The Cognitive Models Of Ocd Psychology Essay

The Cognitive Models Of Ocd Psychology Essay The study is aimed to investigate the Quality of Life of Obsessive Compulsive Disorder patients in relation to Severity of the symptoms and Cognitive Appraisal. The study will explore the predictors of Quality of life of OCD patients from variables of Symptom Severity dimensions and Cognitive Appraisal. It is hypothesized that patients having OCD with more Symptom Severity, and Cognitive Appraisal of obsessions will have impaired Quality of life. Correlational research design and purposive sampling will be used. 60 patients with primary diagnosis of Obsessive Compulsive disorder, with age range of 18 years and above will be recruited. For assessment, Obsessive Compulsive Disorder Symptom Checklist (OCDSC), Stress Appraisal Measure (SAM), and WHOQOL-BREF will be used. Pearson Product Moment will be employed to find the relationship of Symptom Severity and Cognitive Appraisal with Physical health, Psychological health, Social and Environment related Quality of life. In addition, Multip le Regression Analysis will be used to explore the predictor of Quality of life of patients with Obsessive Compulsive disorder. Introduction The study investigates the Quality of Life (QoL) of Obsessive Compulsive Disorder (OCD) patients in terms of Symptom Severity and cognitive appraisal. The severity of symptomology and clinically manifested psychological distress exacerbates the functional impairment of OCDs patients. The functional impairment debilitates and gradually leads to poor treatment compliance as psychotherapy include the dysfunction area in treatment plan. The present study is intended to understand the relationship of the associated factors that will help facilitate the better understanding on etiological and therapeutic grounds. Obsessive Compulsive Disorder According to American Psychiatric Association (2000), Obsessive Compulsive Disorder OCD) is an anxiety disorder classified into Obsessions and Compulsions. Obsessions are intrusive, unwanted thoughts, id, images, or impulses that and individual experienced as senseless yet anxiety evoking. Compulsions are desires to engage in behavioral or mental acts according to specified rules or in reaction to obsessions (i.e., to lower down obsessional anxiety). However, individuals are unaware of the trigger and may perform stereotyped acts according to idiosyncratic rules (Wells, 1997). Obsessions are persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate. The most common obsessions concern thought about contamination, doubting, aggressive or horrific impulses and sexual imagery (Wells, 1994; Wells Morrison, 1994 as cited in Wells, 1997). A compulsion is a repetitive behavior that is overt or covert. Overt compulsions include hand washing, checking, ordering, or alignment of objects. Covert compulsions are mental acts such as praying, counting, or repeating words. The goal of these overt and covert compulsions is to reduce or prevent anxiety or distress (Wells, 1997). Symptom Severity Severe OCD is characterized by Substantial frequency of obsessions and compulsions (from 4 hours a day to every minute of the patients waking hours), Substantial impairment from the OCD (usually in all domains of life including social, work, and family), Poor insight into the symptoms (or how realistic the patient thinks their fears are), and/or Substantial co morbidity which complicates the presentation of the symptoms (e.g., posttraumatic stress disorder or schizophrenia). Severity of symptoms, as characterized by high frequency of symptoms or significant distress, is often measured through self-report measures such as the Obsessive-Compulsive Inventory-Revised (OCI-R; Foa et al., 2002). Obsessive-compulsive disorder symptoms include both obsessions and compulsions. Obsessions often have themes of fear of contamination or dirt, having things orderly and symmetrical, aggressive or horrific impulses and sexual images or thoughts. However, compulsions typically have themes of washing and cleaning, counting, checking, demanding reassurances, performing the same action repeatedly, and orderliness (Mayo Clinic Staff, 2012). Studies indicate that there are clinically meaningful differences among these symptom-based subtypes. It was reported that OCD patients with compulsive hoarding report higher levels of anxiety and depression, greater impairment in occupational, family, and social functioning and poorer response to pharmacological and cognitive-behavioral treatment (Abramowitz, Franklin, Schwartz, Furr, 2003). Despite the documented detrimental effects of OCD on quality of life, evidence suggests that not all individuals with OCD are uniformly impaired. Masellis, Rector, and Richter (2003) found that severity of obsessions, but not compulsions, was related to lower overall quality of life. Similarly, Eisen et al., (2006) reported that severity of obsessions and comorbid depression predicted impairment across eight domains of Life Enjoyment and Satisfaction, whereas compulsion severity was related only to impaired work functioning. In contrast, Stengler-Wenzke, Kroll, Riedel-Heller, Matschinger, and Angermeyer (2007) found obsessions to be unrelated to Quality of life ratings, but that severity of compulsions was associated with reduced physical and psychological well-being, as well as impairment in social and family life and leisure activities. Cognitive Appraisal Grinker and Spiegel (1945, as cited in Sincero, 2012), explained appraisal as a process that requires mental activity involving judgment, discriminating and choice of activity based largely on the past experiences of and individual. According to Lazarus (1984), cognitive appraisal occurs in reaction to stress. One is the threatening tendency of the