Obsessive compulsive disorder & religiosity

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  • 1. Obsessive compulsive disorder and religiosity Dr. Syed Faheem Shams Post graduate student Dept. of Psychiatry, BSMMU

2. Objectives Understand religiosity When it is OCD? Relation of OCD and religiosity Evidence based discussion Scrupulosity Management 3. Case scenario A 35-year-old female from Rangamati was raised as a nonpracticing hindu, but became a Muslim about 10 years ago after marrying a muslim guy.The first five months of her born-anew life were blissful. Then she became increasingly scrupulous. She used to retreat into her room for hours at a time, committing to word-for-word memory about Quran 'Do you really think I'm saved?' She probably ask me that 10 times a day," says her husband. "I'd get frustrated. I felt like a broken record answering her questions. "It became a huge tormenting thing for me," she says. "I started fearing I was never converted or saved. I would have blasphemous thoughts, cursing God in my mind." 4. http://www.ocduk.org/types-ocd 5. What is religion? Religion is defined as the belief in and worship of a superhuman controlling power, especially a personal God or Gods (Oxford English Dictionary, 2006) 6. Ways to measure religiosity Religiousness Screening Questionnaire The Penn Inventory of Scrupulosity (PIOS) 7. Is there a link between religiosity and OCD symptomatology? 8. Religious perspectives 9. Muslims - washing is known as Wudu and is a form of ritual ablution. If a mistake is made, then the whole process must be begun again Faizan e Islam (2010). How to perform Wudu. Available at: http://www.faizaneislam.org/islam/how_to_perform_wudu.shtml This procedure display remarkable similarity to the ritualistic compulsive acts which characterize OCD 10. Christians may believe that their own private thoughts are equivalent to physical actions. This concept is known as moral thought-action fusion (moral TAF) and is thought to have originated from the Sermon on the Mount where Jesus said: Ye have heard it was said by them of old time, Thou shalt not commit adultery: But I say unto you, that whosoever looketh on a woman to lust after her hath committed adultery with her already in his heart (Matthew 5: 27-28, King James Version) 11. Judaism, especially ultra-orthodox sects, requires that the faithful live by an extensive list of laws which govern all aspects of life as laid out in the Shulchan Aruch (Karo, 1565 cited in Hermesh et al., 2003 p.201) If laws are not adhered to or not followed completely then obligations must be repeated until the law is fulfilled 12. Scrupulosity 13. John Moore (shown c. 16911703) was the first to describe the disorder, calling it "religious melancholy" 14. Scrupulosity is a psychological disorder characterized by pathological guilt about moral or religious issues. It is personally distressing, objectively dysfunctional, and often accompanied by significant impairment in social functioning Miller CH, Hedges DW. Scrupulosity disorder: an overview and introductory analysis. J Anxiety Disord. 2008;22(6):104258. 15. It is a type of OCD in which individuals obsessions focus on religious or moral fears, such as sin, divine retribution, and the implications of being an evil or bad person (Ciarrocchi, 1995; Purdon & Clark, 2005). 16. Scrupulosity is a recognized diagnostic criterion for obsessivecompulsive personality disorder American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th, text revision (DSM-IV-TR) ed. 2000 17. Several historical and religious figures suffered from doubts of sin, and expressed their pains Ignatius of Loyola, founder of the Jesuits, wrote "After I have trodden upon a cross formed by two straws ... there comes to me from without a thought that I have sinned ... this is probably a scruple and temptation suggested by the enemy." van Megen HJGM, den Boer-Wolters D, Verhagen PJ. Obsessive compulsive disorder and religion: a reconnaissance. In: Verhagen P, Van Praag HM, Lpez-Ibor JJ Jr, Cox J, Moussaoui D, editors. Religion and Psychiatry: Beyond Boundaries. Wiley; 2010. 18. Alphonsus Liguori, the Redemptorists' founder, wrote of it as "groundless fear of sinning that arises from 'erroneous ideas Taylor CZ. Religious addiction: obsession with spirituality. Pastoral Psych. 2002;50(4):291315 19. link between religiosity and OCD symptomatology? 