On the Nature of Obsessions and Compulsions

Slatman, Jenny; Rietveld, Erik; Denys, Damiaan

doi:10.1159/000351929

Cited by 16 publications

(12 citation statements)

References 19 publications

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“…Along the same line, participants also report being more easily annoyed, impatient, aggressive, or disinhibited. This seems to be a gradual phenomenon with on the one extreme an anxiety induced inhibition and (hyper)reflectivity; being overly controlling and deliberative [ 8 ]. Becoming less anxious, and more unreflective than leads to a welcome increase of openness, spontaneity, and directness.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients: In-Depth Interviews with 18 Patients

et al. 2015

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Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study. We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c) characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research.

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Section: Discussionmentioning

confidence: 99%

“…That is, until the tension or anxiety have tempered or patients feel the action is ‘completed’ [ 6 , 7 ]. Moreover, compulsions need to be performed with uttermost attention and focus: these are not mindless automatisms, but highly controlled rituals [ 8 ]. In case patients get distracted, they even need to start all over again.…”

Section: Introductionmentioning

confidence: 99%

Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients: In-Depth Interviews with 18 Patients

et al. 2015

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“…We suggest that one of the processes that maintains and aggravates this imbalance is what we call the “ hyper-reflexivity trap ” (De Haan et al, 2013). Hyper-reflexivity (Frankl, 1946/2009; Laing, 1960/1990; Sass and Parnas, 2003; Fuchs, 2011b) refers to the exaggerated tendency to reflect on or pay conscious awareness to what one is doing—not afterwards (like ruminations) but rather during the performance itself.…”

Section: What Is Obsessive-compulsive Disorder?mentioning

confidence: 99%

“…In the case of OCD patients, we can indeed see such a negative spiral at work. The “hyper-reflexivity trap” proceeds through several stages (De Haan et al, 2013): First, there is the feeling of tension: the feeling of having insufficient grip.This feeling leads to attempts to regain control through deliberation (What might have gone wrong? What might go wrong in the future?…”

Section: What Is Obsessive-compulsive Disorder?mentioning

confidence: 99%

The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model

Slatman

Rietveld

Stokhof

et al. 2013

Front. Hum. Neurosci.

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136

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People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10% of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). DBS involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioral measures of the severity of the symptoms. In this article we aim to capture the changes in the patients' phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients' experience of the world. We propose to specify the patients' world in terms of a field of affordances, with the three dimensions of broadness of scope (“width” of the field), temporal horizon (“depth”), and relevance of the perceived affordances (“height”). The second aspect is the person-side of the interaction, that is, the patients' self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take toward the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment.

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“…OCD can be a highly disabling disease, with patients spending almost all of their waking time on their obsessions or compulsive behaviours. Patients’ insight into the irrationality of their behaviour even adds to their suffering [22]. The World Health Organisation lists OCD as one of the twenty most disabling diseases [23].…”

Section: Introductionmentioning

confidence: 99%

Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations

et al. 2017

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Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality.

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On the Nature of Obsessions and Compulsions

Cited by 16 publications

References 19 publications

Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients: In-Depth Interviews with 18 Patients

Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients: In-Depth Interviews with 18 Patients

The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model

Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations

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