DOCUMENTARY ANALYSIS

AIM​: To understand an anxiety disorder (Obsessive-compulsive disorder) through use of

secondary data (documentary).

BASIC CONCEPT

Mental disorders

A mental disorder, also called a mental illness ​or psychiatric disorder, is a behavioral or mental
pattern that causes significant distress or impairment of personal functioning. Such features may
be persistent, relapsing and remitting, or occur as a single episode. Many disorders have been
described, with signs and symptoms that vary widely between specific disorders. Such disorders
may be ​diagnosed​ by a ​mental health professional​.

The ​causes of mental disorders​ are often unclear. Theories may incorporate findings from a
range of fields. Mental disorders are usually defined by a combination of how a person behaves,
feels, perceives, or thinks. This may be associated with particular regions or functions of the
brain, often in a ​social context​. A mental disorder is one aspect of ​mental health​. Cultural and
religious beliefs, as well as ​social norms​, should be taken into account when making a diagnosis.

Services​ are based in ​psychiatric hospitals​ or in the ​community​, and assessments are carried out
by mental health professionals such as psychiatrists, psychologists, and ​clinical social workers​,
using various methods such as ​psychometric tests​ but often relying on observation and
questioning. Treatments are provided by various mental health
professionals. ​Psychotherapy​ and ​psychiatric medication​ are two major treatment options. Other
treatments include lifestyle changes, social interventions, ​peer support​, and ​self-help​. In a
minority of cases there might be ​involuntary detention​ or ​treatment​. Prevention programs have
been shown to reduce depression.
Common mental disorders include ​depression​, which affects about 300 million, ​bipolar disorder​,
which affects about 60 million, ​dementia​, which affects about 50 million, and ​schizophrenia​ and
other psychoses, which affects about 23 million people globally. ​Stigma​ and ​discrimination​ can
add to the suffering and disability associated with mental disorders, leading to various ​social
movements​ attempting to increase understanding and challenge ​social exclusion​.

Definition

The definition and classification of mental disorders are key issues for researchers as well as
service providers and those who may be diagnosed. For a mental state to classify as a disorder, it
generally needs to cause dysfunction. Most international clinical documents use the term mental
"disorder", while "illness" is also common. It has been noted that using the term "mental" (i.e., of
the ​mind​) is not necessarily meant to imply separateness from ​brain​ or ​body​.

According to ​DSM-IV​, a mental disorder is a psychological ​syndrome​ or pattern which is

associated with ​distress​ (e.g. via a painful ​symptom​), ​disability​ (impairment in one or more
important areas of functioning), increased risk of death, or causes a significant loss of autonomy;
however it excludes normal responses such as ​grief​ from loss of a loved one, and also
excludes ​deviant behavior​ for political, religious, or societal reasons not arising from a
dysfunction in the individual.

DSM-IV precedes the definition with caveats, stating that, as in the case with many medical
terms, mental disorder "lacks a consistent operational definition that covers all situations", noting
that different levels of abstraction can be used for medical definitions, including pathology,
symptomology, deviance from a normal range, or etiology, and that the same is true for mental
disorders, so that sometimes one type of definition is appropriate, and sometimes another,
depending on the situation.

In 2013, the ​American Psychiatric Association​ (APA) redefined mental disorders in

the ​DSM-5​ as "a syndrome characterized by clinically significant disturbance in an individual's
cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological,
biological, or developmental processes underlying mental functioning.” The final draft
of ​ICD-11​ contains a very similar definition.
The terms "mental breakdown" or "nervous breakdown" may be used by the general population
to mean a mental disorder. The terms "nervous breakdown" and "mental breakdown" have not
been formally defined through a medical diagnostic system such as the ​DSM-5​ or ​ICD-10​, and
are nearly absent from scientific literature regarding mental illness. ​Although "nervous
breakdown" is not rigorously defined, surveys of laypersons suggest that the term refers to a
specific acute time-limited reactive disorder, involving symptoms such as anxiety or depression,
usually precipitated by external ​stressors​. Many health experts today refer to a nervous
breakdown as a "mental health crisis".

Prevalence of mental disorders

Mental disorders are common. Worldwide, more than one in three people in most countries
report sufficient criteria for at least one at some point in their life. In the United States, 46%
qualify for a mental illness at some point. An ongoing survey indicates that anxiety disorders are
the most common in all but one country, followed by mood disorders in all but two countries,
while substance disorders and impulse-control disorders were consistently less prevalent. Rates
varied by region.

A review of anxiety disorder surveys in different countries found average lifetime prevalence
estimates of 16.6%, with women having higher rates on average. A review of mood disorder
surveys in different countries found lifetime rates of 6.7% for major depressive disorder (higher
in some studies, and in women) and 0.8% for Bipolar I disorder.

In the United States the frequency of disorder is: anxiety disorder (28.8%), mood disorder
(20.8%), impulse-control disorder (24.8%) or substance use disorder (14.6%).

A 2004 cross-Europe study found that approximately one in four people reported meeting criteria
at some point in their life for at least one of the DSM-IV disorders assessed, which included
mood disorders (13.9%), anxiety disorders (13.6%) or alcohol disorder (5.2%). Approximately
one in ten met criteria within a 12-month period. Women and younger people of either gender
showed more cases of disorder. ​A 2005 review of surveys in 16 European countries found that
27% of adult Europeans are affected by at least one mental disorder in a 12-month period.
An international review of studies on the prevalence of schizophrenia found an average (median)
figure of 0.4% for lifetime prevalence; it was consistently lower in poorer countries.

Studies of the prevalence of personality disorders (PDs) have been fewer and smaller-scale, but
one broad Norwegian survey found a five-year prevalence of almost 1 in 7 (13.4%). Rates for
specific disorders ranged from 0.8% to 2.8%, differing across countries, and by gender,
educational level and other factors. A US survey that incidentally screened for personality
disorder found a rate of 14.79%.

Approximately 7% of a preschool pediatric sample were given a psychiatric diagnosis in one

clinical study, and approximately 10% of 1- and 2-year-olds receiving developmental screening
have been assessed as having significant emotional/behavioral problems based on parent and
pediatrician reports.

While rates of psychological disorders are often the same for men and women, women tend to
have a higher rate of depression. Each year 73 million women are affected by major depression,
and suicide is ranked 7th as the cause of death for women between the ages of 20–59. Depressive
disorders account for close to 41.9% of the disability from neuropsychiatric disorders among
women compared to 29.3% among men.

