By Vanit Nalwa September 1998 Obsessions, compulsive acts and phobias are serious problems of the psyche that mere psychotherapy cannot cure An obsession is a recurring and involuntary thought, image, or impulse that evokes anxiety. People who are obsessed regard the thoughts senseless and even unpleasant, but are unable to stop or ignore them. Most of us do experience mildly obsessive thoughts, especially when we are tired or under emotional stress. These may take the form of a meaningless word, a catch phrase or slogan, or perhaps a snatch of melody that echoes endlessly in the mind. As long as these do not interfere with normal activity, they are harmless. However, severe obsessions cause serious mental discomfort and make productive work impossible. Most childish games and actions have an overtly obsessional element. Generally, growing up and exposure to normal social influences leads to their disappearance. But in some cases, obsessional traits become more pronounced and troublesome-especially when the child is raised in a household with an adult exhibiting such traits. Research, however, indicates that having an obsessive personality does not necessarily mean that you will develop an obsessive-compulsive disorder. Compulsions are recurrent actions that are generally performed in an attempt to dispel obsessive thoughts. But the effect is quite the opposite. As children, many of us have exhibited compulsions to count, trail fingers over railings or along parked cars, or step over cracks in the pavement. In most cases, socialization helps overcome these habits. However, it becomes a problem when the behavior pattern persists well into adulthood. Compulsions can have countless themes—from a need to check and recheck doors and windows to almost ceaseless rituals concerned with everyday affairs. In fact, recent studies in psychology have shown that most primitive rituals were reflections of mass obsessions. Phobia is a pathological fear of a particular class of objects or situations that are unrelated or even disproportionate to the threat they seem to present. Like obsessions or compulsions, many people have minor phobias that cause them some distress but do not obstruct daily life. It is only when the fear begins interfering with normal social functioning that it demands professional help. Specific or simple phobias, like the fear of a particular animal, do not cause any serious disruption in daily life. Such phobias usually originate from childhood impressions. Simple phobias are a form of learned response. People with such phobias have either been brought up by someone who has a similar fear or have had an early frightening experience that has become associated with the feared object or situation. According to experts, such phobias can easily be avoided if parents do not induce unnecessary fear in their child’s mind. In fact, a large number of obsessions and phobias can be nipped in the bud if you deal with such traits in your child immediately. This also gives a boost to your child’s self-esteem. Social phobias, commonly known as ‘stage fright’, begin in late childhood or early adolescence. People who experience this usually fear the scrutiny of others. Such people tend to be highly sensitive to criticism, and often interpret the actions of others as an attempt to humiliate them. Social phobias are also associated with depression and alcohol abuse. People with such phobias benefit immensely from training in social skills. The most common phobia—agoraphobia—starts during late teens or early 20s. It is the fear of getting hit by a panic attack in a public place. Panic attack is common to all phobias. It is a brief period of anxiety, often dominated by an intense fear of dying or losing one’s reason. Although they begin unpredictably, panic attacks soon become associated with places such as a crowded theater or a cramped lift. The symptoms begin suddenly and usually include a feeling of suffocation, chest pains, dizziness, sweating, and faintness. People who suffer from agoraphobia avoid places and situations where they feel escape would be difficult. As this fear becomes pronounced, the person limits himself to the few places where he feels safe. In severe cases, this ‘safe haven’ may be restricted to one’s house. Interestingly, when two people experience the same fear-inducing situation at the same time, one may develop a phobia while the other may not. This difference has been attributed to a combination of factors relating to heredity and environment. On visiting a therapist, most people who suffer from such conditions want to know whether their experiences are ‘strange’, or whether they indicate madness. When the therapist asks them questions that correctly anticipate some of the symptoms, their fear of being strange is largely assuaged. Often, the mere grasp of a person’s plight is a great source of comfort for him. Obsessions, compulsions and phobias may be seen as habits, which, once ingrained, do not require a further stimulus to be maintained. Research indicates that these conditions may not generally be relieved by interpretative psychotherapies such as psychoanalysis. However, treatment that focuses on changing an individual’s behavior could be effective. One such therapy is behavior modification. It is based on two basic principles: that exposure to the feared experience will render it less threatening; and that desirable behaviors can be encouraged by rewards. Many obsessive-compulsive people feel more anxious after completing their rituals than if they are prevented from carrying them out. Keeping this in mind, a behavior modification therapist helps the affected person in avoiding ritualistic activity by exercising self-control or carrying out alternative activity. While treating a compulsive hand-washer, for example, the therapist first persuades him to increase the period between washing his hands and always perform the compulsion with somebody close by. If, along with behavior modification, the person is also taught how to for deal with stress, the progress is faster. Modeling is yet another method often used in treating compulsions. In this method, the therapist demonstrates to the person that his or her obsession is quite harmless. For example, a compulsive handwasher consistently fears contamination. To combat this fear, the therapist may handle something that is ‘contaminated’, say an object that fell on the floor, and then carry on normally without washing hands. If the person is now asked to handle a similarly ‘contaminated’ object, he or she is initially tempted to carry out the compulsive behavior. But with increased exposure to such modeling, a change is gradually effected. Anti-anxiety medication only helps provide temporary relief from the symptoms in the case of obsessions, compulsions, and phobias. The cure for such behaviors comes only from therapies that help dissociate the action from the feeling. In fact, if you are aware of obsessional tendencies in you, you could build up your life around it and use it to good effect. After all, most geniuses—Einstein, van Gogh, Dali etc—could be termed clinically obsessive personalities! The crux is that you should be aware of your responsibility to yourself. The solution has to come from you alone—a therapist will merely show the way. The author is a neuropsychologist, a personal enrichment trainer, and a practicing hypnotherapist
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