stress to the individual, and second is the evaluation of the resources that is required to minimize, tolerate or eradicate the stressor and the stress it produces. According to Lazarus, appraisal takes two forms, Primary Appraisal and Secondary Appraisal. Primary appraisal has been distinguished into irrelevant, benign-positive and stressful. Irrelevant implies when experiences not stressful, it falls within the category of irrelevant (Lazarus Folkman, 1984). The appraisal of relevancies is not themselves of great concern, but the cognitive processes by which these events are appraised. Benign-positive appraisal occurs if the outcome of encounter is constructed as positive and enhances well-being. These appraisals are characterized by positive emotions. Stress appraisal includes harm/loss, threat and challenge. In harm/loss, damage to the person is suspected. Threat concerns are the anticipated harms or lose. Challenge appraisal focus on the potential for gain or growth inherent in an encounter and they are characterized by pleasurable emotions such as eagerness, excitement, and exhilaration, whereas threat centers on the potential harms and is characterized by negative emotions such as fear, anxiety, and anger (Lazarus Folkman, 198 4). The aim of secondary appraisal is to provide information about the individuals coping options in a situation. It has three components including problem focused coping, emotion focused coping and future expectancy. When an individual is deciding whether a situation is a threat or challenge, or he must do something to manage the situation, secondary appraisal becomes significant in order to figure out what might and can be done. Secondary appraisal activity is crucial feature of stressful encounter (Lazarus Folkman, 1984). When an individual is faced with adverse situation, something needs to be done to control it and avoid any subsequent consequences. Secondary appraisal follows primary appraisal of a situation. This necessarily includes evaluation of the situation and suitable reaction. The person than evaluate what can be done to cope with a particular situation. The reaction to the situation is decided by carefully analyzing what is at stake and what can be done to reduce negative consequences (Lazarus Folkman, 1984). Cognitive Models of OCD According to OLeary (2005), the number of cognitive models describing OCD phenomenon. These illustrate the rate of dysfunctions in general cognitive processing or dysfunction in cognitive appraisal and beliefs. Salkovskis Model (1985; Wells, 1997) based on cognitive and behavioral concepts in the formulation of obsessional problems. It theorized that the importance of appraisal of intrusion as the major source of distress, rather than the content of the intrusion itself. The appraisal of the significance of intrusions is determined by underlying beliefs. Once negative appraisals of responsibility occur, the second process of initiation of neutralizing responses which may be internal or external begins. When a person neutralized the intrusive thought he attempts to reduce responsibility and discomfort. Thus, the recurrences of intrusions become more likely because responses to them result in such cognitions acquiring greater salience. Studies have found significant correlations between responsibility and obsessive-compulsive behaviors in both clinical (e.g., OCCWG, 2001) and nonclinical participants (Freeston, Ladouceur, Thibodeau, Gagnon, 1992; as cited in OLeary, 2005). According to Rachman (1998; as cited in OLeary, 2005), the catastrophic misinterpretation about the importance of unwanted thoughts made by a person increases the range and seriousness of potentially threatening stimuli. In this way numbers of neutral stimuli that were insignificant are interpreted as threatening. This transfer of the neutral stimuli and situation to potentially threatening ones increases the range of threats and therefore increases the opportunities for the provocation of obsessions. This happens with both internal as well as external cues. In internal cues, the person deduces a threat from the fact of feeling anxious. Moreover, when the patient feel anxious he interpret it as if he is losing control of self and thus there is an increased likelihood that he will act upon the unwanted impulse. Hence, the catastrophic misinterpretation of ones anxiety can interact to increase the misinterpretation of the intrusion. Neutralizing prevents exposure to any disconfirming e vidence regarding the personal significance of the intrusive thoughts. This cycle remains until the catastrophic misinterpretation is changed or reduced and the internal or external stimuli are no longer interpreted as threatening. Quality of life The World Health Organization (1994) defines Quality of Life as an individuals perception of his/her position in life in the context of the culture and value systems in which he/she lives, and in relation to his/her goals, expectations, standards and concerns. It is a broad-ranging concept, compromising of the persons physical health, psychological state, social relationships, and their relationship to salient features of their environment (Hollar, 2012, p.74). Obsessive compulsive disorder may significantly affect self-care, social relationships, occupational functioning, family and marital relationships, child-rearing capacities, and use of recreations or spare time (American Psychological Association, 2007). Bobes (2001) revealed that patients with obsessive-compulsive illness had definite impairment in all domains of quality of life other than physical functioning. Similar findings emerged from the studies of Moritz (2005) and Eisen (2006), also showed that as compared to general population, OCD patients have poor health related quality of life in all domains