Classification of mental disorders

There are two classification systems in use currently in the world: DSM and ICD.
1) DSM: The Diagnostic and Statistical Manual of Mental Disorders (DSM) given by
American Psychiatric Association (APA). This is different from American
psychological association also referred to as APA).
2) ICD: International Statistical Classification of Diseases (ICD) developed by WHO.

Both of these list categories of disorder and provide standardized criteria for diagnosis. They
have deliberately converged their codes in recent revisions so that the manuals are often broadly
comparable, although significant differences remain. Other classification schemes may be used
in non-western cultures, for example the ​Chinese Classification of Mental Disorders​, and other
manuals may be used by those of alternative theoretical persuasions, for example
the ​Psychodynamic Diagnostic Manual.​ In general, mental disorders are classified separately
from ​neurological disorders​, ​learning disabilities​ or ​intellectual disability​.

Unlike the DSM and ICD, some approaches are not based on identifying distinct categories of
disorder using ​dichotomous​ symptom profiles intended to separate the abnormal from the
normal. There is significant scientific debate about the relative merits of categorical versus such
non-categorical (or hybrid) schemes, also known as ​continuum​ or dimensional models.
A ​spectrum approach​ may incorporate elements of both.

In the scientific and academic literature on the definition or classification of mental disorder, one
extreme argues that it is entirely a matter of value judgements (including of what is ​normal​)
while another proposes that it is or could be entirely ​objective​ and ​scientific​ (including by
reference to statistical norms). Common hybrid views argue that the concept of mental disorder
is objective even if only a "fuzzy ​prototype​" that can never be precisely defined, or conversely
that the concept always involves a mixture of scientific facts and subjective value judgments.
Although the diagnostic categories are referred to as 'disorders', they are presented as medical
diseases, but are not validated in the same way as most medical diagnoses. Some neurologists
argue that classification will only be reliable and valid when based on neurobiological features
rather than clinical interview, while others suggest that the differing ideological and practical
perspectives need to be better integrated.

The DSM and ICD approach remains under attack both because of the implied causality
model and because some researchers believe it better to aim at underlying brain differences
which can precede symptoms by many years.

Dimensional models

The high degree of comorbidity between disorders in categorical models such as the DSM and
ICD have led some to propose dimensional models. Studying comorbidity between disorders
have demonstrated two latent (unobserved) factors or dimensions in the structure of mental
disorders that are thought to possibly reflect etiological processes. These two dimensions reflect
a distinction between internalizing disorders, such as mood or anxiety symptoms, and
externalizing disorders such as behavioral or substance abuse symptoms. A single general factor
of psychopathology, similar to the ​g factor​ for intelligence, has been empirically supported.
The ​p factor​model supports the internalizing-externalizing distinction, but also supports the
formation of a third dimension of thought disorders such as schizophrenia. Biological evidence
also supports the validity of the internalizing-externalizing structure of mental disorders, with
twin and adoption studies supporting heritable factors for externalizing and internalizing
disorders.

Disorders

There are many different categories of mental disorder, and many different facets of human
behavior and personality that can become disordered.

Anxiety​ or ​fear​ that interferes with normal functioning may be classified as an ​anxiety
​ Commonly recognized categories include specific ​phobias​, ​generalized anxiety
disorder​.[34]​
disorder​, ​social anxiety disorder​, ​panic disorder​, ​agoraphobia​, ​obsessive-compulsive
disorder​ and ​post-traumatic stress disorder​.

Other affective (emotion/mood) processes can also become disordered. ​Mood disorder​ involving
unusually intense and sustained sadness, melancholia, or despair is known as ​major
depression​ (also known as unipolar or clinical depression). Milder but still
prolonged ​depression​ can be diagnosed as ​dysthymia​. ​Bipolar disorder​ (also known as manic
depression) involves abnormally "high" or pressured mood states, known
as ​mania​ or ​hypomania​, alternating with normal or depressed moods. The extent to which
unipolar and bipolar mood phenomena represent distinct categories of disorder, or mix and
merge along a dimension or spectrum of mood, is subject to some scientific debate.

Patterns of belief, language use and perception of reality can become disordered . Psychotic
disorder in this domain include ​schizophrenia​, and ​delusional disorder​. ​Schizoaffective
disorder​ is a category used for individuals showing aspects of both schizophrenia and affective
disorders. ​Schizotypy​ is a category used for individuals showing some of the characteristics
associated with schizophrenia but without meeting cutoff criteria.
Personality​—the fundamental characteristics of a person that influence thoughts and behaviors
across situations and time—may be considered disordered if judged to be abnormally rigid
and ​maladaptive​. Although treated separately by some, the commonly used categorical schemes
include them as mental disorders, albeit on a separate "​axis II​" in the case of the DSM-IV. A
number of different ​personality disorders​ are listed, including those sometimes classed as
"eccentric", such as ​paranoid​, ​schizoid​ and ​schizotypal​ personality disorders; types that have
described as dramatic or emotional such as as antisocial, borderline, histrionic or narcissistic
personality disorders; and those sometimes classed as fear related such as
anxious-avoidant, dependent, or ​obsessive-compulsive​ personality disorders. The personality
disorders, in general, are defined as emerging in childhood, or at least by adolescence or early
adulthood. The ICD also has a category for enduring personality change after a catastrophic
experience or psychiatric illness. If an inability to sufficiently adjust to life circumstances begins
within three months of a particular event or situation, and ends within six months after the
stressor stops or is eliminated, it may instead be classed as an ​adjustment disorder​. There is an
emerging consensus that so-called "personality disorders", like personality traits in general,
actually incorporate a mixture of acute dysfunctional behaviors that may resolve in short periods,
and maladaptive temperamental traits that are more enduring.​[38]​ Furthermore, there are also
non-categorical schemes that rate all individuals via a profile of different dimensions of
personality without a symptom-based cutoff from normal personality variation, for example
through schemes based on dimensional models.

Eating disorders​ involve disproportionate concern in matters of food and weight.​[34]​ Categories of
disorder in this area include ​anorexia nervosa​, ​bulimia nervosa​, ​exercise bulimia​ or ​binge eating
disorder​.

Sleep disorders​ ​such as ​insomnia​ involve disruption to normal ​sleep​ patterns, or a feeling of
tiredness despite sleep appearing normal.

Sexual disorder and gender dysphoria may be diagnosed including ​dyspareunia​ and ​ego-dystonic
homosexuality​. Various kinds of ​paraphilia​ are considered mental disorders (sexual arousal to
objects, situations, or individuals that are considered abnormal or harmful to the person or
others).

