components to Obsessive Compulsive Disorder: Obsessions and Compulsions. The obsessions that are present with the disorder are defined as, “repeated, persistent and unwanted urges or images that cause distress or anxiety.” (“OCD Symptoms”). In order to get rid of such obsessions, one might perform a compulsion or a ritual. In the preliminary case study, it was stated that Darcy had been suffering from a form of anxiety since the passing of her grandmother. It is said that obsessions often will have themes to them such as wanting to have things orderly and symmetrical or someone might have “unwanted thoughts, including aggression, or sexual or religious subjects” (“OCD Symptoms”). Due to the extreme change of environment from a small town to a large city, Darcy was afraid that her family would be harmed by any number of people or situations. She became consumed by the thoughts of her family being harmed, and this then became the obsessive component of the Obsessive Compulsive Disorder. The other half of Obsessive Compulsive Disorder has to do with the compulsions that someone with this disorder feels inclined to perform over and over again. Compulsions are repetitive behaviors that one feels driven to perform. As stated previously, compulsions have the ability to decrease or prevent anxiety that might be caused by obsessions (“OCD Symptoms”). The common examples that are often seen when describing compulsions are the constant washing of hands or the repetitive turning on and off of lights or closing/locking of doors. Darcy is experiencing compulsions in a way that is very different from the previously described examples of how obsessions manifest themselves. So, what exactly do Darcy’s compulsions consist of?
Darcy believed that she had to repeat each family member’s full name 15 times, say a sentence that asked for each person to be kept safe, promise God that she would improve herself, clap her hands 20 times for each person, kneel down and get up 5 times, and then put her hands into a prayer position while bowing. She “had” to do this routine at least 10 times each night, and if she made a mistake anywhere along he way, she had to start totally over again from the beginning, or else something bad would happen to her parents or little brother. As noted in the quotation, Darcy’s compulsions became extremely intricate over the years. The root of each of the motions that Darcy performed all go back to the fact that she wants her family to be kept safe and out of harm. This seems to correlate with the fact that since Darcy’s grandmother who was very close to her passed away, Darcy wanted to make sure that the rest of her family remained safe. This, along with the fear and anxiety that were caused by moving to a new city, show that Darcy has both the obsessions and compulsions that are necessary to be diagnosed with Obsessive Compulsive Disorder. Typically, Obsessive Compulsive Disorder will show signs in an individual, before the age of 25. The mean age of onset seems to be earlier for men than it is for women. The mean age of onset as reported in 1996 was 21 years for men and 24 years for women (“About OCD”). The results of the surveys for ages of onset for OCD have changed over the years, but it is thought that symptoms will often present themselves in childhood and adolescents initially. Another study that was performed in 1996 proved that 64% of OCD cases were chronic, meaning that the chances for long-term recovery were slim (“About OCD”). The prognosis for children and adolescents who go for treatment appears to be steady at a half or more. OCD appears in 1% of the US adult population, with 50.6% of these cases being marked serious (“OCD Among Adults”). In the United States, 2.2 million people are currently experiencing Obsessive Compulsive Disorder (“Facts and Statistics,” 2014). When an individual shows many of the symptoms for OCD, there are a few options when it comes to treatment. Psychotherapy is most definitely one of the strong options that many health care providers will utilize when treating an individual who is suffering from OCD. There is a type of therapy that is called exposure and response prevention (ERP) and this tends to be the most effective treatment when it comes to Obsessive Compulsive Disorder (“OCD Treatment,” 2013). What this therapy does is gradually expose the individual to the feared object or obsession and teach them healthy ways to cope with the anxiety. Antidepressants are often the first medicine that will be used for the treatment/management of OCD. Antidepressants that might be used include Clomipramine (Anafranil), Fluvoxamine (Luvox CR), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), or Sertraline (Zoloft). Overall, these medications can improve an individual’s quality of life when used alongside regular psychotherapy. Someone like Darcy, who is suffering from OCD definitely has options for treatment and the opportunity to live a high functioning and productive life.