except physical health. Few studies, however, have examined whether OCD symptom dimensions are differentially associated with impairment in functioning and Quality of life. Only one study to date has evaluated the impact of different dimensions of OCD symptoms on Quality of life. Fontenelle et al., (2010) found that whereas depression severity predicted impairment across eight domains of functioning assessed by SF-36, only hoarding and washing, but not other OCD symptom domains, predicted impairment in other areas of functioning social functioning and limitations due to physical health problems, respectively. OCD sufferers generally recognize their obsessions and compulsions as irrational, and may become further distressed by this realization. Cummins (2000) suggest that it is difficult to define Quality of Life because it can be characterized in both objective and subjective terms (as cited in Barofsky, 2012). According to Spranger Schwartz (1999), Quality of life is a multidimensional and dynamic concept: perspective can change with the onset of major illness. With the onset of illness, individuals relevant cognitive or affective processes (e.g. in their health or lives) include making comparisons of ones situation, with others who are better or worse off. People may adjust to deteriorating circumstances because they want to feel as good as possible about themselves (Ayers, et al. 2007). According to Salkovskis (1985) the difference between the obsessive compulsive disorder patient who experience prominent distress and disturbance lies in the meaning they make out of their obsessions. However, normal individual tends to view these intrusions as meaningless and benign whereas OCD patient make catastrophic interpretation out to these cognitive intrusions. These maladaptive interpretations discriminates the OCD patients. Cognitive models of OCD implied that a thought will be distressing and repetitive depending on the meaning assigned to it, not because of the content of obsessional thoughts (Teachman, 2005). The Obsessive Compulsive Cognitions Working Group (OCCWG) has shown that symptom severity correlates with appraisals of intrusive thoughts among individuals with OCD. In comparison with individuals who do not have OCD, those with OCD appraise unwanted intrusive thoughts as more important to control and as conveying more responsibility for preventing harm related to the thought (OCCWG, 2001). Purdon and Clark (1994) suggested that high scores on measures of OCD suggest that the individual is more likely to believe that intrusive and unwanted thought will occur in real life and will experience more guilt in reaction to those thoughts. Appraisals that one could act on the intrusive thought as well as appraisals about control, responsibility and the significance of the thought for ones personality also correlate with the OCD symptoms (as cited in Corcoran and Woody, 2007). Thus, models of Obsessive compulsive disorder showed that cognitive appraisal of unwanted intrusive thoughts will produce significant distress in patients having OCD that in turn will affect quality of life. There is evidence suggesting a relationship between Cognitive Appraisal and Psychological and Physical well-being (Coyne, Aldwin Lazarus, 1981; Harris, Heller Braddock, 1988; Jerusalem, 1993; Nezu, 1986). There is a general Conesus among research that an individual appraisal of the significance of the situation in terms of personal well-being will be a major determinant of affect (Carver et al., 1989; Harris et al., 1988; Lazarus Folkman, 1987; Lazarus, 1991; Smith Ellsworth, 1985). The way a person evaluates the significance of an event for him/her produces different emotional reaction, making some people more vulnerable to adverse effect than other (Kessler et al., 1983; as cited in Kausar, 1994). Perceived control experienced by an individual has an effect on outcome (Partridge Johnston, 1989). Increased levels of perceived personal control are associated with more favorable psychological adjustment (Folkman, 1984) and perceived lack of control on the other hand predicts psyc hological symptoms (Prime-Emberry, 1972; as cited in Kausar, 1994). How an individual appraises and copes with the stress is important to his/her well-being (Antonovsky, 1979; Lazarus 1981). According to Lazarus and Folkman (1984), a fit between cognitive appraisal and coping strategies is postulated to produce a better outcome. Johnson and Kenkel (1991) concluded that appraisals of threat (Appraisal of self, holding self back) and use of coping strategies of detachment and seeking social support were associated with emotional distress. Moreover, Felsten (1991) suggested that appraisals of challenges and expectations of successful coping should be associated with lower distress and better well-being. Rassin et al. (2001; as cited in Yorulmaz, 2007) suggested that unwanted and intrusive thoughts are experienced by everyone and the difference between normal and abnormal lies in the appraisal process, frequency and distress. Therefore, the examination symptom severity and cognitive app raisal as the predictors of quality of life of OCD patients may facilitate the understanding if the distress and impairment faced by them. In OCD, primary appraisal occurs in conjunction with the intrusive thoughts associated with obsessions, and secondary appraisal leads to faulty coping (compulsions and avoidance). According to Carr (1971), patients with OCD typically overestimate the likelihood of an unfavorable outcome in the context of primary appraisal (during obsessions) (as cited in Stein, Hollander, Rothbaum, 2009) and they perform compulsive behaviors in order to reduce perceived threat. In term of cognitive domains, studies of patients with OCD have found an exaggerated sense of