Prevalence and Determinants of Obsessive Compulsive Disorder Among the Students at College of Nursing and Midwifery Birnin Kudu
Chapter One
Study aim
The study aims to present rates of OCD amongst students at the College of Nursing and Midwifery, Birnin Kudu, Jigawa state and to determine the relationship between OCD and depression, education-related anxiety and anger during education.
Study objectives
- To determine rates of OCD amongst students at amongst students at College of Nursing and Midwifery, Birnin Kudu, Jigawa state
- To establish if OCD is related to depression, youthful anxiety and anger during education.
CHAPTER TWO
LITERATURE REVIEW
OPERATIONAL DEFINITION OF KEY CONCEPTS
Obsessive-Compulsive Disorder (OCD)
The cognitive models of OCD posit that specific kinds of dysfunctional beliefs underlie the development of the disorder (Abramowitz, Khandkera, Nelson, Deacon, & Rygwalla, 2006; Whiteside & Abramowitz, 2005). On the other hand, one perspective from the biological model of OCD argues that the disorder occurs when there is an implicated dysregulation of the serotonin system which generates obsessional thoughts and compulsive behaviours (Abramowitz et al., 2003). Although the underlying biological or genetic factors might predispose individuals towards developing OCD generally, the cognitive formulations of
OCD are specific, face valid, and can account for the disorder’s highly idiosyncratic nature (Abramowitz et al., 2006). Hence the proposed study uses the cognitive behavioural model as a theoretical framework of the study.
OCD is a discrete diagnostic subcategory in the OCRD chapter of the DSM-5 (American Psychiatric Association, 2013). The DSM-5 defines OCD as a disorder that is characterized by the presence of obsessions and/or compulsions. Obsessions are defined as recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviours or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly (American Psychiatric Association, 2013).
According to the DSM-5 (American Psychiatric Association, 2013, p. 237) OCD is diagnosed as follows:
The presence of both obsessions and compulsions must be evident in an individual. The obsessions are defined by recurrent and persistent thoughts,
urges, or images that are experienced as intrusive and unwanted at some time by the individual. Furthermore, during the disturbance, they cause anxiety or distress in the individual. The individual must also attempt to ignore or supress such thoughts, urges or images or to neutralise them with some actions (performing compulsions). The compulsions include repetitive behaviours such as hand washing, ordering, checking or mental acts such as praying and counting. The individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The individual must perform the compulsions or mental acts with the aim of preventing or reducing anxiety. However, these compulsions are not connected in a realistic way. Criterion B emphasizes that obsessions and compulsions must be time-consuming (more than 1 hour per day) or cause clinically significant distress or impairment to warrant a diagnosis of OCD. Furthermore, OCD symptoms must not be attributable to the physiological effects of a substance (e. g., a drug of abuse, medication) or another medical condition. And the disturbance is not better explained by the symptoms of another mental disorder. Furthermore, you must specify if the OCD is with good or fair insight (the individual recognizes that OCD beliefs are definitely or probably not true or that they may or may not be true); Specify if with poor insight (the individual thinks obsessive-compulsive disorder beliefs are probably true); Specify if it is with absent insight or delusional belief (the individual is completely convinced that OCD beliefs are true) and lastly, specify if it is tic-related: The individual has a current or past history of a tic disorder.
Fenske and Petersen (2015) highlight the point that OCD should be seen as a distinct entity from obsessive-compulsive personality disorder, since the latter is characterized by a pervasive pattern of behaviours emphasizing organization, perfectionism, and a sense of control, rather than repetitive behaviours or intrusive thoughts (the common characteristic in OCD).
THEORETICAL PERSPECTIVE
This study is empirical and not strictly framed according to any particular theory. Concepts that have been found to be associated with OCD are included in the study. The OCD concept of this study emanates from the DSM model of psychopathology. However, it can also be interpreted within the framework of cognitive behavioural theory (CBT). The CBT of OCD explains the relationship between an individual’s thoughts, behaviours and the occurrence of OCD symptoms. The model begins with the premise that intrusive thoughts are normally occurring phenomena and that everyone experiences intrusive thoughts, and such intrusions are not harmful, dangerous or uncommon (Simos, 2002). The theory further states that people with obsessional thoughts appraise normal intrusive thoughts, images and impulses as an indication that harm to themselves or others is a particularly serious risk and they may be responsible for such harm. The difference between individuals with and without OCD symptoms is the negative meaning they assign to such intrusions. Moreover, the theory proposes that compulsive behaviours develop as a means of coping with the stress caused by the intrusive thoughts, and that the use of compulsions increases the probability of subsequent neutralizing (Coles, Pietrefesa, Schofield, & Cook, 2008).