20. The putative link between religion and OCD was first put forward by Freud Obsessional neurosis as an individual religion and religion as a universal obsessional neurosis 21. Religious patients are more likely to complain of religious symptoms of OCD. This implies that religiosity may have an impact on OCD via symptomatology Steketee, G., Quay, S. and White, K. (1991), Religion and OCD patients. Journal of Anxiety Disorders, 5(4): 359-367. Greenberg, D. and Shefler, G. (2002), Obsessive compulsive disorder in ultraorthodox Jewish patients: A comparison on religious and non-religious symptoms. Psychology and Psychotherapy: Theory, Research and Practice, 75(2): 123- 130(8) 22. Highly religious Turkish Muslims reported increased intensity of OCD symptoms and more concerns surrounding thoughts Yorulmaz, O., Gencoz, T. and Woody, S. (2009), OCD cognitions and symptoms in different religious contexts. Journal of Anxiety Disorders, 23(3) 23. Highly religious (HR) group scored higher than the Lower religious (LR) group on key features of moral TAF over importance of thoughts and responsibility. In addition, OCD symptoms were found to be related to control of thoughts and over importance of thoughts in religious subjects. As such, it seems that religious individuals are more at risk Sica, C., Novara, C. and Sanavio, E. (2002), Religiousness and obsessive compulsive cognitions and symptoms in an Italian population. Behaviour Research and Therapy, 40(7): 813-823. 24. Evidence against a link between religiosity and OCD Religiosity and obsessive-compulsive symptoms in a group of Iranian students and found no link between religiosity and OCD No relation Assarian, F., Biqam, H., Asqarnejad, A. (2006), An epidemiological study of obsessive-compulsive disorder among high school students and its relationship with religious attitudes. Archives of Iranian Medicine, 9(2):104-107. Lewis, C. A. (1994) Religiosity and obsessionality: the relationship between Freud's 'religious practices.' Journal of Psychology, 128, 189-196 Siev, J. and Cohen, A. (2007), Is thought-action fusion related to religiosity? Differences between Christians and Jews. Behaviour Research and Theory, 45(4): 829-837. 25. No difference was found between people with OCD and other anxiety disorders in terms of religiosity, although among those with OCD, religiosity was correlated with symptom severity Steketee, G., Quay, S., &White, K. (1991). Religion and guilt in OCD patients. Journal of Anxiety Disorders, 5, 359367. (Canterino, Huppert, Cahill, & Foa, 2006). 26. Management 27. Dont do If religion is conceptualized as causing OCD, the therapist may think that the patients religious faith must be controlled or reduced to support treatment Purdon, C., & Clark, D. A. (2005). Overcoming obsessive thoughts: How to gain control of your OCD. Oakland, CA: New Harbinger Press. 28. Dont do If the therapist conveys that the patients religious beliefs or community support the pathology, then the therapist may adopt a disadvantageous stance toward the patient that can undermine trust and empathy, and lead to conflict 29. Do Understanding that OCD is not caused by religious adherence, but rather that such adherence can influence how OCD manifests in religious patients 30. Psychological management 31. The goal of EX/RP is to weaken the psychological links between obsessions and increased anxiety, and compulsions and decreased anxiety Patients learn to tolerate their anxiety and that it will subside even without ritualizing, and these lessons ultimately reduce anxious reactions 32. ERP is not appropriate for a man obsessed by feelings that God has rejected and is punishing him Cognitive therapy 33. Case scenario A 35-year-old female from Rangamati was raised a nonpracticing hindu, but became a Muslim about 10 years ago after marriage with a muslim guy.The first five months of her born-anew life were blissful. Then she became increasingly scrupulous. She used to retreat into her room for hours at a time, committing to word-for-word memory about quran 'Do you really think I'm saved?' She probably ask me that 10 times a day," says her husband. "I'd get frustrated. I felt like a broken record answering her questions. "It became a huge tormenting thing for me," she says. "I started fearing I was never converted or saved. I would have blasphemous thoughts, cursing God in my mind." 34. In this case, she cannot engage in vivo exposures that violate religious law (e.g., purposefully offending God through behaviors that are forbidden) The therapist must work with the patient to understand the limits of religiously acceptable behavior, and create situations in which she can violate OCD law, but not religious law. This requires understanding, creativity, and tolerance 35. Cognitive Behavioural Therapy (CBT) has been shown to be effective in the treatment CBT known as guided prayer repetition which, it is claimed, is a more acceptable and successful form of therapy for religious patients. It will be interesting to determine its use and effectiveness on a wider scale Bonchek, A. and Greenberg, D. (2009), Compulsive prayer and its management. Journal of Clinical Psychology, 65: 396405. 36. Take away message Whilst the question of whether religiosity causes or predisposes to OCD is still unresolved Studies that directly investigate the relationship between religiosity and OCD fail to demonstrate an association between religiosity and the developme