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Dr Adelbert Scholtz
Counselling Psychologist

HPCSA Number: PS 58157
Practice Number: 8639663

Gender: Male

Languages: Afrikaans, English, German
& Dutch

Range of Fees: According to the tariff
structure of medical aid funds; 15%
discount for cash payments

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Consulting Rooms:

67 Brookside Village
Schapenberg Road
SOMERSET WEST
(Behind Vergelegen Medi-Clinic)

10 Eighth Ave
Boston
BELLVILLE
(Inside church hall of the NG Kerk
Bellville West)

Phone for appointments:
021 852 6978 / 083 583 1476

E-mail:
adelbertscholtz@hotmail.com


Certified BrainWorking Recursive Therapy Practitioner


BrainWorking Recursive Therapy Professionals Worldwide


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OBSESSIONS AND COMPULSIONS

- Dr Adelbert Scholtz

Counselling psychologist

1. Obsessive-compulsive disorder

1.1 Description

You may have into contact with people who suffer from some or other form of obsessive-compulsive disorder - or you may yourself be suffering from it. It is, therefore, necessary to take note of this disorder - as well as of the methods being used to treat people who suffer from this disorder.

Obsessions are thoughts that one cannot control and that dominate one's consciousness at odd moments. It usually amounts to some or other fear.

This fear literally becomes an obsession and the person cannot get rid of it - even if he realises in most cases that it is an unrealistic and irrational fear. There are also compulsions. These are compulsive actions. They usually have a connection with some or other obsessive idea, which revolves in somebody's head and compels him, as it were, to perform some or other ridiculous action.

All people have certain fears and worries - but then these fears and worries usually have a basis in reality. Somebody with an obsessive-compulsive disorder always has unrealistic and even absurd fears. It has to be added: this disorder must not be confused with phobias. Phobias also boil down to irrational fears, but these fears do not disrupt people's lives to the same extent.

1.2 Prevalence

Statistics

According to investigations, between 2% and 2,5% of the members of the population suffer from an obsessive-compulsive disorder (OCD). It often starts with children as young as seven, but mostly with teenagers, although it may only become manifest during adulthood.

Diagnosis

To be diagnosed with an obsessive-compulsive disorder, the person's life must be dominated and severely disrupted by obsessions, compulsions, or both.

An obsession occurs when a person cannot get rid of a thought or impulse from his awareness and it dominates his consciousness, although he tries to ban it from his thoughts, but without success. A compulsion is a forced action a person performs in order to prevent a calamity or an accident and it serves to diminish the person's anxiety and stress. The obsession and/or compulsion have to occupy at least an hour per day. It is often accompanied by other disorders, such as depression, phobias or chemical dependency.

The diagnosis of an obsessive-compulsive disorder must be performed by a psychologist or a medical practitioner such as a psychiatrist. And it is equally important to leave the treatment for this disorder in the hands of a trained person.

Causes

Much research has been done regarding the causes of the obsessive-compulsive disorder. It amounts, in short, to a chemical imbalance in the brains of these patients. They have a deficiency of the neurotransmitter serotonin. It is interesting to note that people who suffer from depression, also have a deficiency of serotonin.

It is, therefore, not surprising that some people suffer simultaneously from both disorders. Because the lives of sufferers are dominated and disrupted by various fears and concerns, it is not amazing that they are also often very depressed. It is worth mentioning that the same types of medication are being prescribed for both conditions, namely antidepressants.

It appears as if the predisposition for an obsessive-compulsive disorder is a genetically controlled state of affairs. It is a condition, which often runs in families. Children may inherit the inclination for this disorder from their parents. But it is not to say that they will acquire it inevitably. This disorder is often triggered by some or other traumatic event in the life of the child, which may cause him to become afraid or anxious - such as the death of a parent, a divorce in the family, a financial crisis, etcetera - and then these fears and anxieties get out of control.

It is interesting to note that certain diseases, such as viral infections, may also aid the development of this disorder. Experts are not yet sure how this works. The most probable answer is that a human being manufactures certain antibodies to fight a viral infection. The antibodies may, in certain cases, attack the patient's own body and cause harm to certain sections of the brain. Because these sections of the brain do not function properly anymore, it may happen that that person's fears, worries and anxieties spin out of control.

1.3 Types of obsessions and compulsions

There are basically six types of obsessive-compulsive disorders, although all of them have basically the same pattern. Somebody expressed it in this way: the melody stays the same - it is only the words of the songs that differ from case to case. One may classify the sufferers as follows:

Washers and cleaners

These people have an obsession regarding germs and hygiene. They always wash their hands after shaking somebody's hand, if they touched a door handle, handled money or touched something they may consider to be dirty or contaminated. The companies that manufacture soap and detergents earn lots of money from these people.