responsibility, overestimation of threat, perfectionism, over importance of thoughts, need for control and intolerance of ambiguity (Rachman, 1993; Salkovskis, 1985; as cited in Sten, Hollander, Rothbaum, 2009). Individuals with OCD report markedly reduced Quality of life and general well-being, diminished occupational attainment, impaired family functioning, and higher rates of suicidal thought attempts. According to Koran et al. ( 1996), severity of OCD is inversely correlated with social functioning (as cited in Simpson, Neria, Fernandaz Schneier, 2010). According to Teachman (2007), subjective cognitive complaints exacerbate the effects of obsessional beliefs, and promote maladaptive responses to intrusive thoughts thus increasing the severity of the OCD symptoms. In present study, it is intended to explore mediating role of Cognitive Appraisal on Quality of Life perceived by Obsessive Compulsive Disorder patients with Symptom Severity and Cognitive Appraisal of the disorder are expected to impair the patients functioning. Literature Review This section includes the review of the studies that investigated the studied variables that are Symptom Severity, Cognitive Appraisal and Quality of life. Kumar, Sharma, Kandavel Reddy (2012) examined the contribution of cognitive appraisals to the quality of life (QoL) in patients with obsessive compulsive disorder. In Cross sectional study, it was hypothesized that cognitive appraisals of obsession contribute to poor quality of life in OCD patients. Sample size was 31 consecutive patients from Behavioral Medicine Unit of the NIMHANS and 30 Normal controls. Exclusion criteria were patients having severe co morbid psychiatric, physical and neurological disorder. The assessment was done by using mini Internal Neuropsychiatry Interview (MINI), the YBOCS severity scale, Clinical Global Impression-severity, the Depression Anxiety and Stress Scale-21, the Interpretation of Intrusive Inventory-31 and WHOQOL-BREF. Data was analyzed using independent t-test and chi-square test. Relationship between the domains of cognitive appraisal and the QoL after controlling for the duration of symptoms was analyzed by using Partial correlation. The resul ts indicated that all the domains of cognitive appraisal have strong negative relationship with psychological domain of QoL. Thought control and inflated personal responsibility also correlated negatively with the total QoL. Cognitive appraisal specifically contributes to poorer QoL in OCD so modification of beliefs and appraisal may be essential for better QoL. Main limitations were small size, patients were recruited from Behavioral Medicine Unit of major psychiatric hospital, and findings may not be easily generalized. Sample was predominantly male so its important to examine gender difference in cognitive appraisal and its relationship to QoL. Fontelle et al., (2010) in a study compared patients with OCD and normal on severity of different OCD dimensions and levels of QoL of patients with OCD. Further, it was also investigated the socio demographic variables and co occurring depressions and anxiety symptoms have significant contribution in impairment of QoL of OCD patient. They hypothesized that universal pattern of impairment in the physical, mental, and social aspects of quality of life of patient will be associated with more significant hoarding symptoms. The patients with the diagnosis of OCD were included; age between 18-80 years and without any other neurological, endocrinological or systematic disorder. The measures used were Saving inventory revised (SI-R), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Obsessive Compulsive Inventory- Revised (OCI-R), Medical Outcome Study 36-item short form health survey (SF-36). Chi-square and independent student t-test was used for the comparison of categorical a nd continuous variables respectively. The patient who met the inclusion criteria was 135 out of which 65 were patients, and 70 were controls. The result supported the hypothesize only partially, the decline in particular aspects of patients QoL was significantly associated with hoarding and washing symptoms for but co occurring symptoms, the most prominent determinant of the impairment of QoL of subject with OCD were depressive and anxious ones. The study had limitations that sample was taken from specialized institutions, second control group was of nonclinical individuals, rating on depression scale and QoL Instrument may be dependent on state and change during continuity of OCD, they applied generic tool for measuring QoL in OCD. Teachman (2007) studied subjective concerns about cognitive decline partially mediate this relationship between obsessional beliefs and OCD symptoms across young and older adult age group in a large community sample. The sample size was 335 including males and females. Obsessive-Compulsive Inventory-Revised, Obsessional Beliefs Questionnaire and Memory Functioning Questionnaire were used. This study attempted to evaluate the modification of cognitive model proposed by Rachman and Salkovskis. The results provide support to cognitive models of obsessions and suggest that obsessional beliefs that have been validated in younger adult samples are also important for older adults. It was shown that the relationship among subjective cognitive concerns, obsessional beliefs and OCD symptoms was consisted but older patients showed greater subjective cognitive concerns, Grant et al. (2006) carried out a study to find out the differences of OCD patients with primary OCD and sexual obsessions and OCD patients without sexual obsession on number of clinical variables. They included co morbidity, symptom severity, insight, quality of life, and social and occupational functioning under the clinical domains. 