ABSTRACT
Few emotional disorders are as devastating as obsessive-compulsive disorder (OCD). Patients often have difficulty with work or school, falter in maintaining social and emotional relationships, and struggle with daily life events that others take for granted. Moreover, the psychopathology is among the most complex of the emotional disorders. Sufferers undertake a measureless struggle against seemingly ubiquitous opponents: recurrent thoughts, images, impulses, and doubts that although senseless on the one hand, are perceived as danger signs on the other. If such thoughts cannot be avoided or suppressed, if they cannot be resisted or rationalized, individuals with OCD turn to superstitious behavior in an attempt to prevent being accountable for feared disasters. The wide array and intricate associations between behavioral and mental symptoms can perplex even the most experienced clinicians. To illustrate the elaborate and seemingly bizarre features of OCD, consider the following case example.
Sarah was a 26-year-old graduate student who had recently become engaged to marry her longtime boyfriend, Alan. At her initial assessment, Sarah described “weird thoughts and worries” that she might cheat on (or might have already cheated on) Alan, even though she had absolutely no desire to do so and had no history of this sort of behavior. The thoughts were continually on her mind and had become increasingly persistent and distressing as their wedding day drew nearer. On further inquiry, Sarah revealed that she also experienced recurrent unwanted thoughts and images of hurting innocent people. For example, while shopping for silverware for her new house, Sarah became worried she might use her new knives to stab people. After babysitting for her 1-year-old niece, she had intrusive distressing thoughts that perhaps she had done something terrible to hurt this baby, such as feeding her poison. Sarah had always considered herself a very kind and gentle individual—someone others sought out for advice. She had no legal history of any kind, which made the occurrence of these terrible thoughts even more bewildering.
Indeed, Sarah felt very guilty for thinking these thoughts. She had begun locking the kitchen drawers where her knives were kept and avoiding small children. She had also started taking certain precautions out of the fear that she might cheat on her fiancé. For instance, she tried to avoid going out alone so that she would not impulsively “hook up” with strange men. She also kept a written log of all her activities from the time she woke up to the time she went to sleep. This entailed recording where she was, whom she was with, and what she was doing every 5 minutes throughout the day. Thus, whenever the doubts arose, Sarah could verify to herself that she had not cheated or committed violent acts. Only when she was with Alan or other close friends did she not feel the need to keep the log. Still, she spent excessive time trying to analyze her thoughts and recall whether she had cheated or acted violently. In addition, when experiencing the unpleasant thoughts and doubts, Sarah often asked her friends if they had heard any rumors about her cheating on Alan. She also watched the news to make sure there were no stories about random violence. Needless to say, these symptoms were interfering with Sarah's ability to concentrate in school, interact socially, and enjoy her leisure time. Alan was becoming frustrated with Sarah's attempts to seek reassurance that she had not cheated. At the time of her assessment, Sarah estimated that the unwanted thoughts occupied about 8 hours each day.
