Obsessive Compulsive On Disorder

This essay will analyses two types of mental illnesses. We will evaluate Obsessive compulsive disorder and Boarder-line personality disorder. There will be an assessment of the treatment techniques, in-depth scrutiny of interview questions with patients, and a break down description of the demographics and DSM-5 criteria that must be met for each disorder. Patients must meet criteria described in the DSM-5 in order to be diagnosed with Obsessive Compulsive Disorder (OCD). In the DSM-5 the criteria is broken down into four categories which must be met.

“The presence of obsessive thoughts, images and impulses.” (APA. 2010) is the first criteria. This is subcategorized by explaining that the intrusive thoughts may not be worry about every day stressors.

Even though the intrusive thought may be about something irrational the patient must not be able to cope with the intrusive thoughts. The intrusive thoughts must also cause anxiety and dysfunction in everyday life. NOCD patients must present compulsive or repetitive behaviors, (APA.2010) typically this may include excessive handwashing, organizing and checking while the patient feels an “urge” to perform the tasks.

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The patient must feel that the task will relieve stress or prevent some scenario from happening. The last two criteria that must be met are self-explanatory and do not have sub categories. The patient must “recognize the behaviors as excessive or unreasonable”. The “obsessions or compulsions must occupy significant amounts of time and interfere with a person’s life”. While is diagnostic criteria is a guideline an interview with a suspected patient must be conducted in order to conclude a proper diagnosis.

In an interview with two individuals a line of questioning was asked in order to understand the complexity of OCD. The following summary of the questions were chosen because these patients present themselves as seemingly normal people. They may struggle with the OCD but answer the following interview questions with positivity. Laura and Marna are friends that both have OCD. Their symptoms may be somewhat similar but the obsessions and compulsions they express are unique to them individually. When asked to give an example of how Marna may have a problem making decisions. Marna explained that no matter the day, bad or good the process for her has always been complex. As a young girl she began to have difficulty in decision making even with the simple task of picking out clothes to wear. Marna would obsess about what she was to wear the next day until the peak hours of the morning.

In order to process the thoughts in her mind she would have to force herself to “pair down all the choices”. Marna has only recently found a way to systematically prepare uniforms for herself so she would not have to make a decision day to day. Under those circumstances Marna has difficulty with simple tasks like going to the grocery store. She describes this experience as problematic. Marna often avoids grocery shopping because of the extreme anxiety if causes. In the “insight to the disorder” theme the question is asked if they are aware that the compulsive behaviors are irrational. Marna expresses the difficulty she has with the specific task of picking out something to wear. Equally, Laura’s obsessive tendency to check tags and check paper work consumes most of her time which causes her to be unproductive in other areas of life.

In both cases of Laura and Marna the women recognize the irrational behaviors and attempt to process themselves out of the cycle. This practice is acknowledged to be successful only some of the time. The factors the make their OCD worse are just as complex as the disorder itself. In the interview Laura answers reluctantly on how other people affect her OCD behaviors. Laura makes it known that positivity is her best coping mechanism and although she may be embarrassed by family members calling her out on her behaviors she accepts scrutiny in stride. The treatment for OCD has developed greatly over the past few decades.

During the 1980’s antidepressants and anti-anxiety medications were found to greatly reduce obsession and compulsions. Statistically these SRIs (serotonin reuptake inhibitors) showed relief in 20% of patients. At the same time, the same percentage of patients reported no relief. Although these statistics show that SRIs alone provide little relief. Medication combined with psychotherapy has proven effective for patients to reach remission. Cognitive-behavioral therapy has been the favored method for psychotherapy. In cognitive-behavioral therapy the techniques of exposer followed by response prevention is a common practice. For example a patient may be exposed to the certain stimulus in order to provoke anxiety or the unwanted behavior. Without delay the therapist implements practices of prevention during the prolonged exposer

Borderline Personality Disorder

The Traits that describe Boarder-line personality disorder (BPD) is complex and different for each individual. BPD has a group of emotional and behavioral traits that include impulsivity, anger, and self-destructiveness. These traits destroy a person’s interpersonal relationships and sense of self in society. The DMS defines BPD in a number of traits which are divided into five categories. Emotional traits consists of extreme mood swings that last a few hours. Moods much include “anger that is inappropriate intense or uncontrollable” Behavioral traits include self-destruction including self-mutilation and suicidal ideation or intention. The traits involving identity are expressed by an instability in the patient’s identity including self-image, sexual orientation, career choice and long-term goals.

