Understanding the obsessive-compulsive disorder: A book review

REVIEW ARTICLE

VIEIRA, Fernando Filipe Paulos [1], NETO, Francisco Lotufo [2]

VIEIRA, Fernando Filipe Paulos. NETO, Francisco Lotufo. Understanding the obsessive-
compulsive disorder: A book review. Multidisciplinary Scientific Journal Knowledge Nucleus.
Year 04, Ed. 10, Vol. 10, pp. 146-154. October 2019. ISSN:2448-0959. Acess Link:
https://www.nucleodoconhecimento.com.br/psychology/obsessive-compulsive-disorder, DOI:
10.32749/nucleodoconhecimento.com.br/psychology/obsessive-compulsive-disorder

Contents

SUMMARY
1. INTRODUCTION
2. THE BIOLOGICAL PERSPECTIVE
3. THE PSYCHODYNAMIC PERSPECTIVE
4. THE BEHAVIORAL PERSPECTIVE
5. THE COGNITIVE AND LEARNING PERSPECTIVE
6. FINAL CONSIDERATIONS
REFERENCES

SUMMARY

The following article has as objective present the principal theories that explain the
obsessive-compulsive disorder. These theories includes the biological, psychodynamic,
behavioral, cognitive and learning perspectives. Each of these theories enfatizes a specific
topic on the development of obsessive-compulsive disorder. Biological perspective enfatizes
the functionning of neurotransmitters and structure of the brain in patients with obsessive-
compulsive disorder. Psychodynamic perspective enfatizes the developmental experiences
that are relationated with the development of obsessions. Behavioral perspective concentres
on the behavior that is realized by the patients with obsessive-compulsive disorder that is
realized to control anxiety that is provoked by obsessions. Cognitive perspective enfatizes
the idea that obsessions are caused by the idea that something must be perfect. Finally, the

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 Understanding the obsessive-compulsive disorder: A book review

learning perspective enfatizes the idea that compulsions are the result of operant responses
that are negativelly reinforced by the relief from anxiety that is provoked by obsessions.

Keywords: obsessive-compulsive disorder, understanding, etiology.

1. INTRODUCTION

Obsessive-compulsive disorder is a psychiatric disorder that is characterized by the presence

of recurrent obsessions or compulsions that are time-consuming or causes significant distress
or interference with normal functionning of an individual (AMERICAN PSYCHIATRIC
ASSOCIATION, 2013; PARMET, LYNM, GOLUB, 2011). Obsessions are thoughts, images, ideas,
or urges that invade the individual mind, and that cause significant anxiety or distress.
Compulsions are repetitive behaviors or mental acts that an individual feel that he or she
must to perform to control anxiety caused by obsessions (AMERICAN PSYCHIATRIC
ASSOCIATION, 2013).

Some themes characterize thoughts of individuals with obsessive-compulsive disorder

(ABRAMOWITZ, MCKAY, TAYLOR, 2008). The theme of obsession most common is dirt or
contamination (TOLIN, MEUNIER, 2008). Other common themes are violence and agression,
orderliness, religion, and sexuality. The prevalence of these themes vary from culture to
culture (MATSUNAGA, SEEDAT, 2011). Religious obsessions are more commom in cultures or
countries with strict moral codes and religious values (BJORGVINSSON, HART, 2008).

In general, obsessive-compulsive disorder begins at youth, in males between the six and the
fifteen years old and in females between the twenty and the twenty nine years old (ANGST ET
AL, 2004, FOA, FRANKLIN, 2001).

Is estimated that between one and three percent of individuals will develop obsessive-
compulsive disorder at some time in their lives (KESSLER ET AL, 2005; LECKMAN ET AL,
2010). In the United States, individuals that have origin from Europe have more probability to
have obsessive-compulsive disorder than individuals that have origins from Africa (HEWLETT,
2000).

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 Understanding the obsessive-compulsive disorder: A book review

2. THE BIOLOGICAL PERSPECTIVE

Biological perspective of obsessive-compulsive disorder focuses on the idea that obsessive-

compulsive disorder may be linked to biological factors (LAMBERT, KINSLEY, 2005). Twins
studies suggests that if one identical twin displays obsessive-compulsive disorder, the other
can also develops the same disorder. Resumidly, the more similar the gene composes two
individuals, the more likely both are to have obsessive-compulsive disorder if one of them
have the disorder (COMER, 2013).

In recent years two lines of research have constatated that biological factors play a important
role in the development of obsessive-compulsive disorder. This research focuses on abnormal
activity of serotonin and the some regions of the brain (COMER, 2013).

Serotonin is a neurotransmitter that transmit messages from neuron to neuron. Clinical

researchers found that antidepressants clomipramine and fluoxetine (Anafranil and Prozac),
reduce obsessive and compulsive symptoms (STEIN, FINEBERG, 2007). By the fact that these
drugs increase serotonin activity, some researchers concluded that obsessive-compulsive
disorder could be caused by low serotonin activity. Only antidepressants that increase
serotonin activity help individuals with diagnostic of obsessive-compulsive disorder (JENIKE,
1992).

Serotonin is the neurotransmitter most cited in the spoke of obsessive-compulsive disorder,

but recent studies suggests that other neurotransmitters like glutamate, GABA, and
dopamine may also play an important role in the development of obsessive-compulsive
disorder (SPOOREN ET AL, 2010; LAMBERT, KINSLEY, 2005).