People who are abnormally unable to resist certain urges or impulses that could be harmful to
themselves or others, may be classed as having an impulse control disorder, and disorders such
as ​kleptomania​ (stealing) or ​pyromania​ (fire-setting). Various behavioral addictions, such
as ​gambling​ addiction, may be classed as a disorder. ​Obsessive-compulsive disorder can
sometimes involve an inability to resist certain acts but is classed separately as being primarily
an anxiety disorder.

The use of drugs (legal or illegal, including ​alcohol​), when it persists despite significant
problems related to its use, may be defined as a mental disorder. The DSM incorporates such
conditions under the umbrella category of ​substance use disorders​, which includes ​substance
dependence​ and ​substance abuse​. The DSM does not currently use the common term drug
addiction, and the ICD simply refers to "harmful use". Disordered substance use may be due to a
pattern of compulsive and repetitive use of the drug that results in tolerance to its effects and
withdrawal symptoms when use is reduced or stopped.

People who suffer severe disturbances of their self-identity, memory and general awareness of
themselves and their surroundings may be classed as having a ​dissociative identity disorder​, such
as ​depersonalization disorder​ or ​Dissociative Identity Disorder itself (which has also been called
multiple personality disorder, or "split personality"). Other memory or ​cognitive
disorders​ include ​amnesia​ or various kinds of old age ​dementia​.

A range of ​developmental disorders​ that initially occur in childhood may be diagnosed, for
example ​autism spectrum​ disorders, ​oppositional defiant disorder​ and ​conduct disorder​,
and ​attention deficit hyperactivity disorder​ (ADHD), which may continue into adulthood.

Conduct disorder, if continuing into adulthood, may be diagnosed as ​antisocial personality

disorder​ (dissocial personality disorder in the ICD). Popularist labels such as ​psychopath​ (or
sociopath) do not appear in the DSM or ICD but are linked by some to these diagnoses.

Somatoform disorders may be diagnosed when there are problems that appear to originate in the
body that are thought to be manifestations of a mental disorder. This includes ​somatization
disorder​ and ​conversion disorder​. There are also disorders of how a person perceives their body,
such as ​body dysmorphic disorder​. ​Neurasthenia​ is an old diagnosis involving somatic
complaints as well as fatigue and low spirits/depression, which is officially recognized by the
ICD-10 but no longer by the DSM-IV.

Factitious disorders​, such as ​Munchausen syndrome​, are diagnosed where symptoms are thought
to be experienced (deliberately produced) and/or reported (feigned) for personal gain.

There are attempts to introduce a category of ​relational disorder​, where the diagnosis is of a
relationship rather than on any one individual in that relationship. The relationship may be
between children and their parents, between couples, or others. There already exists, under the
category of psychosis, a diagnosis of ​shared psychotic disorder​ where two or more individuals
share a particular delusion because of their close relationship with each other.

There are a number of uncommon psychiatric ​syndromes​, which are often named after the person
who first described them, such as ​Capgras syndrome​, ​De Clerambault syndrome​, ​Othello
syndrome​, ​Ganser syndrome​, ​Cotard delusion​, and ​Ekbom syndrome​, and additional disorders
such as the ​Couvade syndrome​ and ​Geschwind syndrome​.

Various new types of mental disorder diagnosis are occasionally proposed. Among those
controversially considered by the official ​committees​ of the diagnostic manuals
include ​self-defeating personality disorder​, ​sadistic personality disorder​, ​passive-aggressive
personality disorder​ and ​premenstrual dysphoric disorder​.

Anxiety disorders

Anxiety disorders are a group of ​mental disorders​ characterized by significant feelings

of ​anxiety​ and ​fear​. Anxiety is a worry about future events, and fear is a reaction to current
events. These feelings may cause physical symptoms, such as a ​fast heart
rate​ and ​shakiness​. There are several anxiety disorders, including ​generalized anxiety
disorder​, ​specific phobia​, ​social anxiety disorder​, ​separation anxiety disorder​, ​agoraphobia​, ​panic
disorder​, and ​selective mutism​. The disorder differs by what results in the symptoms. People
often have more than one anxiety disorder.
The cause of anxiety disorders is a combination of ​genetic​ and environmental factors. Risk
factors include a history of ​child abuse​, family history of mental disorders, and ​poverty​. Anxiety
disorders often occur with other mental disorders, particularly ​major depressive
disorder​, ​personality disorder​, and ​substance use disorder​. To be diagnosed symptoms typically
need to be present for at least 6 months, be more than what would be expected for the situation,
and decrease functioning. Other problems that may result in similar symptoms
include ​hyperthyroidism​; ​heart disease​; ​caffeine​, ​alcohol​, or ​cannabis​ use; and withdrawal from
certain drugs, among others.

Without treatment, anxiety disorders tend to remain. Treatment may include lifestyle
changes, ​counselling​, and medications. Counselling is typically with a type of ​cognitive
behavioral therapy​. Medications, such as ​antidepressants​, ​benzodiazepines​, or ​beta blockers​, may
improve symptoms.

In DSM 11 all anxiety disorders were placed under “neurosis” but no longer is this system
followed. DSM 111 was revolutionary in that the term “neurosis” was removed and this was no
longer the basis for classification. However, ICD still uses the term neurosis though this is not
the basis of classification as was the case in DSM 11. This section provides a brief summary of
the diagnostic criteria for each of the six main anxiety disorders.

1. Panic Disorder with Agoraphobia (PDA) and without Agoraphobia (PD)

A person with panic disorder has repeated panic attacks. Many sufferers of a panic attack believe
they are dying, going insane or having a heart attack (“catastrophic thoughts”). DSM 1V
distinguishes b/w two types of Panic Disorders: with Agoraphobia (PDA) and without
Agoraphobia (PD)

2. OCD
OCD is defined by the presence of obsessions and/or compulsions. Typical obsessions include
concern about contamination, doubting, and disturbing sexual or religious thoughts. Typical
compulsions include washing, checking, ordering things, and counting. Individuals with OCD
attempt to ignore or suppress their obsessive thoughts, which are not simply excessive worries
about everyday problems.