293 subjects, meting criteria for OCD, aged 19 years or older were included and interviewed. Clinical interview for DSM-IV Axis-I disorder, Yale-Brown Obsessive Compulsive Scale (YBOCS) to assess OCD symptom severity, Subject Clinical Global Improvement scale was used to evaluate the response towards medication. Rating on the degree to which previous treatments have proved to be effective was taken on 7 point scale. Brown assessment of Beliefs Scale (BABS) was used to evaluate the insight and current Depressive symptom and QOL by were assessed by using 17-item Hamilton Rating scale for Depression and Quality of life Enjoyment and Satisfaction Questionn aire respectively. The findings supported the hypothesize that earlier age of OCD, presiding entry in treatment, increased rate of aggressive and religious obsession onset was related to having OCD with sexual obsessions, and also with increaser depressive symptoms, longer duration of treatment, and higher rates of impulse control disorder. Teachman, Woody and Magee (2006) attempted to evaluate cognitive theories of obsessions and they experimentally manipulated appraisals of the importance of intrusive thoughts. The design contained both experimental and quasi-experimental elements. Implicit Association Test was used to examine the influence of instructions about the importance versus meaninglessness of unwanted thoughts on reaction time. Obsessive-Compulsive Inventory-Revised, Beck Depression Inventory, Interpretation of Intrusions Inventory III, Obsessional Beliefs Questionnaire-Short Form, State Self-Esteem Scale, and Personal Significance Scale were the part of study. Results indicated that the manipulation shifted implicit appraisals of unwanted thoughts in the expected direction, but not self-evaluation of morality or dangerousness. Interestingly, explicit self-esteem and beliefs about the significance of unwanted thoughts were associated wit the measure of OCD beliefs, whereas implicit self-evaluations of danger ousness were better predicted by the interaction of pre-existing OCD beliefs with the manipulation. Libby et al., (2004) studied Cognitive Appraisals in young people with Obsessive Compulsive Disorder. The study had two aims to investigate whether the same pattern of cognitive appraisal found in studies with adults will be observed in the younger population. A secondary aim of the study was to establish the relationship between cognitive appraisal and the extent these predict obsessive-compulsive symptoms. Three groups of young people aged between 11 and 18 years old were recruited for the study. First group were of patients with OCD, second was patient with anxiety disorder and third one was non clinical group. Leyton Obsessional Inventory-Child Version, Responsibility Attitude Scale, thought-Action Fusion Scale, and Multidimensional Perfectionism Scale was used n the study. The young people with OCD had significantly higher scores on inflated responsibility, thought-action fusion, and one aspect of perfectionism, concern over mistakes, than the other groups. In addition, inflated responsibility independently predicted OCD symptom severity. The results generally supported the cognitive appraisals held by adults with OCD to young people with the disorder. Saxena et al., (2010) conducted a research to compare compulsive hoarding and non compulsive hoarding OCD patients across variety of QoL domains. They hypothesized that hoarders would be older and have lower FAF scores than non hoarding OCD patients. Secondly, hoarding patients would be less satisfied with their living situations, given their amount of clutter, and hoarders would have greater victimization/ safety concerns and finally hoarders would have greater financial problems and receive more social service assistance than non-hoarding OCD patients. To study this171 adult patients were selected (84 males, 87 females) with age aged 18-72. They were diagnosed OCD and treated openly between 1998 and 2005. Out of these patient 34 met criteria of having compulsive hoarding syndrome. 137 patients didnt report any hoarding symptoms. Patient presented with a wide range of co morbid diagnosis. Those with active psychosis, mania, dementia, mental retardation or other cognitive impairment were excluded. Standardized rating scales were used to assess symptom severity and level of functioning. YBOCS was used to measure OCD symptom severity. Severity of depressive and anxiety symptoms were measured by 28 item Hamilton Depression rating scale (HDRS-28) and Hamilton Anxiety Scale (Ham-A) respectively. QoL was assessed with Lehman Quality of Life Interview Short. Obtained scores for QoL between 2 groups were compared using Analysis of Variance procedures. ANCOVA were performed with covariates and also for secondary analysis on individual items. Results showed that compulsive hoarders were significantly older that non hoarding OCD patients. QoL scores on victimization and safety factors differed significant between 2 groups. Hoarder felt less safe in streets and less satisfied with protection. Both groups had significant occupational impairment, unemployment and disability. Discrepancy in sample size between 2 patient groups and intensive patient setting were the limitation s of study. Eisen et al., (2006) conducted a study to assess multiple aspects of QoL in individuals with OCD. It was hypothesized that all aspects of QoL would be affected, and that severity of OCD symptoms and depressive symptoms would be associated with impairment in QoL. 5 years prospective naturalistic study was conducted on 197 participants with an age 18 years or older, primary OCD. An exclusion criterion was having an organic mental disorder. YBOCS, Brown assessment of Belief scale, Modified Hamilton rating scale for Depression, Quality of Life Enjoyment and Satisfaction