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
In this chapter the researcher discusses the methodology used in collecting data. The research design, variables of the study, sampling, data collection, and measures used are also presented. The psychometric properties of the measures will also be supplied.
RESEARCH DESIGN
The study is quantitative in nature and uses a cross-sectional survey design. A cross-sectional design involves the measurement of a subset of a population at a certain point in time, with no intention of conducting a follow-up study at a different time (Mann, 2003).
VARIABLES OF THE STUDY
The variables of the study are as follows:
CHAPTER FOUR
RESULTS
INTRODUCTION
This chapter includes the plan for analysing data, description of the sample and the results of the study.
PLAN FOR ANALYSING DATA
The data was analyzed using version 23 of the Statistical Package for the Social Sciences (SPSS 23). Before analysis could proceed, data was checked and cleaned, and the Kolmogorov was used to detect outliers. The data was considered to have been extracted from a normal distribution (p < .05), based on the failure of the Shapiro-Wilk test to reach statistical significance. Subsequently, data analysis proceeded parametric statistics. Firstly, a descriptive analysis of the background information was performed. Thereafter, correlation and regression analyses were conducted to determine the association between the main variables of the study and the predictive capacity of independent variables to predict obsessive-compulsive symptoms.
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
INTRODUCTION
In this chapter, the researcher discusses the results of the study. The purpose of the study was to establish the prevalence rate of OCD during education among students at College of Nursing and Midwifery, Birnin Kudu, Jigawa state.. Furthermore, the study also aimed to investigate whether depression, youthful anxiety and anger, together with selected demographic variables, can predict obsessive-compulsive symptoms. This chapter also includes a discussion of the limitations of the study and the recommendations emanating from the findings.
The prevalence of OCD during education
To reiterate what we said earlier about the occurrence of OCD, the prevalence rate of OCD in the general population is 1.1% to 1.8% (American Psychiatric Association, 2013). The condition is more prevalent among females, especially those of childbearing age, than it is in the general population (Abramowitz et al., 2003; Fenske & Petersen, 2015; Frías et al., 2015; Kaya et al., 2015; Russell, Fawcett, & Mazmanian, 2013; Sharma & Sharma, 2015; Uguz & Ayhan, 2011; Vythilingum, 2009). Although other psychiatric conditions are common following education, a number of studies consider OCD to be relatively more predominant (Chaudron & Nirodi, 2010; Fenske & Petersen, 2015; Ross & McLean, 2006). In fact, education and childbirth are two of the life events considered to trigger OCD (Johnson, 2013).
With the above information in mind, the current study set out to establish the prevalence rate of OCD among clinic attending students at College of Nursing and Midwifery, Birnin Kudu, Jigawa state.. The students who participated in the study obtained a median OCI-R score of 32 and further obtained median scores of 5 and 6 on each of the subscales of the same measure. This meant that almost 81% of the students could be classified as OC disordered, when using the Foa et al. (2002) cut-off score of 21.
The relationship between OCD and both depression and anxiety
The most common comorbid disorders to OCD, especially during education, are depression and anxiety (Fenske & Petersen, 2015; Rintala et al., 2017).
Additionally, depression and anxiety are comorbid during education (Verreault et al., 2014), and anxiety has been found to predict the experience of depression during education (Mohamad Yusuff, Tang, Binns, & Lee, 2015). Regardless, students tend to score higher on depression and anxiety measures (Sharma & Sharma, 2015). This has also been the case in South Africa (Brittain et al., 2015; van Heyningen et al., 2016; Rochat, et al., 2011). Whiteside and Abramowitz (2004) also found that individuals who report severe OCD symptoms also report severe depression. However, at least in one study, major depression was common in non-gravid students when compared with students (Kaya et al., 2015).
The relationship between anger and OCD
Anger is a feature of many psychiatric conditions (Cassiello-Robins & Barlow, 2016), including premenstrual dysphoric disorder, separation anxiety disorder, disruptive, impulse-control, conduct disorders, and trauma and stressor-related disorders such as acute stress disorder and posttraumatic stress disorder (American Psychiatric Association, 2013). The present study investigated the element of anger in OCD among students. Elevated levels of anger may co-occur with OCD or be associated with certain presentations or dimensions of OCD (Whiteside & Abramowitz, 2004, 2005). This study found the CAS measured anger to be associated with OCD; students who scored high on the OCI-R reported higher CAS rates when compared to students who scored low on the measure.