3. Phobias
A phobia is an irrational fear that produces a conscious avoidance of the feared object. DSM 1V
has three main categories of phobias:
1) Specific phobias (formerly known as “simple phobias”) - fear of specific objects such as
snakes, heights
2) Social phobias – Social phobia is an excessive or unrealistic fear of social situations.
3) Agoraphobias it is the fear of situations where escape is difficult

4. Generalized Anxiety Disorder (GAD)

The main feature of generalized anxiety disorder is excessive worry about a number of different
domains or activities (e.g., work, finances, family, and health). The worry must be experienced
as difficult to control and be associated with at least three of six symptoms, which include
restlessness, fatigue, impaired concentration, irritability, muscle tension, and impaired sleep.

5. Posttraumatic Stress Disorder (PTSD)

Posttraumatic stress disorder is a disorder in which an individual experiences a traumatic event
(e.g. death or serious injury) and responds to the event with intense fear. The fear is associated
with three types of symptoms: (1) re-experiencing the event (e.g., nightmares, flashbacks); (2)
avoidance and emotional numbing (e.g., avoiding talking or thinking about the trauma); and (3)
symptoms of increased arousal (e.g., sleeplessness, hypervigilance). Acute stress disorder is
similar to PTSD but the diagnosis can be given only in the first month and after the first month if
symptoms persist then the diagnosis of PTSD is warranted.

About 12% of people are affected by an anxiety disorder in a given year, and between 5% and
30% are affected over a lifetime. They occur in females about twice as often as in males, and
generally begin before age 25 years. The most common are specific phobias, which affect nearly
12%, and social anxiety disorder, which affects 10%.Phobias mainly affect people between the
ages of 15 and 35, and become less common after age 55. Rates appear to be higher in the United
States and Europe.

Generalized anxiety disorder

Anxiety is a normal reaction to stress as it helps one cope with stress. But when anxiety becomes
‘​excessive’ ​it leads to GAD. Thus the core symptom of GAD is excessive cognitive activity in
the form of uncontrollable worry.
Experience of anxiety​: ​‘Anxiety’ is considered ‘free floating’ and not attached to a specific
object while ‘fear’ is attached to a specific object. Worry which involves ‘self talk’ is considered
the cognitive element of anxiety. Lang[1968] classified the symptoms of anxiety into a system of
three-responses:
• worry or thoughts of future threat (verbal-subjective),
• avoidance (overt motor acts),
• central nervous system hyperarousal resulting in muscle tension (somato-visceral activity).
Normal versus abnormal anxiety response: Anxiety is a natural and a necessary response to
threat or stress as it alerts the person to carry out certain acts that reduce the danger (e.g. working
hard for the exam). However, anxiety can become a pathologic disorder when it is ‘excessive and
uncontrollable’ i.e., if it is developmentally inappropriate (e.g., fear of separation in a
10-year-old child) or if it is inappropriate to an individual's life circumstances (e.g., worries
about unemployment in a successful business executive). Patients who have GAD tend to worry
‘​excessively​’ about many common problems - employment, finances, the health and safety of
family and friends, and the ability to complete chores and errands on time, to give just a few
examples. Often, when asked

Generalized anxiety disorder (or GAD) is characterized by excessive, exaggerated ​anxiety​ and
worry about everyday life events with no obvious reasons for worry. People with symptoms
of ​generalized anxiety disorder​ tend to always expect disaster and can't stop ​worrying​ about
health, money, family, work, or school. In people with GAD, the worry is often unrealistic or out
of proportion for the situation. Daily life becomes a constant state of worry, fear, and dread.
Eventually, the ​anxiety​ so dominates the person's thinking that it interferes with daily
functioning, including work, school, social activities, and ​relationships​.

What Are the Symptoms of GAD?

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well.
Symptoms of GAD can include:

● Excessive, ongoing worry and tension

● An unrealistic view of problems
● Restlessness or a feeling of being "edgy"
● Irritability
● Muscle tension
● Headaches
● Sweating
● Difficulty concentrating
● Nausea
● The need to go to the bathroom frequently
● Tiredness
● Trouble falling or staying asleep
● Trembling
● Being easily startled

In addition, people with GAD often have other anxiety disorders (such as panic disorder
or ​phobias​), obsessive-compulsive disorder, clinical ​depression​, or additional problems with drug
or alcohol misuse.

What Causes GAD?

The exact cause of GAD is not fully known, but a number of factors -- including
genetics, ​brain​ chemistry, and environmental stresses -- appear to contribute to its development.
 ● Genetics: Some research suggests that family history plays a part in increasing the
likelihood that a person will develop GAD. This means that the tendency to develop
GAD may be passed on in families.
● Brain​ chemistry: GAD has been associated with abnormal functioning of certain nerve
cell pathways that connect particular ​brain​ regions involved in thinking and emotion.
These nerve cell connections depend on chemicals called neurotransmitters that transmit
information from one nerve cell to the next. If the pathways that connect
particular ​brain​ regions do not run efficiently, problems related to mood or anxiety may
result. Medicines, psychotherapies, or other treatments that are thought to "tweak" these
neurotransmitters may improve the signaling between circuits and help to improve
symptoms related to anxiety or ​depression​.
● Environmental factors: Trauma and stressful events, such as abuse, the death of a loved
one, divorce, changing jobs or schools, may contribute to GAD. GAD also may become
worse during periods of stress. The use of and withdrawal from addictive substances,
including alcohol, ​caffeine​, and nicotine, can also worsen anxiety.

Prevalence & Age of onset

• Although patients with GAD do not typically seek psychological treatment, the life time
prevalence of this disorder is fairly high. It occurs in about 5 % of the general population
(Kessler, 1994).
• Age of onset is difficult to determine with 60 to 80 % stating that they remember being anxious
all their lives.
• Gender differences: It is twice as common in women as in men (Brown, ‘2001).
• The course of GAD is chronic but fluctuating and often worsen during times of stress (Barlow
et al, al’86)

Obsessive Compulsive Disorder

Obsessive-compulsive disorder is the presence of either an obsession or a compulsion that

individuals may have that ultimately interferes with their life, either by taking up too much time
or impairing their ability to function adequately. An obsession is an unwanted thought or mental
ritual that pops into the mind that one wants to dispel but cannot do so with any ease. A
compulsion is the same thing, except that it is a behavior that one does that one would prefer not
doing but cannot prevent oneself from doing.