Because they have such an exaggerated fear of germs and contamination they will never venture into a public toilet.

Checkers

Somebody with this variation will check twenty times at night before going to bed whether all the doors are locked. Even if he had a look two minutes previously whether the doors are locked, the fears gets a grip on him that he may, perhaps, may have made a mistake. This type of person may, for instance, also be afraid that his home will burn down if he forgets to turn off the iron or the stove before leaving the house and he will check dozens of times that these appliances are switched off.

There is a never-ending list of things that these people may check and control. They may often check whether all the taps in the house are shut for fear of a deluge. They may be afraid of pieces of glass in their food, afraid that their children will open the medicine drawer or they may be afraid they forgot to pull up the brakes of their motor cars - and then these things are checked every few minutes.

Repeaters

Repeaters are people who feel compelled to perform a certain action or repeat it in a certain situation to avert some or other disaster. They may be afraid that a child will fail at school or that a family member will get an accident or those burglars will plunder their homes - and then a certain (usually absurd) action or ritual is performed to prevent the calamity. Examples of such actions are to count to ten, to mumble a certain word repeatedly or even to repeat a certain prayer ten times. It may seem as if these people believe in some or other form of magic.

The fact that the feared disaster, of course, does not strike after they have performed the compulsive action, reinforces the behaviour of these people - and then they believe that the compulsive ritual was the reason why the disaster did not happen.

Perfectionists

The perfectionists are people who prefer everything to be extremely neat and symmetrical. An example is a child who never invites is friends to visit him because they may cause wrinkles by sitting on his bed or disturb his arrangement of books and pens. He cannot tolerate a single wrinkle on his bed and prefers that all his books, pens and other possessions in his room stay on their appointed places. Every small item must be exactly on the right spot.

Collectors or hoarders

There are people who hoard any conceivable type of object: empty yoghurt containers, bottles, plastic bags, magazines, newspapers - you name it. It is usually rubbish that is hoarded. The person always argues that he keeps these things because he may need them again some or other time. This compulsion may even become so severe that a hoarder extends his home or rents extra space to store his collection of worthless objects. Much time is usually spent to organise the collection and even to catalogue it. This person is often able to tell how many wine bottles, beer bottles, mayonnaise bottles and tomato sauce bottles he has. This type of person cannot tolerate throwing anything away and he gets extremely upset if one of the inhabitants of his home inadvertedly allows a bottle or newspaper to get into the garbage bin.

One cannot classify stamp collectors of numismatics as being obsessive or compulsive. They do not collect rubbish and their collections may be worth a lot. Their hobbies also do not disrupt their lives.

Worriers or full-time self-tormentors

These people are always afraid that they made a mistake, that they harmed somebody or that they offended somebody. They are, therefore, extremely self-critical and may apologise in an exaggerated manner or have exaggerated feelings of guilt. They are extremely attentative of various sins and transgressions and it worries them if they believe that they have done something. which perhaps caused the Lord pain or offense. Somebody with this type of obsessive-compulsive disorder may, for instance, harbour an intense fear that he may inadvertedly harm one of his family members or even kill one of them.

It may also be that they consistently find fault with everything and everybody around them and that they are hyper-critical regarding the mistakes or purported mistakes and sins of others. They always only see that which is ugly or bad - although there are also beautiful and good things to see.

Vicious circle

The compulsive behaviour helps those who suffer from this disorder to relax in a certain sense. If somebody washed his hands thirty times a day or checked twenty times whether all the doors are locked and checked whether his collection of bottles is stored correctly, it does lessen his anxiety. The he tells himself unconsciously that his rituals or actions actually prevented some or other disaster from happening to him or his family. There is, therefore, a vicious circle. When his fears become stronger, he performs his compulsions more vigorously to avert dangers and calamities. And when he increases the performance of his compulsions, his attention is focused all the more on his fears and in the process his fears become all the more entrenched.

1.4 Treatment

Medication

Antidepressants are often prescribed by psychiatrists and other medical practitioners. The aim with these substances is to increase the availability of serotonin in the brain - and that alleviates the symptoms of depression and also of the obsessive-compulsive disorder. Antidepressants neutralise the enzymes, which neutralise serotonin after having performed its task - and in this manner the quantity of serotonin in the brain is kept artificially high.

Unfortunately, antidepressants are not efficacious in all the instances - only in about 60% of cases. Apart from that, they often have certain unpleasant side-effects, such as dizziness, dry mouth, a skin rash, sleepiness, tiredness, an irritated feeling, a disrupted digestive system and headaches.