Relationship traits are intense, chaotic and unstable in which the patient makes frantic efforts to avoid abandonment. Common life stressors can trigger a patient causing short-term dissociative thought and actions.  Demographics show that approximately 1-2% of the population fit the criteria for BPD in some point of a person’s life. Diagnosis for BPD is often coupled with depression symptoms, anxiety disorder and a range of substance abuse. Though there is extensive disagreement between clinicians, when it comes the symptoms and expression of BDP the DSM has been revised in order to include a wide range of symptoms to solve debates. The DSM includes specific symptoms but one must remember that the symptoms expressed can overlap into other personality disorders including narcissistic and paranoid personality disorders.

Even with advances in treatment, research has found that 50% of patients with BPD fit the criteria for the disorder for at least seven years following the original diagnosis. Even though a prognosis for BPD may seem unfavorable most patients with the disorder are clever, outgoing, and well liked among peers. The underlying issues that many patients have are reports from childhood physical and sexual abuse. This common factor has found to be a pattern among patients diagnosed with BPD.  In an interview the following patient divulges her deep thoughts regarding childhood experiences, thoughts on self-mutilation and identity. Becky which has been diagnosed with BPD when she was 24 year old gives an outward personification that is collected calm and caring. What she doesn’t show and discloses to be a regular kept secret is the rages, losing control of her mood impulsivity and she loss of identity.

All the while Becky has been accepting treatment and continues to try and progress in a healthy and sustainable manner. As a child Becky describes herself and “needy” for attention and admits to a tendency tell “fibs” out of impulse to receive the attention she says she craved. Becky states she struggled with religious identity while in high school and wanting a sense of self that she belonged to a certain group of people. In regards to the cause of her mental illness Becky discusses her relationship with her mother. Becky describes her mother as manipulative and says that because of her mother’s unconventional tendency to divulge too much information to her as a child caused some of her BPD symptoms. The treatment that Becky has received has been positive.

Though, at times her patient therapist relationship could be considered unorthodox Becky shows improvement in processing her episodes of mania. The techniques used to treat a patient with BPD is one of strategical matter. Patients with BPD often have a hard time trusting people therefore the therapist must set an understanding of open and honest communication. In therapy sessions there may be misunderstandings and since a patient with BPD has difficulty processing miscommunication, the problem must be resolved as soon as possible. The therapist must set concise expectations for the patient which instills simple positive-reinforcement techniques. Therapist must keep in mind that a patient with BPD can have demanding and sometimes aggressive behaviors along with expressions of “splitting”. Therefore it is common to have two separate therapists working with the same patient with BPD.

This practice is used because when the patient gets hostile toward one therapist, they can open up the different one that knows the case. The most successful types of therapy for BPD have been drug therapy and dialectical-behavioral therapy. The most common type of drug therapy chosen by psychiatrists has been SSRI’s even though they have mixed reports on the effectiveness of the medications. Dialectical-behavioral therapy focuses on regulating emotions as well as learning how to cope with distress and negative emotions. Patients learn how to be mindful and in the present moment. Among these practices patients learn how to communication and interact in a proper manner with others.

These disorders exhibited complex diagnosis and intricate treatment techniques required from therapist and clinicians. Obsessive compulsive disorder can be debilitation when a patient feels as though they cannot function properly unless they perform their practices. Luckily, research has advanced findings over decades and has opened doors for treatment leading to remission. Borderline personality disorder may still have substantial development to make in the matter of understanding the complexity of the disorder, all things considered the treatment for BPD has made headway in the psychotherapy practice.