The cause is unknown. There appear to be some ​genetic​ components with both ​identical
twins​ more often affected than both non-identical twins. Risk factors include a history of ​child
abuse​ or other ​stress​-inducing event. Some cases have been documented to occur
following ​infections​. The diagnosis is based on the symptoms and requires ruling out other drug
related or medical causes. Rating scales such as the ​Yale–Brown Obsessive Compulsive
Scale​ (Y-BOCS) can be used to assess the severity. Other disorders with similar symptoms
include anxiety disorder, ​major depressive disorder​, ​eating disorders​, ​tic disorders​,
and ​obsessive–compulsive personality disorder​. Treatment involves ​counseling​, such
as ​cognitive behavioral therapy​ (CBT), and sometimes ​antidepressants​ such as ​selective
serotonin reuptake inhibitors​ (SSRIs) or ​clomipramine​. CBT for OCD involves increasing
exposure to what causes the problems while

not allowing the repetitive behavior to occur. While clomipramine appears to work as well as
SSRIs, it has greater side effects so is typically reserved as a second line treatment. ​Atypical
antipsychotics​ may be useful when used in addition to an SSRI in treatment-resistant cases but
are also associated with an increased risk of side effects. Without treatment, the condition often
lasts decades.

Obsessive–compulsive disorder affects about 2.3% of people at some point in their life. Rates
during a given year are about 1.2%, and it occurs worldwide. It is unusual for symptoms to begin
after the age of 35, and half of people develop problems before 20. Males and females are
affected about equally. The phrase ​obsessive–compulsive​is sometimes used in an informal
manner unrelated to OCD to describe someone as being excessively meticulous, ​perfectionistic​,
absorbed, or otherwise fixated.

Clinical picture/symptoms of OCD

A person with OCD may have obsessions, compulsions, or both. DSM IV defines obsessions and
compulsions as follows:
Obsessions (persistent thoughts) are defined by:
1. Recurrent, intrusive thoughts that cause anxiety. The obsessions are ‘ego dystonic’ meaning
that the content of the obsessions is alien and not within the control of the sufferer.
2. The thoughts are not simply excessive worries about everyday life.
3. The person will usually try to stop these thoughts (e.g. through compulsions).
4. The person recognizes that the obsessional thoughts are a product of his or her own mind, and
are not based in reality. Because obsessions are distressing, individuals with OCD attempt to
ignore or suppress the obsessions or to neutralize them with another thought or action (i.e., a
compulsion).
Examples of obsessions​:
1. Aggressive (or harm) obsessions, such as thoughts of harming old people or children or
relatives (I will push an elderly man under the oncoming train; I will stab my mother; I will
throw rocks at children) or thoughts of harm coming to relatives/friends (my parents will be
brutally assaulted by an intruder). Many of these harm obsessions involve violence.
2. Sexual obsessions include: fear of inappropriate acts or gestures (“I will sexually molest a
young child; I will expose myself in a public place”), and repeated images of sex with
inappropriate partners (“I see myself having sex with a religious figure; I experience sexual
thoughts about my sister/brother, mother/father”). Sexual obsessions are more common among
men than women.
3. Blasphemous (meaning: an act of cursing God): obsessions include: a fear of making
sacrilegious (violation of anything that is scared) gestures in a holy place (“I will shout foul,
obscene language in church”), the pollution of prayers or other rituals by impure, disgusting
thoughts (the intrusion of foul language during prayers).
4. Contamination obsessions: Some people with OCD fear contamination, whether from dirt,
germs, certain illnesses (AIDS, rabies), bodily wastes or secretions (urine, feces, saliva).

Compulsions (repetitive behaviors or rituals) are defined by:

1. Repetitive behaviors (e.g., hand washing) or mental acts (e.g., praying) that are performed in a
rigid and ritualistic manner.
2. The compulsions are aimed at reducing distress; however, these compulsions are not based in
reality.
Examples of Compulsions/Rituals:
Five main types of rituals (Antony et al., 1998):
1. Reading again and again: Reading and rereading things for hours, excessive worrying that one
didn’t understand something one read, excessive writing and rewriting things, repeating routine
activities-going in and out of doorways.
2. Ordering/arranging: Arranging items in a certain order-books, pencils, cupboards
3. Counting: Counting items-books on a shelf, ceiling tiles, cars going by;
4. Cleaning: This my include washing rituals and may vary from mild (15 to 20 minutes washing
hands after going to the bathroom) to more extreme behaviour such as going as washing hands
for hours everyday to the point that the hands bleed.
5. Checking: These may also vary from relatively mild such as checking all the lights, appliances
and locks two to three times to very extreme such as going back to an intersection where one
thinks that one may have run over a pedestrian and spending hours checking for any signs of the
imagined accident.

Distinctions between OCD and GAD

A common source of diagnostic confusion arises from the overlap between obsessions and
worry. For instance, it is not immediately apparent whether an adolescent repeatedly
experiencing intrusive cognition regarding his mother getting into an automobile accident is
obsessing (suggesting OCD) or worrying (suggesting GAD). Following are the most common
distinctions (Andrews, 1994):
• Unlike obsessions, ruminations (worry) are not repetitive.
• Individuals suffering from GAD are primarily concerned with everyday issues (e.g. family,
health), whereas OCD sufferers frequently report unusual themes concerning dirt and
contamination.
REVIEW OF RELATED LITERATURE

Prevalence and Incidence Studies of Anxiety Disorders: A Systematic Review of the

Literature (Julian M, Elliot M, and Paul Waraich, 2006)

The objective was to present the results of a systematic review of literature published between
1980 and 2004 reporting findings of the prevalence and incidence of anxiety disorders in the
general population. ​A literature search of epidemiologic studies of anxiety disorders was
conducted, using MEDLINE and HealthSTAR databases, canvassing English-language
publications. A total of 41 prevalence and 5 incidence studies met eligibility criteria. We found
heterogeneity across 1-year and lifetime prevalence rates of all anxiety disorder categories.
Pooled 1-year and lifetime prevalence rates for total anxiety disorders were 10.6% and 16.6%.
Pooled rates for individual disorders varied widely. Women had generally higher prevalence
rates across all anxiety disorder categories, compared with men, but the magnitude of this
difference varied. The international prevalence of anxiety disorders varies greatly between
published epidemiologic reports. The variability associated with all anxiety disorders is
considerably smaller than the variability associated with individual disorders. Women report
higher rates of anxiety disorders than men. Several factors were found to be associated with
heterogeneity among rates, including diagnostic criteria, diagnostic instrument, sample size,
country studied, and response rate.

Salzman, L., & Thaler, F. H. (1981). Obsessive-compulsive disorders: A review of

the literature. ​The American Journal of Psychiatry, 138​(3), 286-296.