Anger also significantly predicted OCD symptoms when included in regression models to predict all aspects of OCD measured by the OCI-R. However, the effect was limited to the Checking and Neutralising dimensions. Anger could not predict the OCI-R dimensions of Washing, Obsessing, Hoarding and Ordering, while its prediction of the total OCI-R score was only marginal. The results of this study are close to those of Whiteside and Abramowitz (2004), who found anger to be more strongly related to the Checking dimension than any other type of OC symptoms. However, the difference between the current study findings and Whiteside and Abramowitz (2004) findings is that the current study also found anger to be strongly related to the Neutralizing dimension which was not found in their study. It is possible that anger is related to the Neutralizing dimension in so far as the students may seek to deal with ego dystonic feelings of aggression by minimizing (neutralizing) their impact.
CONCLUSION
The current study indicates that Students also experience OCD symptoms. Based on the results of the OCI-R, it can also be stated that rates of OCD are much higher than expected. The study further indicates that there is an association between depression, education related anxiety, anger and OCD. The predictive part of the study further suggests that the relationships are not straight forward. For instance, it is clear that anger associates with some dimensions of OCD symptoms and not others. The same applies to factors related to reproduction, such as age at education and complications experienced in past studies. The factors do not apply to all dimensions of OCD symptoms.
RECOMMENDATIONS
All the variables of the study were measured at one point only. Therefore, cause and effect was not possible to establish. It is recommended that in future researchers should use longitudinal designs to study the variables. For instance, it will be clear whether the anxiety, depression and anger observed during education were there before education or not. Besides, relying on retrospective accounts of symptom occurrence has drawbacks, including inaccurate recall. Longitudinal study designs will also help to establish whether all the conditions, including OCD symptoms, still exist postpartum, and whether there is a change in the contents of obsessions and compulsions. The designs will also help to detect change in the severity of all symptoms during the postpartum period.
SUMMARY
This chapter discussed the findings of the study,and presented a conclusion and the recommendations thereof. The prevalence rate of OCD symptoms in this study was high as compared to the rates found in other studies. In a number of studies, students are studied with regard to their youthful age. However, students were included without regard to the youthful stage they were in in this study, which may partly explain the reason why the rate of prevalence was so high. The use of different diagnostic tools may also explain the difference
REFERENCES
- Abramowitz, J. S., & Deacon, B. J. (2006). Psychometric properties and construct validity of the obsessive-compulsive inventory revised: Replication and extension with a clinical sample. Journal of Anxiety Disorders, 20, 1016-1035.
- http://dx.doi.org/10.1016/j.janxdis.2006.03.001
- Abramowitz, J. S., Schwartz, S. A., Moore, K. A., & Luenzmann, K. R. (2003). Obsessive-compulsive symptoms in education and the puerperium: A review of the literature. Anxiety Disorders, 17, 461–478.
- Adewuya, A. O., Ola, B. A., Aloba, O. O., & Mapayi, B. M. (2006). Anxiety disorders among Nigerian students in late education: A controlled study. Archives of
- Students’s Mental Health, 9, 325-328. doi:10.1007/s00737-006-0157-5
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders fifth edition (DSM-5TM). Arlington, VA: Author.
- Andersson, L., Sundström-Poromaa I., Bixo, M., Wulff, M., Bondestam, K., & Åström, M. (2003). Point prevalence of psychiatric disorders during the second trimester of education: A population-based study. American Journal of Obstetrics & Gynaecology, 189(1), 148-154.
- Al-Tawil, S. R. (2013). Biochemical and hematological profile of normal students in Gaza Governorate, Gaza strip. Master’s Thesis (Medicine Studies), University of Gaza. Retrieved from library.iugaza.edu.ps/thesis/959
- Babbie, E., & Mouton, J. (2010). The practice of social research. Cape Town, South Africa: Oxford University.
- Belloch, A., Roncero, M., García-Soriano, G., Carrió, C., Cabedo, E., & FernándezÁlvarez, H. (2013). The Spanish version of the Obsessive-Compulsive Inventory-Revised (OCI-R): Reliability, validity, diagnostic accuracy, and sensitivity to treatment effects in clinical samples. Journal of ObsessiveCompulsive & Related Disorders, 2(3), 249–256. http://dx.doi.org/10.1016/j. jocrd.2013.05.001