Questionnaire, Social Occupational Functioning assessment scale, Medical outcome survey 36-item short form Health Pearson product moment correlation coefficient was conducted to assess relationship between clinical features of OCD and QoL. Results showed that YBOCS score of 20 appeared to be an inflection point where QoL becomes significantly more impaired, suggesting that functioning and QoL, may be preserved in individu als with OCD until threshold of severity is crossed. Limitations of the study were participants seeking treatment and therefore finding may not apply to those individuals who do not seek treatment. Moreover, subjects were evaluated only once. It was suggested that the role of treatment in improving QoL in OCD should be further investigated along with a need to assess which aspect of QoL and psychological functioning. Guraraj et al., (2008) conducted research in which they hypothesized that patients suffering from severe OCD may have comparable level of global functioning, family burden and QoL and disability with patient suffering from schizophrenia. 70 subjects from National Institute of Mental Health and Neuroscience gave informed consent. Inclusion criteria were (a) a primary diagnosis of DSM IV OCD/schizophrenia (b) continuous illness for the previous 2 year (c) Clinical Global Impression Severity (CGI-S) score of > 4 (d) availability of a primary care giver involved in patient care for 2 years Mini-international Neuropsychiatry Interview was conducted to confirm the diagnosis. Global Assessment of Functioning (GAF), World Health Organization (WHO-Quality of life (QOL)(BREF Version), WHO Disability Assessment Schedule-II (WHO-DAS-II). Family Burden Schedule (FBS) were used to assess global functioning, quality of life and disability. ANCOVA was employed with age of onset and duration of illne ss as covariate for comparison of family burden, QoL and disability between 2 groups. Pearson correlation between socio demographic/ clinical variable, family accommodation and functioning with family burden were performed. The results demonstrated that severe OCD is associated with significant impairment in functioning and severe family burden and disability. QoL was poor and severe OCD and schizophrenia are often associated with comparable disability, family burden and poor QoL. Huppert et al., (2009) compared the QoL of OCD patients with functioning of matched healthy controls. They hypothesized that OCD patients in remission would report similar QoL and functioning matched healthy controls (HCs), while individuals with OCD would report poorer QoL and functional impairment. Additional prediction was that OCD patients and comorbid psychiatric disorder would report the worst QoL and functional impairment. Finally, Individuals with a history of OCD (current or past) increased severity of OCD would be related to decrease in QoL and increased functional impairment, even when controlling for depression. 66 comprised the current sample. 36 HCs were included. They were matched on age, sex and ethnicity. Stru

The Causes of Altruism Essay -- Psychology

How do humans actually behave when faced with the decision to help others? The innate desire that compels humans to help is called altruism by psychologists. Through this feeling, humans transform from a selfish jerk to a more compassionate and caring person. Some psychologists believe that this feeling stems from nature itself. Despite the fact that some altruistic acts originate from the pressures of society, altruism predominantly comes from the survival of the fittest, the feeling of empathy, and the selfish desire to benefit your own kin. Before a case can be made for the causes of altruism, altruism itself must first be defined. Most leading psychologists agree that the definition of altruism is â€Å"a motivational state with the ultimate goal of increasing another’s welfare.† (Batson, 1981). The only way for a person to be truly altruistic is if their intent is to help the community before themselves. However, the only thing humans can see is the actions themselves, and so, selfish intent may seem the same as altruistic intent. Alas, the only way that altruism can be judged is if the intent is obvious. Through that, we must conclude that only certain intents can be defined as altruistic, and as intent stemming from nature benefits the group while other intent benefits yourself, only actions caused by nature are truly altruistic. Some psychologists believe that altruism stems from evolution, or the survival of the fittest. They point to examples where ants will willingly bury themselves to seal the anthill from foreign attacks, or the honeybee’s sting. That sting rips out the honeybee’s own internal organs, and has been described as â€Å"instruments of altruistic self-sacrifice. Although the individual dies, the bee’... ...ence for Altruism: Toward a Pluralism of Prosocial Motives.† Psychological Inquiry 2.2 (1991): 107-122. Web. 5.Feb. 2012. Dach-Gruschow, Karl Otto. Peace on Earth and Goodwill Toward Men: Altruism of Long Term Volunteers Diss. University of Illinois at Urbana-Chamaign, 2011. Print. Gintis, Herbert, Samuel Bowles, Robert Boyd, and Ermst Fehr. â€Å"Explaining Altruistic Behavior in Humans.† Evolution and Human Behavior 24 (2003): 153-172. Web. 5 Feb. 2012 Nunney, Len. â€Å"Group Selection, Altruism, and Structured-Deme Models.† The American Naturalist 126.2 (1985): 212-230. Web. 10 Feb. 2012. Rushton, J. Philippe. â€Å"Is Altruism Innate?† Psychological Inquiry 2.2 (1991): 141-143. Web. 5 Feb. 2012. Thomas, George and C. Daniel Batson. â€Å"Effect of Helping Under Normative Pressure on Self-Perceived Altruism.† Social Psychology Quarterly 44.2 (1981): 127-131. Web. 5 Feb. 2012

The Turning Point of the American Civil War: Battle of Gettysburg or Siege of Vicksburg?