Reviews studies on obsessive-compulsive disorders published from 1953 to 1978. Various

theories of the etiology of the disorders are reported, and an overview of the studies based on
these theories is provided. The treatment modalities covered include behavioral modification,
drug therapy, psychotherapy, surgery, and experimental therapies. It is concluded that although
the obsessive-compulsive disorders are widely present, there is a paucity of new data concerning
their treatment. The evidence to date, however, suggests that psychotherapy is an essential
ingredient in the treatment process. It is recommended that further clinical studies be done to
elucidate the etiology and treatment of these disorders.

​Twin Studies on Obsessive–Compulsive Disorder: A Review, Daniel S, Danielle C,

Aartjan T, and Dorret I. (2012)

Genetic factors have historically been thought of as important in the development of

obsessive–compulsive disorder (OCD). For the estimation of the relative importance of genetic
and environmental factors, twin studies are an obvious approach. Twin studies of OCD have a
long history, starting in 1929. In this review, over 70 years of twin research of OCD is presented,
using four different approaches that represent the steps in the twin research of OCD from past to
present. These steps include (1) case-studies of twins with OCD from the old literature; (2) twin
studies of OCD using ​Diagnostic and Statistical Manual of Mental Disorders​(DSM) criteria; (3)
twin studies of OCD using a dimensional approach, comparing resemblances in monozygotic
and dizygotic twins; and (4) twin studies of OCD using a dimensional approach, analyzing the
data with Structural Equation Modeling. It is concluded that only the studies using the last
method have convincingly shown that, in children, obsessive–compulsive (OC) symptoms are
heritable, with genetic influences in the range of 45% to 65%. In adults, studies are suggestive
for a genetic influence on OC symptoms, ranging from 27% to 47%, but a large twin study using
a bio- metrical approach with continuous data is still needed to provide conclusive evidence.

Symptom subtypes of obsessive-compulsive disorder in behavioral treatment

studies: a quantitative review, (​Susan G.Ball​ ,​LeeBaer​,​,​Michael W.Otto​ , 1996)

Recent reviews and meta-analytic studies have provided an encouraging account of the
effectiveness of behavioral interventions for obsessive-compulsive disorder (OCD). One
question regarding these estimates concerns their degree of generalizability to the range of OCD
subtypes encountered in clinical settings. The purpose of the present study was to provide a
quantitative description of the prevalence of various OCD subtypes (i.e. type of compulsions)
within the behavioral treatment literature. We examined 65 studies that permitted classification
of patients according to symptom subtype. Patients with primarily cleaning and/or checking
compulsions predominated, accounting for 75% of the treatment population. On the other hand,
patients with multiple compulsions or other compulsions, such as exactness, counting, hoarding,
or slowness rituals were underrepresented, comprising only 12% of the population, which is
markedly less than clinical epidemiological estimates. Rates of improvements in patients with
OCD are most applicable to patients with cleaning and checking compulsions, but may not yet be
generalizable to patients with other symptoms. These findings encourage studies of the efficacy
of existing and novel interventions for patients with counting, repeating, symmetry, hoarding, or
multiple compulsions in order to broaden the clinical application of OCD behavioral treatment.

In a study by ​Khanna ​et al.​ ​, 222 consecutive subjects were evaluated using the
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) symptom checklist and the Scale
for Assessment of Form and Content (SFC). The data was subjected to factor analysis
with varimax rotation. The main factors that emerged were washers, checkers, hoarding
and two pure obsession factors. The obsession groups had a preponderance of sexual and
religious themes. The findings are largely in concordance with those of studies from other
parts of the world suggesting similarity across cultures. The study, however, supports
separating obsessions from compulsions because two pure obsession factors emerged,
which is in keeping with the findings of the two previous studies. Three recent studies of
OCD in adults have also used the Y-BOCS to measure obsessive-compulsive symptoms.
The phenomenology of OCD in these studies is similar to that described in the western
population.

METHOD
Descriptive content analysis examines the quantitative and qualitative data collected through
methods as e.g. document analysis, interviews or surveys with the aim of summarising the
informational contents of these data with respect to the research question. The informational
content is presented in a straight and descriptive summary structured according to the needs of
the study.
It refers to a family of procedures for the systematic, replicable analysis of text. In essence it
involves the classification of parts of a text through the application of a structured, systematic
coding scheme from which conclusions can be drawn about the message content. By clearly
specifying the coding and other procedures content analysis is replicable in the sense that other
researchers could reproduce the study. Content analysis can be applied to all kinds of written text
such as speeches, letters or articles whether digital or in print, as well as text in the form of
pictures, video, film or other visual media.

Description of content
The House of Obsessive Compulsives
The content follows a experiment in attempt to cure suffers from obsessive-compulsive
disorders.
It is released by the channel ​only human​ on ​4 february 2017​.

ANALYSIS AND DISCUSSION

The documentary follows a ground-breaking experiment in attempt to cure suffers from

obsessive-compulsive disorders. It shows people with obsessive-compulsive disorders (OCD)
who agree to live together as part of a experiment in an attempt to cure them through a new kind
of accelerated therapy. Over the past 20 years, all three have tried medication, assorted therapies
and even contemplated brain surgery in order to rid themselves of their OCD.
It portrays the journey of three patients with different type of ocd, named Wendy , Sophie and
Gerard.

About the patients

Wendy 44-year-old woman who lives in Horsham, West Sussex, UK with her husband David
and is one of the three patients, who suffers from the most common obsessions which include
repeated thoughts about contamination and a fear ​that contamination might cause harm to herself
for the past 20-25 years. This also includes her compulsion to check everything multiple times in
order to reassure herself that she is not being contaminated.
She has a specific fear of contamination through shiny flakes of dirt, paint and glitters which
prevented her from touching her husband and their two twin children for 3 years.She also is not
employed and due to her illness is not able to carry out most of her daily work.

Onset of ocd
The normal obsessive tendencies can be triggered into fully blown OCD by an emotional trauma.
And in her case it is when she had a miscarraige around 20 years ago.She mentioned that after
reflecting upon it she realised that she is becoming very conscious and particular about keeping
the house tidy and ensuring that it remains neat and clean in order to feel that she has a control
over her life. Thus this mere incident and its after effects might have triggered her to become
obsessed over the thoughts of being harmed by contamination of germs, dirt and dust.

