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Helping the patient maintain independence after professional community support has been discontinued was a primary objective from the initial treatment planning.
The symptoms of obsessive-compulsive disorder (OCD) are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, American Psychiatric Association [APA] 1994), an American diagnostic tool used widely by mental health teams.
Obsessions are defined as "Persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. The most common obsessions are repeated thoughts about contamination, repeated doubts, a need to have things in a particular order, aggressive or horrific impulses and sexual imagery. The thoughts, impulses or images are not simply excessive worries about real life problems and are unlikely to be related to a real life problem. The individual with obsessions usually attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action (i.e., a compulsion). For example, an individual plagued by doubts about having turned off the stove attempts to neutralize them by repeatedly checking to ensure that it is off' (APA ,1994).
Compulsions are defined as "Repetitive behaviors or mental acts the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification. In most cases the person feels driven to perform the compulsion to reduce the distress that accompanies an obsession or to prevent some dreaded event or situation. For example, individuals with obsessions about being contaminated may reduce their mental distress by washing their hands until their skin is raw. Compulsions are either clearly excessive or are not connected in a realistic way with what they are designed to neutralize or prevent. The most common compulsions involve washing and cleaning, counting, checking, requesting or demanding assurances, repeating actions, and ordering" (DSM, 1994).
The behavior is not an end in itself but is designed to produce or prevent some future event or situation. The individual generally recognizes the senselessness of the behavior and does not derive pleasure from carrying out the activity, although it provides a release of tension."
In most cases, people who have been diagnosed with OCD are fully aware of how unreasonable their thoughts and behaviors are but are unable to...