Another line of investigation focuses on the abnormal funcionning of specific regions of the
brain, in particular the orbitofrontal cortex and the caudate nuclei. These regions are part of
a circuit of the brain that converts sensory information in thoughts and actions (CRAIG,
CHAMBERLAIN, 2010; STEIN, FINEBERG, 2007). The circuit begins in the orbitofrontal córtex,
where sexual, violent, and other primitive impulses arise. These impulses move on to the
caudate nuclei that act as filters that send the most powerful impulses on to the thalamus,
the next stop on the circuit. If the impulses reach the thalamus, the individual is driven to
think then about them and perhaps to act. Many theorists believe that orbitofrontal cortex or

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 Understanding the obsessive-compulsive disorder: A book review

the caudate nuclei of some individual are too active, leading to a constant eruption of
thoughts and actions (ENDRASS ET AL, 2011; LAMBERT, KINSLEY, 2005). Additional parts of
the brain circuit have also been identified including the cingulate córtex and the amygdala
(STEIN, FINEBERG, 2007).

Investigators found that obsessive-compulsive symptoms do sometimes arise or subside after

the orbitofrontal cortex, caudate nuclei or other regions in the circuit are damaged by
accident or illness (COETZER, 2004). Brain scan investigations found that the caudate nuclei
and the orbitofrontal cortex of individuals with obsessive-compulsive disorder are more active
than individuals of control group (CHAMBERLAIN ET AL, 2005; BAXTER ET AL, 2001, 1990).
Some research suggests that the abnormalities of serotonin and brain circuits characteristis
of obsessive-compulsive disorder are partly the result of genetic inheritance (NICOLINI ET AL,
2011).

3. THE PSYCHODYNAMIC PERSPECTIVE

According to psychodynamic theorists anxiety disorders are developed when children fear
their own id impulses and use ego defense mechanisms to confront anxiety that is the result
of the fear of id impulses. In the obsessive-compulsive disorder the confront between anxiety
that provokes id impulses and the anxiety that reduces defense mechanisms develops
thoughts and actions (COMER, 2013).

Three ego defense mechanisms are common in obsessive-compulsive disorder: isolation,

undoing and reaction formation. Individuals who uses isolation disown their unwanted
thoughts and experience them as foreign intrusions. Individuals who uses undoing perform
acts that cancel their undesirable impulses. And individuals who uses reaction formation take
a lifestyle that confront their unaccepting order to counter unacceptable aggressive impulses
(COMER, 2013)

Sigmund Freud did a relation between obsessive-compulsive disorder anal stage of

development. He proposed that during this stage some children experience intense rage and
shame as a result of negative training experiences relative to their physiologic needs
(ERIKSON, 1963; SULLIVAN, 1953; HORNEY, 1937).

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 Understanding the obsessive-compulsive disorder: A book review

4. THE BEHAVIORAL PERSPECTIVE

Behavioral theorists concentres on the explication and treatment of compulsions proposing

that individuals perform compulsions quite casualty. When the threat lifts, they link the
improvement to that particular action. Individuals with obsessive-compulsive disorder believe
that the action give them good luck or can change the situation, and so they perform the
same actions again and again in similar situations. The act becomes a method of avoiding
feared situations or reducing anxiety provoked by obsessional thoughts (FROST, STEKETEE,
2001).

5. THE COGNITIVE AND LEARNING PERSPECTIVE

Individuals with the diagnostic of obsessive-compulsive disorder tend to be concentrated on

thoughts (TAYLOR, JANG, 2011). They cannot stop the mental loop in that the intrusive
thoughts reverbarates in their minds. They also tend to exaggerate the risk of unfortunate
events that can occur. By the fact that they expect terrible things, individuals with obsessive-
compulsive disorder engage in rituals to prevent them.

Another cognitive theory is the perfectionism or the idea that one must perform flawlessly
(MORETZ, MCKAY, 2009; TAYLOR, JANG, 2011).

According to the learining perspective, compulsive behaviors can be considerated as operant

responses that are negatively reinforced by relief from anxiety provoked by obsessional
thoughts (FRANKLIN ET AL, 2002).

6. FINAL CONSIDERATIONS

The objective of this article was to present the theoretical perspectives on the spoke of
understanding obsessive-compulsive disorder. These theoretical perspectives includes
biological, psychodynamic, cognitive and learning perspectives and each of them focuses on
a research’s subject. Biologic perspective focuses on the investigation of abnormal
functionning of neurotransmitters and brain structures. Psychodynamic perspective analyse

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 Understanding the obsessive-compulsive disorder: A book review

the impact of early developmental experiences on the development of obsessions. Behavioral

theorists focuses on the compulsions that are performed to control anxiety caused by
obsessional thoughts. Cognitive perspective believe that obsessional thoughts are caused by
the belief of perfeccionism or the belief that something must be performed flawlessly. And,
learning perspective enfatizes that compulsive behaviors can be viewed as operant
responses that are negatively reinforced by relief from anxiety triggered by obsessional
thoughts.

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[1]
Master in Clinical and Health Psychology from the Lusófona University of Porto, Graduated
in Social and Work Psychology from the Higher Institute of Business and Tourism Sciences.

[2]
Doctorate in Psychiatry. Specialization – Medical Residence. Bachelor of Medicine.
Graduation at Faculty of Psychology PUC-SP.

Submitted: September, 2019.

Approved: October, 2019.

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