Psychotherapy and dietary supplements

The best results are being obtained by a combination of psychotherapy and dietary supplements. The type of dietary supplementation, which is used with the aim of increasing the supply of serotonin to the brain, is 5-HTP or L-Tryptophan. These two amino acids are basically the same substance. They are the most important building blocks for the production of serotonin.

Behaviour therapy is the therapy of choice for this type of disorder. One may often be cured of this disorder within five sessions - depending on how long the disorder has persisted and how serious it is. Previously, psychologists laboured months and even years with patients. They digged deep into the memories of these people's childhood and various causes were sought. In the process the patients gained much insight into themselves, but the symptoms of the obsessive-compulsive disorder refused to disappear.

Behaviour therapy, in short, amounts to de-sentisation. That means that the patient is somehow bombarded with situations which usually cause him to become anxious or worried, while he is not allowed to perform his compulsions. For example, somebody has an extreme fear of lifts; he is afraid that the contraption will stop and that he cannot get out. But he works on the tenth floor of a building and he must use the lift every day. To counter his fears he recites certain phrases in his thoughts. The psychologist takes him for a series of rides in a lift - up and down - while forcing the person to talk to him about various subjects. In this manner, he prevents the patient of reciting his phrases in his thoughts. If the patient has had enough exposure to the lift and no disaster took place, although he never recited his phrases, the fear will start to dissipate.

This approach is, unfortunately, not always feasible. If a patient has the excessive fear that his home will burn down and he, therefore, has to check 30 times a day whether his stove or iron has been switched off, it will not help to expose him to burning buildings. It will not do to ignite a house from time to time and to let the patient watch the spectacle. But fortunately, the Creator gave us the ability to use our imaginations. Psychologists also speak of visualisation. The patient is aided to relax and while he is sitting quietly he must see the feared situation in his mind. One may even use hypnosis in order to liven up, that which the person sees in his imagination.

Somebody who stores all the bottles he can lay his hands on may be treated as follows: He must, first of all, see in his imagination how he disposes of his unnecessary bottles in a rubbish bin and then he has to agree in his imagination that this did not cause a calamity. After that, the person can be aided to dispose of the bottles of another person and in the end he may start to throw away his own superfluous bottles.

For children a technique known as externalisation helps - and that is also a variety of behavioral therapy. The child has to give a name to his exaggerated fears and worries, such as "Mr Bossiness", "Miss Worrisome", "Mr Scrubbing Brush" or "Shining Miss Neatness". That helps the child to recognise that the state of affairs is not to be ascribed to any mistake on his part and that it is, as it were, a force outside of himself that harasses him. Then he may start to talk back and tell "Mr Bossiness" or "Shining Ms Neatness" in a loud voice: "I will not do as you tell me. I will not allow you to take over my life".

The parents of the child have also to be involved in order to help the child to apply this new approach every.

2. Compulsive gambling

2.1 Description

Recognized disease

Gambling dependency is a recognised disease, which appears on the list of diseases of the World Health Organisation (the ICD-10). It is also mentioned in the DSM-IV(TR) of the American Psychiatric Association. The official name is "pathological gambling" and it has its own code number in both these publications.

It is quite possible that the pastoral care giver will have to deal with the distress of a compulsive gambler and his family and, therefore, it is necessary to have knowledge regarding this disorder.

Symptoms

If somebody exhibits five or more of the following 10 symptoms he may be diagnosed with pathological gambling:

  • Preoccupation with gambling - the person often talks about gambling, often thinks about his previous gains and plans his next gambling outing;
  • The person must systematically gamble more money to get the same excitement as at the beginning;
  • He tried often in vain to stop;
  • He feels irritated if he cannot gamble;
  • Gambling is a way of forgetting about his problems;
  • He tries to compensate for his losses by gambling increasingly more;
  • He lies about his gambling habit;
  • He steals of commits fraud to obtain gambling money;
  • He endangers an important relationship in his to life because of gambling - his marriage, his family, his work etcetera; and
  • He borrows money to gamble and, therefore, gets more deeply into debt.

Prevalence

South Africa experiences an epidemic of compulsive gambling. According to the newest statistics, 85% of our country's adult population gambles in some or other way - visits to a casino, horse racing, purchasing Lotto tickets, etcetera. Only 15% never gamble. Those who regularly visited a casino during 2008 - at least once a month - are more or less 4% of the adult population. This is decrease from more than 13% during 2005. The global economic recession of 2008 presumably contributed to this decrease.