The Turning Point of the American Civil War: Battle of Gettysburg or Siege of Vicksburg? The American Civil War, also known as the War Between the States, was a brutal onslaught between the Union (the North) and the Confederacy (the South) originating in the fractious issue of slavery. The ruthlessness of this war, mostly fought in the South, lasted from 1861 through 1865, where the Confederacy was ultimately defeated, slavery was abolished, and the extremely difficult process of the reconstruction of the United States and its unity began.There were many battles fought during the American Civil War including the Battle of Fort Sumter, the Battle of Yorktown, and the Battle of Hanover, however, the most known confrontation is the Battle of Gettysburg. The Battle of Gettysburg took place in Pennsylvania from July 1st through July 3rd of 1863. General Robert E. Lee (commanding the Confederate army) concentrated his full strength against Major General George G. Meade’s Army of the Potomac (Union) at the crossroads county seat of Gettysburg.On July 1st, Confederate and Union forces collided at Gettysburg, with General Lee’s intention being to engage the Union army and to destroy it. Initially, the Union defended low ridges to the northwest of town. Unfortunately for the two corps of Union infantry and the Union cavalry division that was defending the region; two large corps of Confederate infantry assaulted them from the north and northwest. This collapsed the hastily developed Union lines of defense and sent the defenders retreating south through the streets of town and to the hills close by.On the second day of battle, July 2nd, most of the Union and Confederate armies had been assembled. Fierce fighting raged this day, figuratively and literally staining the ground crimson with blood. Despite the onslaught of the Confederacy, the Union managed to hold their lines even with the significant losses that they suffered. On July 3rd, the last day of the B attle of Gettysburg, the Union army repulsed the attack with artillery fire, at great losses to the Confederate army. General Lee led his army on a torturous retreat back to Virginia, making the Union the victor of the battle.But was the Battle of Gettysburg really the turning point of the Civil War? All that the Battle of Gettysburg accomplished was prohibiting the Confederacy from further travel into Union territory. This is where the Siege of Vicksburg comes into play. Believed to be one of the most remarkable campaigns of the American Civil War, the Siege of Vicksburg is also arguably the turning point of the Civil War militarily. General Ulysses S. Grant’s campaign on Vicksburg secured John Pemberton’s army’s surrender on July 4th, 1863 as well as the Mississippi River firmly in Union hands.With that, the Confederacy’s fate was all but sealed. Also known as the Battle of Vicksburg, this confrontation was a culmination of a long land and naval campaig n by Union forces to capture this strategic position. Abraham Lincoln (the president at the time) recognized the significance of Vicksburg. He said, â€Å"Vicksburg is the key, the war can never be brought to a close until that key is in our pocket. † There were many attempts at securing Vicksburg, the first being in the summer of 1862.It included a prolonged bombardment by Union naval vessels, but unfortunately after the ships withdrew the attempt failed. General Grant was moving his troops on land towards the town from the rear. However, his advance ended when General Nathan Bedford Forrest of the Confederacy destroyed Grant’s rail supply line, and General Earl Van Dorn of the Confederacy captured the Union supply base at Holly Springs. General Grant tried again that December, but again was met with failure. Another Union General, General William T. Sherman, led an assault against the high ground of the Chickasaw Bluffs north of Vicksburg.To the Union’s dismay this resulted in nearly 1,800 casualties of their own with only just over 200 casualties to the Confederate defenders. Because of this, Grant’s men attempted to find ways through the shallow and narrow bayous to bypass what is called the Confederate â€Å"Gibraltar of the West†. After months of trying to find a bypass, Grant finally decided that his army would have to operate south of Vicksburg, which would require the cooperation of the navy. To mask his army’s movement down the Louisiana side of the Mississippi river, Grant had Sherman administer two deceptive maneuvers north of Vicksburg.On April 16th, 1863, Rear Admiral David Dixon Porter traveled down the Mississippi River, running a gauntlet of guns firing from the Vicksburg cliff, and met with Grant’s army. In the largest amphibious operation ever conducted by an American force before World War II, Porter and Grant transferred 24,000 men and 60 guns from the west bank to the east bank of the Missi ssippi. Unopposed at Bruinsburg, Mississippi they landed and began marching toward Grand Gulf and Port Gibson which were towns that were to the north along the river.On May 1st, four divisions of the Union army clashed with a Confederate brigade near Port Gibson. This battle cost each side between 700 and 900 men. Even with the losses, the two river towns were captured without any more significant fighting between the Union and the Confederacy. With General Sherman leading the rest of General Grant’s army, they then crossed the river at Grand Gulf, bringing the force to over 45,000 men. He then turned them all inland toward the Mississippi state capital, Jackson.There were two Confederate forces in the area, one in Jackson of only approximately 5,000 soldiers and another at Vicksburg of approximately 26,500 soldiers who were under the leadership of General John C. Pemberton. One of Grant’s advancing divisions came into contact with a Confederate force at Raymond on May 12. Although this was not a major battle, it was this confrontation that sent Pemberton’s army retreating. After hours of confused conflict, the Confederate army withdrew from the battle and ran to the shelter of Vicksburg. After a few more battles, General Grant decided to besiege Vicksburg on May 25th, 1863.He devised a plan that is still studied to this day as a basis for siege warfare. Inside the town of Vicksburg, civilians were huddled in caves to avoid the artillery shells that Grant’s army were constantly bombarding the town with. Foods as well as other much needed supplies were cut off from the town. Animals like dogs, cats, horses, and sometimes