Compulsions

Most obsessive-compulsive patients also exhibit a series of repetitive, intentional,
stereotyped behaviors known as compulsions, which serve to reduce
the anxiety experienced from severe obsessive thinking. The most common
forms include counting (for example, tapping a pencil three times before
laying it down), cleaning (for example, hand washing after shaking another
person’s hand), checking (for example, checking pilot lights several times a
day), and ordering (for example, arranging pencils from longest to shortest
before doing homework). Compulsions are different from simple habits in
that attempts to resist urges to engage in them result in a substantial increase
in anxiety, eventually forcing the patient to engage in the compelling
behavior to reduce the tension. Urges to engage in simple habits, on the
other hand, can often be resisted with minimal discomfort. Furthermore,
most habits result in deriving some degree of pleasure from the activity (for
example, shopping, gambling, drinking), while engaging in compulsive behaviors
is rarely enjoyable for the patient. Compulsions must also be distinguished
from superstitious behaviors, such as an athlete’s warm-up ritual or
wearing the same “lucky” shoes for each sporting event. In contrast to superstitious
people, who employ their rituals to enhance confidence, obsessivecompulsive
patients are never certain their rituals will result in anxiety reduction.
This typically forces these patients continually to expand their repertoire of ritualistic behaviors, searching for new and better ways to eliminate
the anxiety produced by obsessive thinking.
It is estimated that approximately 2 percent of the adult population in
the United States—a larger percentage than was once believed—has at
some time experienced obsessive-compulsive symptoms severe enough to
warrant diagnosis. Typically, obsessive-compulsive symptoms begin in adolescence
or early adulthood, although most patients report symptoms of
anxiety and nervousness as children. Regarding early developmental histories,
many obsessive-compulsive patients report being raised in very strict,
puritanical homes. The disorder occurs equally in males and females, although
cleaning rituals occur more frequently among women. While the
course of the disorder is chronic, the intensity of symptoms fluctuates
throughout life and occasionally has been reported to remit spontaneously.
Because of the unusual nature of the symptoms, obsessive-compulsive patients
often keep their rituals hidden and become introverted and withdrawn;
as a result, the clinical picture becomes complicated by a coexisting
depressive disorder. It is typically the depression which forces the patient to
seek psychological help. 579