rewiring of frontostriatal loops, cognitive and motor habits become strongly established, especially when dealing with the repression of anxiety, needs for decision-making, and controlling some of the individual’s emotional processes (Menzies, et al., 2008). Etiology of OCD According to Psychological Model The effects of neurobiological malfunctions in the brains of OCD sufferers have strong influences with regards to the behavioral output of these patients, which cause them to develop deep-seated behaviors in order to compensate for their feelings of anxiety. It is due to this kind of neurological imbalances that OCD was not treatable when relying on classical psychological interventions alone, and for that matter behavioral therapy became a better option in later experiments (McLean, et al., 2001). The behavioral aspect of OCD can be explained by deriving ideas from neurobiological concepts. Due to the error signals that persist longer among individuals with OCD in comparison with normal individuals, those with OCD develop the compulsion to reduce their anxieties and remove the sense of feeling that something is wrong (Gehring, et al., 2000). The prolonged habitation can also be explained by negative feedback loop as well: that in the process of the individual trying to decrease the error signals, the actions can become much more repetitive, causing the generation of more error signals, which trigger more of the repetitive actions, and so forth (Dziegielewski, 2010). Due to these effects, OCD sufferers come to believe that doing the behaviors repetitively would decrease their symptoms from worsening, and by preventing them from performing their actions, their anxiety actually increases. It would take a long time, along with patience and dedication for psychiatrists to assist in modifying the behaviors of the OCD patients, as well as for the latter to learn or re-learn ways of processing and regulating information and other stimuli (such as exposure to fears) to change their ritualized behavior and thinking patterns gradually (Dziegielewski, 2010). Etiology of OCD According to Interpersonal Model OCD is not only inherited, but it can also be passed down from one generation to another through children learning the ways of the older members of the family, which could lead to problems with regards to the functionality of the family as a secure and safe system since most of the time the parent with OCD would put more energies on performing the habitual action than actually interacting with the rest of the family (Dziegielewski, 2010). The age of onset of OCD could affect various stages of the individual, wherein males tend to develop OCD at younger ages in comparison with females, which could explain why some male OCD sufferers remain in their parents’ homes as bachelors and females having OCD have higher likelihoods of being in a relationship or marriage (Steketee & Van Noppen, 2003). Still, the fact that an individual having OCD could easily pass on the disorder to offspring is still very likely, as the parent with OCD could passively or actively reinforce the habits to children, further increasing the likelihood that the child or children would also become obsessive-compulsive themselves. Conflicts in marriages arise when the parent without OCD decides to divorce the parent with OCD due to either lack of awareness on how to tackle the situation (relying solely on marriage counseling instead of actually pursuing to treat the OCD itself), and in such a case the individual with OCD would not be able to get proper help (Steketee & Van Noppen, 2003). Even worse, since the issue of OCD itself was not addressed, it is possible that children would also continue the behaviors themselves, long after contacts with the OCD parent has decreased. It is not easily realized by partners without OCD that their marriages and families are actually affected by the disorder itself, supported by the fact that OCD is one of the most ignored psychological disorders since the individual is still capable of doing and deciding despite the drawbacks (Dziegielewski, 2010). Thus in order to retain the normal function of the family with members having OCD, the disorder must be treated, as well as allowing the family to undergo therapy to better understand how OCD happens and how to prevent it from recurring, as well as to give support to the member having the disorder to recover. Impact and Effect of OCD OCD has been originally thought as a form of possession of evil spirits on certain individuals, but in the process of the formation of psychoanalytic concepts gained more ground on being recognized as a disease around the early 1800’s (Dziegielewski, 2010). As such, it was included in the first edition of the DSM manual in 1952, initially a disease which is not easily treatable using classical psychological approaches (McLean, et al., 2001). However, due to technological advancements in observing the progression of the disease, as well as the various changes in the field of psychology, the disorder itself became recognized to be curable due to the various ways by which it can be diagnosed and treated, such as the use of behavioral therapy, pharmacological therapy, or a combination of both (Stein, 2002). In addition, since the OCD patients still maintain a sizeable level of functionality, there has been lesser stigma over the disease, with some exceptions that pose potential threat or harm to the individual’s safety such as excessive hoarding compulsions (Dziegielewski, 2010). Clinically Observable Symptoms Main symptoms that can be observed among individuals with OCD would be the following: obsessive thoughts (intrusive thoughts, distressing ideas); compulsive actions or behaviors (repetitive actions and behaviors); or the combination of both (Dziegielewski, 2010). Patients can be observed to be fidgety due to persistent worrying or anxiety and may have marks or scars on their hands. They can either be any of the following: washers (have cleaning or washing compulsions); checkers (have tendencies of repetitively checking locks, gas knobs, etc.); counters/arrangers (obsessed with order and symmetry); perfectionists (fears the retribution of doing something wrong or with flaws); and hoarders (fears something bad will happen if things got thrown away) (Heyman, et al., 2006). The disorder can be roughly diagnosed when the individuals are given questionnaires such as the Yale-Brown obsessive compulsive scale or the obsessive compulsive inventory. The majority of patients have both compulsions and obsessive behavior, while around 25% only have obsessions, and around 5% have compulsions (APA, 2000). The obsessive or compulsive behaviors can appear or disappear in cycles, with a small number of patients undergoing near or full remission, while in others relapses occur with greater severity than before. Conclusion Obsessive-compulsive disorder (OCD) is an anxiety disorder that can be further understood using various approaches in psychopathology. Using behavioral models, it is caused by malfunctioning in the orbitofronto-striato-thalamic circuits in the brain, causing abnormal transmission of signals. In relation to this, using the behavioral approach, due to the abnormality of signal transfers in the brain, the individual with OCD develops the disorder due to the error signals that linger longer in the brain and cause further anxiety, forcing the person to develop compulsive habits or obsessive thoughts as relief from further experiencing anxiety. In terms of the effects of OCD in familial relationships, aside from passing on the compulsive and obsessive disorders to younger family members, there is also a greater likelihood of the breakdown of the family due to one of the older members putting much more focus on performing the obsessive behaviors than actually interacting with other family members. The overall impact of the disease to the individual depends on the severity of the symptoms, and it is important that patients with OCD must be diagnosed as early as possible, as well as to purse behavioral therapy promptly, especially with the younger-aged patients. By understanding the different ways by which psychological disorders operate in individuals and seeing this happen using a holistic approach, successful intervention among individuals with OCD can be achieved. References American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author. Dziegielewski, S. (2010). DSM-IV-TR in Action. Hoboken, NJ: John Wiley & Sons, Inc. Gehring, W. J., Himle, J., & Nisenson, L. G. (2000). Action-monitoring dysfunction in obsessive-compulsive disorder. Psychological science, 11(1), 1-6. Heyman, I., Mataix-Cols, D., & Fineberg, N.A. (2006). Obsessive-compulsive disorder. British Medical Journal, 333(7565), 424-249. Mataix-Cols, D., do Rosario-Campos, M. C., & Leckman, J. F. (2005). A multidimensional model of obsessive-compulsive disorder. American Journal of Psychiatry, 162(2), 228-238. McLean, P. D., Whittal, M. L., Thordarson, D. S., Taylor, S., Sochting, I., Koch, W. 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