Obsessive Compulsive Disorder Essay

Case Study in Obsessive-Compulsive Disorder
Institution:
Course:
Instructor:
Name:
Date:
Case Study in Obsessive-Compulsive Disorder
Introduction
Ridley Scott’s Matchstick Men (2003), is a film about high profile tricksters. The main protagonist, Roy (played by Nicolas Cage), is a con artist who also suffers from Obsessive-Compulsive Disorder and Tourette’s syndrome. Other than the highly twisted story of conmen, Matchstick Men presents a personal experience and struggle of Roy as a victim of a serious mental illness. This research paper uses Matchstick Men’s character, Roy Waller, as a basis in investigating Obsessive Compulsive Disorder.
Since he divorced his wife 15 years ago, Roy has been avoiding all forms of romantic and even social relationships. The only contact in his social world is Frank, his partner in con escapades. Roy, though in his middle ages, does not care much about what is happening in the society. He prefers a lonely life and playing by his own rules. Roy is aware of his mental illness and has been depending on prescribed medication and smoking. He has been experiencing various obsessive-compulsive symptoms which have highly compromised his life. Such symptoms include a desire for order, hygiene, and cleanliness, and a habit of opening and closing doors thrice before walking past them. Roy normally counts loudly as he opens and closes the door. Facial tics and audible grunts are common with Roy, but their frequency and intensity increase when he is stressed, anxious, or in a state of panic.
Over the years, Roy has been struggling to cope with his mental illness on his own. But the appearance of his “teenage daughter” was a new dawn in his life. Besides his past troubled marriage and a long period of time without any romantic relationship, Roy managed to find love and marriage with a cashier, with whom they are expecting their first child. He has been on medication and his obsessive-compulsive symptoms have remarkably decreased. He has been trying to focus on the positives in his life, family, and work. However, he at times finds it difficult to control his need for orderliness, both at home and work. Roy finds peace in a clean and well-organized environment, failure to which he becomes uneasy and unable to act normal. In most cases, he finds himself conducting duties that are not meant for him while seeking cleanliness and order he desires. He does not want to ruin his current marriage or jeopardize his employment as a result of his mental illness. He, therefore, has come to therapy to seek help on how he can cope with his obsessive-compulsive symptoms and relate appropriately with his family and the society in general.
Diagnosis
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), OCD is characterized by consuming thoughts and beliefs that eventually lead to uncontrollable and repetitive behaviors known as compulsions (Ameringen, Patterson, & Simpson, 2014). Under OCD, the brain commits itself to rituals so as to reduce or completely prevent further straining. According to Nolen-Hoeksema and Rector (2015) victims of OCD experience several obsessive behaviors, which include fear of exposure to contamination, somatic obsessions, and extreme need of symmetry. Roy reported his checking and counting behaviors (opening and closing of doors three times), compulsive need for cleanliness, agoraphobia, and panic attacks and nervous tics when under stressful situations.
Patients diagnosed with Obsessive Compulsive Disorder cannot effectively control their intrusive thoughts. Normally, fear and anxiety are elements of their thoughts. While studying brain’s inhibition of fear memories, the hippocampus and prefrontal cortex (PFC) are the parts of the brain which are essential for fear conditioning and extinction. Fear extinction involves the formation of a newer and safer memory with abilities to override the older traumatic one. An anticipation of fearful occurrences is due to an activation of the amygdala while increased glucocorticoids trigger CRH which in turn creates anxiety (Hauser, Eldar, & Dolan 2016).
On Axis I, exhibits multiple symptoms classified under Anxiety Disorder, Obsessive-Compulsive Disorder. Other than the repeated opening and closing of doors, Roy exhibits a compulsion for orderliness and hygiene. He can only eat tuna from the can. It is unusual for him to clean, wrap, and dispose the can after eating. He cannot withstand a leaf in his pool or even a strand on his carpet. He is bothered by minor issues while neglecting a greater part of his life. These can be illustrated by the vast number of cleaning products neatly arranged. On the same axis, Roy has agoraphobia as characterized by panic attacks which disfigure his reality. On Axis II, he might be having a Mild Schizoid Personality Disorder. He prefers being alone most of the time. He is very detached from the society and other pleasurable activities to an extent of not even having a television in his house. He is always emotionally cold to those around him. However, Roy does not exhibit any behavior related to Mental Retardation. He has a very fast speech with long pauses in between. But this cannot be attributed to his IQ level. Similarly, there are no significant medical aspects that can be attributed to Roy’s illness on Axis III. On Axis IV, which refers to psychosocial and environmental relationships, Roy might be having a challenge while relating to his social environment. He prefers or rather lives a lonely life with little social support. He experiences a hard time when trying to cope with the presence of his estranged daughter. His antisocial life could be also be attributed to the nature of his profession because he finds no happiness in stealing from others. But there is a close positive relationship between OCD and depression, which indeed affects the quality of OCD patients. Therefore, Roy’s OCD condition could have deteriorated his quality of life, and his depression and distress escalated the severity of his OCD eventually.