Sign and symptoms

Throughout the documentary we can see the signs and symptoms of her type of OCD include
both obsession and compulsion. Obsession can be seen in the form of her excessive thoughts and
worries regarding contamination. She thinks that engaging in a certain action will cause
irreplaceable damage to herself. Also she ​is aware of these intrusive thoughts and feelings and
does not want to have these ideas but she just can’t help it. ​However her compulsion includes
actions like checking multiple times a day and mental compulsions ( ​mentally reviewing events
that have a potential to harm her).With every action she does she feels more and more anxious.
And as we mentioned earlier this all become prevalent after her very first symptom that she
talked about ,during the traumatic experiance of miscarriage which led her become so particular
about keeping things tidy and clean all the time so that she can feel a sense of control over her
life .

Functioning
Other than this her daily life goes around , wearing gloves all the time , absolutely no physical
touch with anybody , checking every corner of the every cloth several times, she mentions that
because of her ocd she can't afford to touch anything with bare hands , cant cook , rarely goes out
and cant do even the simplest work such as opening the door , having a shower or picking up
post and to add to this she even sleeps wearing gloves. Not to mention she never shares her bed
with anyone.During packing her luggage , when can see that she even segregates each cloth and
puts it in different plastic bags so that they remain uncontaminated with dirt.She makes sure to
check her bed remains intact and free from even a tiny particle of dust. She avoids being in a
shared environment.

Treatment
Her case shows extreme effects of her ocd on her relationship with her husband and children and
on her daily life. The group of therapists designed a number of activities in order to cure her ocd
and lower her symptoms. She made to live in a house with other two ocd patient .She made
quite a few goals that she wanted to achieve like stop using tissues , having a shower, sleeping in
the same bed as her husband and treating each room of her house as same. And to begin with, the
first activity was given her is to perform a simple task of making coffee but with a condition of
working with bare hands and without using tissues to handle anything. During this process she is
being assisted by her fellow ocd patient sophie.She at last make through this and is able to fulfil
what she is been told to do. Although the major success of this activity can be contributed to the
fact that she is being able to touch sophie’s hand which is is actually her first physical touch in 3
years. However after some time touching sophies hand. she surely seem struggling coming to the
terms about what she has done. But the presence of her fellow ocd patients support make her
feel comfortable and proud of her achievement.

After this the team of therapists wanted to push wendy further more to deal with her fear of
glitters but this battle may be a one that is a little too far. She seem to be even get afraid by
looking at the glitter particles. However they started from a minor step by making her feel the
glitter over her palm. During this she mentions that at that very moment she feels to just get rid
of the glitter and wanted to escape , her heart starts to pound . but she holds up as this is the
reactional thing that is occurring and is natural. She deeply felt the particles of glitter in between
her palms and without being told touched her whole face and hair with that hand . After this
progress they made her had the glitter on the back side of her palm and than scatter it all over
her bedroom. The therapist felt that they are quite ahead with her case but that feeling does not
last long as the very next morning Wendy wakes up having a panic attack and extreme distress
and the enormity of what she has achieved began to sink.

However not wendy and nor the therapists lose hope to help her overcome her fears and
anxieties. She again was presented with another task which is to go for a grocery shopping all by
herself so that she can confront her fear of getting contaminated in a shared environment.
Although its tough on her as she starts losing concentration after becoming agitated by all going
around her. But after much difficulty she is being able to successfully complete her task.

The therapists planned a weekend trip back for them to their respective houses so that they can
felt the changes in them outside the control environment they are in now. However wendy does
not seem to come in terms with her going home. But this is a very crucial step in the therapy
after all this will decide whether the changes in them are going to sustain or not when they are in
their natural habitat. Windy though makes it , she send back to her home to her husband. Upon
reaching their she cant resist giving a hug to her husband , which he last received in the year
2002. She happens to sleep on the same bed as her husband , but the road does have bumps and
here her anxiety and panic attack again comes in waking her up at 3 am at night and resisting her
to sleep again peacefully. She is not being able to digest what she is doing. Every step further
bring a lot of anxiety to her.

But she is steadily making progress at each day. Other that day she decided to cook for her
family without the help of anybody and with touching everything from the crockery to the cutlets
etc. at this point when her second child came to meet her, she hugged him after 4 years without
being feeling hesitant. She indeed showed courage and bravery to stand up against her all fears
and anxiety related to contamination.

To bring a proper ending to the therapy, the therapists make them watch their previous
introduction video as an ocd patient. So that they can trace their progress and acknowledge their
achievements regarding what were they before and what are they now. Later interview of wendy
showed that she is now being able to do all of what a normal person can do.

About the patient

Sophie ​Morgan is a 31 year old woman who lives in Plymouth, Devon , the second patient who
also suffers from extreme ocd. She lives with her husband and has a rabbit as her pet. She
developed a very common form of ocd which is obsessive and compulsive in nature.

About her ocd

She is a compulsive washer , she would clean herself for upto 7 hours a day. She would spend 4
hours at doing her night time routine, and brushing till it starting bleeding. But even after giving
that much time in cleaning herself she always felt that it is not enough , she just cant stop the
urge to wash again to reassure herself.

Functioning
She enters the house with a goal of trying to combat her obsession so she can realise her dream
of having a baby. She shares that she has an rabbit , but is even afraid to fill the water container
for the him because she always feels that by somehow she is going to contaminate it. The fear
does not let her sleep peacefully , she always have thoughts that the rabbit is going to die and to
make sure this does not happen she spend almost 4 hours at night watching over him and is
scared to go to the bed. These thoughts feed her fears that she is not clean enough and is going to
harm everyone else including herself.

Onset of ocd
Soph lives with her husband , he is supportive that she has a condition but is concerned about the
growing distance between them as she tends to spend her most of the time cleaning herself than
to invest in their relationship. The onset of her ocd seems to became prevalent during her
puberty. However she is now 31 and the symptoms are just getting worse by each day.

Treatment
Her therapy began with making her touch the toilet flush first with bare hands which later moves
to toilet seat and at last ended up by making her touch the water inside the toilet.(all with bare
hands). Then after that she made to eat with that hand without washing it. This was readily done
to make her understand that even this extreme action of hers is absolutely not going to kill her or
anybody. But it is not true to say that she overcomes her fear as later after that her anxiety once
again kicks in . She felt that she is not clean. However later that night one more task was given to
her which is wrapping her night time routine in maximum 10 minutes for which originally she
would spend almost 4 hours and more till she feels she is clean abd germ free.

Second activity performed by her is babysitting two children one 14 months old and other 4
years. The basic idea behind this type of therapy is to make her to clear her mind so that she can
starts connecting the dots which lead her to her dream of having a baby. And to basically made
her to gain experience of responsibility and taking care of children and also to ensure to
demolish her fear of contaminating the other person which can be harmful for them.