Case Study #5 Martha, who currently in high school, has been experiencing symptoms that suggest a persistent eating disorder. Those around her think that her symptoms were first triggered by a school dance that made Martha fixate about the way that she looked. All of her friends had boyfriends and dates to the dance but Martha did not. In order to fit into her dress the way that she wanted to, she dropped a few pounds. One thing led to another and Martha continued to lose weight after the dance. Her eating habits became intensely restricted and altered in a variety of ways (eating only vegetables and sweets and completely ignoring carbohydrates). Due to the symptoms that her friends described being present with Martha, it can be determined that she is suffering from Anorexia Nervosa. Anorexia Nervosa is characterized as a Feeding and Eating Disorder in the DSM-5.
The symptoms for this particular disorder manifest themselves both physically and mentally. The physical symptoms of Anorexia Nervosa include: Extreme weight loss, thin appearance, abnormal blood counts, dehydration, insomnia and intolerance of cold (“Anorexia Overview,” 2014). Other physical symptoms of Anorexia will most certainly be present in individuals who are suffering from the disorder. Heart problems, organ failure and death are some of the most extreme symptoms that are caused by Anorexia. In terms of the physical manifestation of Anorexia, Martha is clearly experiencing extreme weight loss and her friends noticed that her appearance had become very thin. Even under her very large winter clothing, her friends were aware that there was a problem with the amount of weight that Martha was losing. Another physical sign that Martha is suffering from is the fact that she was very cold during her friend’s trip to the mountains. This is another physical sign that Martha is suffering from
Anorexia. While the physical symptoms of Anorexia Nervosa are serious and important, the emotional and behavioral symptoms are just as important and should be examined with the same caution that the physical symptoms are examined with. Some of the most common behavioral symptoms of Anorexia include: refusal to eat, denial of hunger, lying about how much food has been eaten, social withdrawal, and severely restricting food intake through dieting or fasting (“Anorexia Overview,” 2014). Martha severely restricted her diet by only eating lots of vegetables and sweets. Carbohydrates were not a part of her diet, and she often ate very little. Another symptom that she exhibits is the fact that she would lie about how much food she had eaten. Her friends noticed that she was throwing away her food each day in the garbage can. Her friends also noted on their trip to the mountains that Martha had become increasingly withdrawn from social activities, which is a very significant emotional/behavioral symptom of Anorexia Nervosa. Anorexia Nervosa is a very serious disorder, especially in certain populations within our country. Upwards of 30 million people of various ages and genders suffer from an eating disorder (“Eating Disorder Statistics”). While the prevalence of Anorexia is only about 10-15% in males, it is important to consider that anyone can suffer from an eating disorder. The age of onset was reported by 86% of those suffering with Anorexia to be by the age of 20. Forty-three percent of participants noted that the age of onset was between 16 and 20 (“Eating Disorder Statistics”). There is currently no medication that has been proven to specifically target and get rid of Anorexia. A very significant part of the recovery process is for the person is to acknowledge that they have an eating disorder and then to say that they want to go through the process to recovery. If the person has another underlying disorder, such as anxiety or depression, medication can be given to treat that. If the Anorexia is serious enough to affect the organs of the body, medical interventions can take place in order to stabilize the person. It is important to make sure that the person is a stable and healthy weight, before any therapeutic intervention can be had. Therapy is the primary way in which Anorexia is combatted, following the stabilization of the individual’s weight. Two different types of psychotherapy may be implemented for people who are living with Anorexia. Family-based therapy is used a lot with children and teenagers who are struggling with Anorexia. If it seems as if the child/teenager is unable to make proper decisions about what they should be eating and about their overall personal nutrition, it might be more helpful in their recovery process if their family is involved. The family might be able to provide support in their daughter or son’s recovery by making sure that they are including healthy choices in their life (“Anorexia Treatment,” 2014). Individual therapy is the second option for treating Anorexia. With adults, it has been seen that cognitive behavioral therapy is extremely helpful with dealing with Anorexia (“Anorexia Treatment,” 2014). This therapy might be done once a week or in a day treatment program, but some people may seek treatment in a psychiatric hospital. The goal of individual therapy is usually to change distorted beliefs and thoughts that are leading to the restricted eating. Through the use of therapeutic interventions, a person who is suffering from Anorexia has the potential to live a very healthy life in the future.