Other than the obsessive-compulsive symptoms, Roy also exhibits behaviors that illustrate Tourette’s syndrome. Tourette’s syndrome is a neurological condition expressed by unconscious random gestures, movements, and sounds referred to as tics (Ameringen, Patterson, & Simpson, 2014). In most cases, tics develop during childhood. If a child is diagnosed with Tourette’s syndrome, he or she is likely to have obsessive-compulsive disorder. However, tics are for calming oneself, especially during uncomfortable feelings or sensations. They are involuntary responses making it difficult for most people to identify theirs. In our case, Roy exhibits tics and grunts as a response to his increase in anxiety levels. It is also clear that the severity of his condition reduced after he abandoned his criminal life and finds a meaningful relationship.
Origins
Neuroimaging technologies show that various parts in the brains of OCD patients work differently compared to those of normal people. According to research, OCD symptoms are as a result of malfunction in various parts of the brain’s communication system. The brain parts involved are the thalamus, the striatum, the orbitofrontal cortex, and the anterior cingulate cortex. The communication errors in the brain also involve neurotransmitter systems, that is, the chemicals that transmit messages between brain cells. However, there has been no definite cause of or cause of OCD. Most studies suggest that OCD condition result from an interaction of various factors. They are genetic, neurobiological, cognitive, behavioral, and environmental factors that predispose a particular individual to develop the disorder.
According to a research by Hauser, Eldar, and Dolan (2016), several psychiatric disorders including OCD might occur due to a rare mutation of the human serotonin transporter gene (hSERT). In the event of a second variation of the same gene, severe OCD symptoms are witnessed. In their study, Gillan et al. (2015) found out that about a quarter of OCD patients have at least one family member who suffers from the obsessive-compulsive behaviors. Similar studies were carried out on twins. If one of the identical twins is diagnosed with OCD, there are high chances of the other twin having the same condition. But this is not the case with fraternal twins. Based on the twins’ studies, it can be argued that genetics is responsible for developing OCD by about 50%. However, Roy does not mention any incidence of OCD amongst his family member. Genetics is thus less likely to be a contributing factor in his OCD case. Having dismissed genetics, a number of other factors including behavioral, cognitive, and environmental factors, might be the reason behind Roy’s disorder.
According to the behavioral theory, OCD patients link certain events, situation, or objects with a particular fear and anxiety. As a result, they tend to avoid whatever triggers their fear and/or engage in certain activities that help them subdue their fear. It is a psychological perspective with an assertion that patterns of fear and avoidance or ritual are likely to develop when individuals are in straining moments, such as moving to a unfamiliar neighborhood or terminating a relationship (Hauser, Eldar, & Dolan, 2016). During such moments, those involved are more vulnerable to fear and anxiety. At this moment, the things or situations they once termed as “neutral” or “normal” became their sources of fear. For instance, an individual who has always been able to drink tap water may when under stress, associate the tap water with a fear of contracting a disease. Once OCD patients associated certain items with a feeling of fear, they try as much as possible to avoid those items instead of confronting or tolerating the fear. Individuals who associate public toilets with a fear of catching an illness will always avoid using them. In the event that they have no choice other than using them, they will perform particular cleaning rituals. For example, they may clean the toilet seat or door handles or any other detailed washing procedure. The behavioral theory best explains Roy’s cleaning habits. However, there is no evidence of what causes his fear of dirt or why he is obsessed with cleanliness.
On the other hand, the cognitive theory is used to explain the tendency of misinterpreting thoughts in individuals with COD. Intrusive thoughts experienced by OCD patients are similar to those of most people. If a mother, for example, is under severe stress as a result of caring for a child may develop uninvited thoughts of harming or doing away with the infant. It is an unusual thought which most people would be able to quickly dismiss and forget. It might not be the case with those prone to developing OCD. People with OCD might perceive the thought in an exaggerated way and respond as if the thought is a real risk. They perceive themselves as threat because of their harming thoughts. As a result, the thought triggers anxiety, shame, and other negative feelings in them. Those who are afraid of their own thoughts console themselves by avoiding situations which trigger such thoughts or by participating in activities such as cleaning or other ritual behaviors. This explains why Roy avoided any form of romantic relationship for about 15 years since he divorced his wife, whom he suspected was expectant with his child. He purposely avoided romantic relationships for they sparked certain traumatic memories related to his past relationship. It is evident that Roy’s obsessive-compulsive behaviors including cleanliness and orderliness are rituals or avoidance mechanisms of avoiding thoughts of his past marriage, which he considers as catastrophic. Most likely, Roy interprets his thoughts on his past marriage as an “exaggerated responsibility” towards its end. He has a strong belief that he is responsible for not preventing the divorce from happening in the past place. He believes that he is a...