The last task given to her was to dress up for a party which needs her to skip the night routine
and shower. She surely makes upto this without giving anytime to her ocd urges. To give a
proper end to all the things that has being able to bring out the changes in sophie life was done
by making her watch her own previously introduction video as an ocd patient , this is important
as this will make them understand what they being doing in their life by feeding all those ocd
symptoms, also this will make them aware of they have to work upon or what they have to avoid
in their future.She emerged as as a person for whom OCD is now not the problem in life. She
starts living her life fruitfully again with her husband and is eager to plan and invest in their
future ahead together. And at a end result of this sophie indeed is being expecting her first child.

About the patient

Gerard is a middle aged man, who lives in Lockerbie, Scotland with wife Sarah and is one of
the three patient, who suffers from the most common obsessions which include repeated thoughts
about confession for unimaginary crimes.He is what psychologists call a "classic ruminator" .

About their ocd

This compulsion is very uncommon in those with obsessive-compulsive disorder is the need to
confess. Confessions related to OCD can run the gamut from something as minor as confessing
to ignoring an acquaintance on the street to something as major as confessing that maybe you
committed murder by hitting someone with your car while driving. Not only is OCD tricky, but it
also has quite the imagination!So why do those with OCD often feel the need to confess? It is
because confessing is just another way to seek reassurance.

Functioning
Even he left his job of teaching because he do not have any contact with pen and paper. He also
suffer from sleepwalking, also known as ​somnambulism or ​noctambulism​, is a phenomenon of
combined ​sleep and wakefulness.​[1] It is classified as a ​sleep disorder belonging to the
parasomnia family. It occurs during ​slow wave sleep stage, in a state of low consciousness, with
performance of activities that are usually performed during a state of full consciousness. He goes
through comorbidity,comorbidity refers to the presence of more than one diagnosis occurring in
an individual at the same time.He keep himself tied with the strong chain in night while sleeping
as he has the fear that if he will not tie himself he would go to some one and confess for an
unimaginary crime.

Onset of ocd
He lives with his wife , she is not so supportive that she says many time” i often think i should
leave him because of him ,i am wasting my one complete life”.I feel so sad for gerry, his wife is
not even helpful, you can tell there is bitterness to her attitude. The onset of his OCD seems to
became prevalent during his schooldays when he was bullied by his own schoolmates.

The similar onset of OCD was shown in the case of Sumi mukherjee,one of the fine indian
author,The onset of my OCD occurred in May 1992 at the age of 16. For the first five years of
my mental illness, my single greatest struggle and obstacle became simply telling someone what
was going on. Before long, merely managing to function through an average day became the
greatest challenge of all. I was finally able to discuss this openly at the age of 21 in 1997, and got
started with the therapy and medication that I needed to defeat OCD. At last, I was able to
change my pessimistic perspective, willingly engage in cognitive behavioral therapy and begin to
make significant progress with my illness. During this time period, I was also able to look up and
confront my very worst bully from childhood. This most fascinating, revealing encounter helped
me to finally deal with the bullying and with the PTSD from my past. Eventually, I was able to
derive a lasting positive impact after spending only 16 days in Rogers inpatient treatment facility
- ​a positive impact that has lasted throughout the past several years of my life.

Treatment
His first activity was to write a letter to his wife,he faced lot of difficulties in writing the letter
for his wife by using pen and paper but after lot of struggle he became successful in writing and
he himself posted it to his wife.

Once the professor is confirmed that jerry is brave to confirm the fear of confession for the
unimaginary crime which he has not committed ,then he made to write on a piece of paper in
public that “I ran the woman over” then he made to tuch the paper on his body parts.He also
helped wendy to prepare her shopping list.

After seven days in the house the The therapists planned a weekend trip back for them to their
respective houses so that they can felt the changes in them outside the control environment they
are in now, he was little bit excited to go home.His wife said while they were having tea that
there is a pen which is switched on then he replied “thats not an issue for me, i m holding the pen
,i am on roll dear”.then he wrote his wife name on the paper lying there to confirm his wife that
there was no at all issue with him.

In the last gerry gave inspirational speech how he overcome with his OCD .Gerry has continued
to see paul for follow up sessions and he is doing much better.

Conclusion

The aim of the practical was to understand an anxiety disorder (Obsessive-compulsive disorder)
through use of secondary data (documentary). The documentary was analyzed qualitatively in
which, four themes were identified based on which the disorder was understood better in the
context of the documentary. The four themes were - Identifying the onset of the disorder among
the patients, analyzing the progression of the disorder, the present condition of the patients,
Treatment or method of treatment used and finally the situation or condition after the treatment.
The documentary was published on the YouTube channel "Only Human" with the title "House of
OCD". The documentary is about 3 people Wendy, Sophie and Gerard may look perfectly
normal but their lives are dominated by seriously weird behaviour. They face much problem and
distress due to their obsessive-compulsive disorders (OCD) which affects their day to day
functioning. House of OCD is a house, wherein they agree to live together as part of a
ground-breaking experiment in an attempt to cure them through a new kind of accelerated
therapy. The three put themselves in the hands of therapists from the centre for anxiety disorders
and trauma at the Maudsley Hospital in London, led by Professor Paul Salkovskis. He claims his
radical nine-day group-therapy approach can turn the obsessive into the ordinary. In the later part
of documentary treatment is given to 3 of them in group therapy which had positive results. The
three- Wendy, Gerard and Sophie’s journey to overcome the debilitating effects of their illness
proves more intense and surprising than anyone, including the, doctors, could ever have
imagined.

References
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disorders (3rd ed.). Washington, DC: Author.
● Barlow, D.H. (1987). The classification of anxiety disorders. In G.L. Tischler (Ed.),
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Cambridge Univ. Press.
● Hollander E, Allen A, Steiner M, et al. Acute and long-term treatment and prevention of
relapse of obsessive-compulsive disorder with paroxetine. Journal of Clinical
Psychiatry. 2003;64:1113–1121.
● Khanna S, Rajendra PN, Channabasavanna SM. Life events and onset of obsessive
compulsive disorder. International Journal of Social Psychiatry. 1988;34:305–309.
● Widiger, T. A. (1997). The construct of mental disorder. Clinical Psychology: Science
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● https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder
● https://www.youtube.com/playlist?list=PLxNRGjzMwCdzKgFCY_t0MwSxBZT7-72no
● https://www.webmd.com/mental-health/understanding-obsessive-compulsive-disorder-sy
mptoms
● https://www.medicalnewstoday.com/articles/178508.php