Prevalence and Research

Obsessions and compulsions represent human phenomena that have been
a topic of interest for several centuries; for example, William Shakespeare’s
characterization of the hand-washing Lady Macbeth has entertained audiences
for hundreds of years. Prior to the first therapeutic analysis of obsessive-
compulsive disorder, then called a neurosis—Freud’s description of the
“rat man”—obsessive thoughts were commonly attributed to demoniac influence
and treated with exorcism. Freud’s major contribution was delivering
the phenomenon from the spiritual into the psychological realm.
Although initial case reports employing psychoanalysis were promising, subsequent
developments using behavioral and pharmacological formulations
have more rapidly advanced the understanding of the phenomenology and
treatment of this unusual condition. In addition, with the public revelation
that certain prominent individuals, such as the aircraft designer and film
producer Howard Hughes, suffered from this condition, the prevalence estimates
of this disorder have steadily increased. Although a number of patients
have sought help for this debilitating disorder since the time it was
first clinically described, it has been confirmed that this problem is far more
prevalent than initially thought. The increase is probably related not to an
actual increase in incidence but to individuals becoming more willing to
seek help for the problem. Because of the increasing number of individuals
requesting help for problems relating to obsessions and compulsions, it is
becoming more and more important to foster the maturation of appropriate
treatment strategies to deal with this disorder.
Further, it has become increasingly important to understand the manifestation
of obsessions and compulsions from a biological, psychological, and
socio-occupational level. Ongoing investigations are examining the biological
makeup of the nervous systems peculiar to this disorder. Research examining
the specific information-processing styles and cognitive vulnerabilities
of obsessive-compulsive patients is also being conducted. Both responseprevention
and biochemical-intervention strategies (for example, clomipramine)
are deserving of continued research, primarily in the examining
characteristics of obsessive-compulsive patients that predict treatment efficacy
with either form of intervention. Finally, early markers for this condition,
including childhood environments, early learning experiences, and biological
predispositions, require further investigation so that prevention efforts can be provided for individuals who may be at risk for developing obsessive-
compulsive disorder. With these advances, psychologists will be in a
better position to reduce the chronic nature of obsessive-compulsive disorder
and to prevent these distressing symptoms in forthcoming generations.
Sources for Further Study
American Psychiatric Association. Diagnostic and Statistical Manual of Disorders:
DSM-IV-TR. Rev. 4th ed. Washington, D.C.: Author, 2000. The DSMIV-
TR provides specific criteria for making psychiatric diagnoses of obsessive-
compulsive disorder and other anxiety disorders. Brief summaries of
research findings regarding each condition are also provided.
Emmelkamp, Paul M. G. Phobic and Obsessive Compulsive Disorders: Theory, Research,
and Practice. New York: Plenum Press, 1982. A somewhat dated but
classic work outlining the importance of behavioral strategies in overcoming
obsessive-compulsive, as well as phobic, conditions.
Jenike, Michael A., Lee Baer, and William E. Minichiello. Obsessive-Compulsive
Disorders: Theory and Management. 3d ed. St. Louis: Mosby, 1998. A
comprehensive overview of the topic that does not burden the reader
with intricate details of analysis. Readable by the layperson. Covers the
topic thoroughly.
Mavissakalian, Matig, Samuel M. Turner, and Larry Michelson. Obsessive-
Compulsive Disorders: Psychological and Pharmacological Treatment. New York:
Plenum Press, 1985. An exceptionally well written text based upon a symposium
held at the University of Pittsburgh. Issues pertaining to etiology,
assessment, diagnosis, and treatment are covered in detail.
Rachman, S. J. “Obsessional-Compulsive Disorders.” In International Handbook
of Behavior Modification and Therapy, edited by Alan S. Bellack, Michel
Hersen, and Alan E. Kazdin. 2d ed. New York: Plenum Press, 1990.
Rachman’s work using behavioral strategies with obsessive-compulsive
patients is unparalleled. No bibliography would be complete without a
contribution from Rachman, one of the most respected authorities in the
field.
Steketee, Gail, and Andrew Ellis. Treatment of Obsessive-Compulsive Disorder.
New York: Guilford Press, 1996. A comprehensive resource for mental
health professionals. Covers behavioral and cognitive approaches, biological
models, and pharmacological therapies.
Turner, S. M., and L. Michelson. “Obsessive-Compulsive Disorders.” In Behavioral
Theories and Treatment of Anxiety, edited by Samuel M. Turner. New
York: Plenum Press, 1984. Summarizes information regarding diagnostic
issues, assessment strategies, and treatment interventions for obsessivecompulsive
disorder. Provides an excellent review of intervention efforts
employing response prevention and clomipramine.
Kevin T. Larkin and Virginia L. Goetsch
See also: Anxiety Disorders; Cognitive Therapy; Drug Therapies. 585