According to the SA Foundation for Responsible Gambling more or less one out of every twenty gamblers becomes addicted to gambling. That means that more or less 4% of the adult population is problem gamblers. More or less 0,5% of the population suffers from serious pathological gambling.

The impact of pathological gambling

The families of pathological gamblers usually suffer the most. If a gambler gambles his whole salary away, pawn his motor car, takes a loan on his home and borrows money from his family members and friends to finance his gambling habit, then it means that he plunges his family into very serious financial difficulties.

Because pathological gamblers spend so much time at casinos or other gambling dens and stay away till late at night their wives often suspect them of visiting other women - which may not always be the case. But it is clear that it causes much tension in a marriage.

In order to try and forget of their losses many pathological gamblers start to drink. Some gambling addicts start to steal and commit fraud in order to obtain money for gambling - and that causes clashes with the law.

Legislation

The National Gambling Act came into operation in 1996. Section 8 of this act provides that the National Gaming Board - which governs the activities of all licensed gambling institutions - has to set aside some of its funds for the rehabilitation of people who are addicted to obsessive gambling. The Board receives some of its money from the proceeds of the holders of gambling licenses. If somebody suspects that he is addicted to gambling he may dial a toll-free number to seek help (0800 006 008).

Staff members at casinos are trained to recognise gambling addiction. They may, though, not volunteer to help clients of the casino. If one of the gamblers should ask for help such a staff member may inform him where he may get expert support.

Sin

Many people would like to know: is it a sin to gamble? This is as issue about which the Bible is silent. One cannot, therefore, condemn gambling in general outright.

It is nevertheless clear that pathological gambling amounts to a social evil. It has already been mentioned how much heartache and suffering such a gambling addict can cause around him.

Many people start gambling because of greed - and the love of money is definitely a sin (2 Ki 5: 20 - 27; 1 Tim 3: 3 and 1 Tim 6: 10). They endeavour to earn bags of money for which they haven't worked. Accordingly, most churches regard gambling not as an honest and honourable way of making money.

One can also state without fear of contradiction that gambling is a very stupid way of getting rid of your money. The holder of the gambling license must make a profit from the money that is being gambled and the result always is that less money is being paid out as prizes than is being received from the gamblers. The chances to hit the "jackpot" are, therefore, never good. The average gambler always looses more money than he wins. Gambling is, therefore, plain foolish and a waste of good money. If somebody really has a great need to get rid of his money then there are many more meritorious entities such as churches and charitable organisations to which the money may be donated.

Help for gambling addicts

It has already been mentioned that there is a toll-free number which may be dialed by a compulsive gambler who is in trouble. People may also contact Gamblers Anonymous. Their number is in the telephone guide. Many clinics where alcoholics and drug addicts are being treated are also able to help gambling addicts.

The technique being used in most cases is much the same as for people who suffer from other obsessions and compulsions, namely a combination of behavioral therapy and dietary supplements to boost serotonin levels.

3. Kleptomania

3.1 Description

A kleptomaniac is a compulsive thief. He does not steal because he needs something but because he is not able to withstand the impulse to steal. After he has stolen, the tension that has been building up in him is broken when he has seen something that he can easily let disappear into his pocket. It is, therefore, a condition that has certain similarities with an obsessive-compulsive disorder, although it is regarded as a separate disorder.

This disorder is more prevalent amongst women than amongst men and it usually starts during adolescents, although children as young as five have been diagnosed with this malady.

There are indications that it - the same as depression - is connected to a deficiency of the neurotransmitter serotonin. The symptoms are briefly as follows:

  • The person often experiences an uncontrollable impulse to steal articles he does not need:
  • He experiences a high level of tension before committing the deed and after having committed the deed he feels relieved and more relaxed;
  • The crime is not committed because of poverty, feelings of vengeance or anger; and
  • The deed is often followed by intense feelings of guilt and shame.

It is obvious that the compulsive thief may easily get into trouble because of this disorder and that he may even may clash with the law.

Not every person who commits shoplifting is necessarily a kleptomaniac; it is estimated that only about 5% of shoplifters are also kleptomaniacs. Kleptomaniacs very often also suffer from other disorders, such as depression, chemical dependency, anxiety disorders or eating disorders.

3.2 Treatment

Antidepressants are the medication usually prescribed. The problem with this type of medication usually is that the disorder usually returns if the medication is discontinued. Medication only masks the symptoms but does not cure the disorder.

A combination of psychotherapy and dietary supplements to boost the person's serotonin levels has a better chance of success. The person may be taught strategies to lessen temptations, for instance to take a family member or friend along when a shop is being visited, to warn friends and family members to guard their possessions when the patient is around and to avoid big shopping centres consistently.