Posted by Amelia_in_StPaul on June 27, 2009, at 0:01:29
In reply to med to prevent instability?, posted by garnet71 on June 26, 2009, at 2:18:31
Sorry to be posting so much, but if there is one thing I know, it is OCD, and it is OCD centered around fears of becoming psychotic.
Two more things:
1. At your age, and I'll just say this once (b/c of the reassurance thing I talked about, above) you are probably less than 1% likely to get a psychotic disorder like schizophrenia.
2. To back up what I was saying about OCD NOT being about internal conflicts or denial, and about what DOES cause it:
Dr. Claiborn, an expert in OCD, on psychodynamic theories of OCD:
"The assumption behind psychodynamic approaches is that the problems we see such
as obsessions are the result of some underlying conflict or other problem. This
leads to the idea that it is necessary to get at these underlying reasons to
properly treat the problem.There are several problems with this model. One is that no one has ever
demonstrated that such hidden conflicts exist in the first place much less are
the cause or otherwise related to the symptoms we observe. Second there is no
evidence that therapy designed to uncover the supposed causes works to reduce
symptoms. Third there is good reason to believe that the material "discovered"
in psychodynamic therapy is not an accurate representation of things that
actually happened and the supposed conflicts that are uncovered may have been
fabricated to satisfy the therapist. The psychodynamic model would predict that
if the underlying conflict is not dealt with that symptoms should reappear
albeit perhaps in a different form. This problem of symptom substitution is
predicted but not found suggesting the theory is wrong. People are very capable
of making connections in their head and to some extent this is what makes
intrusive thoughts a problem. People make connections and assume meaning. The
more effort we spend trying to identify this meaning the more we believe it
exists and is important.I have repeatedly written here about the fact that the content of intrusive
thoughts observed in the general population is indistinguishable from the
content of obsessions. This supports the idea that obsessions are actually
normal intrusive thoughts that people react to in a dysfunctional way. As a
result it doesn't make sense to try to figure out the underlying meaning of the
thoughts as there is none. In fact trying to figure it out is likely to
reinforce the idea that they are meaningful. Since believing they are meaningful
is part of the problem in OCD this type of therapy would seem to risk worsening
OCD.
--
Contrary to popular opinion, meaning is not discovered. It is not something
lying around on life's road waiting to be tripped over. One makes meaning.
E Davies & J BurdettJ. Claiborn Ph.D. ABPP"
About causes of OCD, from another expert, Dr. Grayson:
"In worldwide epidemiological studies, the rates of OCD tends to be roughly
the same. I believe the underlying core of OCD is difficulty coping with
uncertainty. Not uncertainty in every part of life, but in the focus of the
symptoms. Generally, sufferers are seeking absolute certainty in their
problem area, e.g., there is no chance my hands are dirty; how can I be sure
I won't kill my wife tonight; are these thoughts evil and am I evil; is the
door locked? Underlying the attempt to be absolutely certain are the feared
consequences of what failing to ritualize might mean or lead to. These
aren't obvious from the symptoms. For example, with contamination, the
issue may be that I don't want to be dirty, I'm afraid of getting others
sick, a thought that I don't like will stay with me if I don't wash and then
there are different reasons I don't want that thought. The consequence can
simply be that I don't want the thought in my head, because I hate it.In looking at the parts of the brain that seem to play a role in OCD, it
does seem to be an area that for all people responds to uncertainty.
Presumably, the threshold for feeling discomfort in response to uncertainty
is lower for sufferers. However, learning is involved, since sufferers have
no difficulty with uncertainties that are not part of their symptoms. It is
for this reason that medication alone doesn't work. Medication may work on
the underlying biology, but it is not touching learning.As to why OCD would survive in the gene pool - it does seem that most
sufferers have 3 traits that we can't change. Most sufferers are above
average intelligence. This is one of the reasons they can't be 100%
certain. Most sufferers are creative, since the core of creativity is
saying what if. In normal what iffing, the individual considers all
possibilities without demanding an definite answer. In OCD, the suffer
says, 'what if. no! That isn't acceptable.' What one needs to remember
about creativity is that this trait does not exist to create art, but is for
survival. For primitive man creativity asks: where is the tiger and how can
I make sure it doesn't eat me? In the modern world, survival isn't only
physical, but mental. Some sufferers feel like OCD always attacks what is
important to them. They are right, because they are exploring what is
important to them, considering how to lose it and then rather than trying to
cope with that possibility try to do the impossible of attaining absolute
certainty. The third trait is imaginative, which means being able to think
about something so vividly that it feels real. Sufferers scare the hell out
of themselves. These three traits are not OCD, but are misused by their
OCD.Take care,
Jonathan Grayson, Ph.D"
poster:Amelia_in_StPaul
thread:903272
URL: http://www.dr-bob.org/babble/20090620/msgs/903402.html