even rats were reportedly becoming part of the diets of civilians and soldiers alike. Conditions for the town of Vicksburg became so unbearable that on July 3rd, 1863, General Pemberton of the Confederacy rode out to discuss the terms of surrender of his army.The next morning on July 4th, 1863 Pemberton’s men began marching out and stacking their guns in surrender to Grant’s army. The city of Vicksburg was so defeated by the surrender that they would not celebrate Independence Day thereafter until well into the 20th century. During the Siege of Vicksburg, Union and Confederate forces alike kept busy in their supporting roles on the Louisiana side of the Mississippi River. Lieutenant General Edmund Kirby Smith of the Confederacy received a telegraph form Pemberton requesting a movement against Grant’s communication lines along the Mississippi.To the Confederacy’s dismay, Grant had established supply depots at Milliken’s Bend, Young’s Point, and Lake Providence within Smith’s jurisdiction. However, Smith failed to recognize the importance of Pemberton’s situation. It wasn’t until June when Smith finally decided to act on Pemberton’s request the month earlier. To the growing Confederate activity in the area, Grant decided to res pond by dispatching troops from the Vicksburg trenches across the Mississippi River. General John G. Walker’s Confederate division on the Louisiana side of the Mississippi was of particular concern.Its presence could possibly aid Pemberton’s Confederate army’s escape from the city of Vicksburg. Therefore, the Union sent a brigade in the vicinity of Milliken’s Bend to stop the threat. Many smaller battles were fought to prevent support to those in Vicksburg; one included an artillery battery targeting an iron foundry that was recasting spent Union artillery shells as the men returned to De Soto Point. The targeted foundry was destroyed on June 25th. Additional Confederate activity occurred on June 29th at Goodrich’s Landing.The Confederates attacked a plantation and army training center run by former slaves. They destroyed the plantations and captured over a hundred former slaves before disengaging in the face of the Union army. Confederate raids su ch as these were disruptive and caused damage, but they were only minor setbacks. They also showed the Confederates that they could only cause momentary disturbances in the area and ultimately would not halt the Union. Later in the Siege of Vicksburg, Union troops tunneled under the 3rd Louisiana Redan and packed the mine with 2,200 pounds of gunpowder, then proceeded to detonate it.The explosion destroyed the Confederate lines on June 25th, while an infantry attack followed the blast. The 45th Illinois Regiment (known as the â€Å"Lead Mine Regiment†) charged into the 40 foot diameter 12 foot deep crater with ease, but unfortunately they were stopped by the recovering Confederate infantry. The Union soldiers became pinned down while the defenders also rolled the artillery shells with short fuses into the pit with very deadly results. Union engineers worked to set up a casemate in the crater in order to extricate the infantry, and soon the soldiers fell back to a new defensiv e line.From the crater left by the explosion on June 25th, Union miners worked to dig a new mine to the south and on July 1st this mine was detonated but no infantry attack followed the explosion. This attack was much more successful Due to the brilliance of General Grant’s leadership the fortress city had fallen, and with the surrender of Port Hudson on July 9th, the Mississippi River was firmly in Union hands, leaving the Confederacy effectively split into two. During the Siege of Vicksburg, the Union’s casualties mounted up to just under 5,000 men while the Confederacy lost over 32,000 men.The full forty-seven day siege claimed many lives, but in doing so many were also saved. With the Mississippi in Union hands, communication between the Confederate army was lost, which ultimately secured the fate of the war being in the Union’s favor. The Battle of Gettysburg, although a very important engagement between the Union and the Confederacy, was not the turning po int of the American Civil War militarily. After crossing the Mississippi River on April 30th, 1863, General Ulysses S. Grant’s Union army waged a fighting campaign and maneuvered to isolate the city of Vicksburg and the Confederate army defending it.The constant defeats Grant and his army inflicted gave the Confederate commander General John C. Pemberton no choice but to retreat to the defenses of the city of Vicksburg and hold out until much needed reinforcements could arrive. On May 19th and May 22nd, General Grant launched a series of frontal assaults against Pemberton’s forces, suffering heavy casualties. Finding it irresponsible to continue these frontal assaults, Grant decided to lay siege to the city of Vicksburg, ordering his men to dig a series of trenches to the Confederate standings.For 47 days, the Union bombarded Vicksburg while the Confederate soldiers and civilians alike suffered the hardships of siege warfare On July 4th, General Pemberton surrendered h is army to General Grant and the Union, ending the siege and granted control of the vital Mississippi River in the North’s hands, effectively cutting the Confederacy in half. Grant’s success here secured the South’s fate and inevitably led to the Union victory. The Battle of Gettysburg was not the turning point of the Civil War considering all that the Union achieved was prohibiting the Confederacy from proceeding north.The Siege of Vicksburg destroyed the Confederacy offensive and ultimately led to the end of the American Civil War with the North as the victors, the abolishment of slavery, and the beginning of the reconstruction of the south as well as the United States of America. Bibliography 1. Bearss, Edwin C. Fields of Honor: Pivotal Battles of the Civil War. Washington, D. C: National Geographic Society, 2006 2. Hay, Thomas Robson. â€Å"Confederate Leadership at Vicksburg. †Ã‚  The Mississippi Valley Historical Review. 11. no. 4 (1925): pp. 543-56 0 3. Hoehling, A. Vicksburg: 47 Days of Siege. Stackpole Books, 1996. 400.Print 4. Rhodes, James Ford. â€Å"The Battle of Gettysburg. † (1899): pg. 665-677 5. Sabin, Edwin L. â€Å"Vicksburg, and after: Being the Experience of a Southern Merchant and Non-Combatant during the Sixties. †Ã‚  The Sewanee Review. 15. no. 4 (1907): pg. 485-496 6. Woodworth, Steven E. Jefferson Davis and His Generals: The Failure of Confederate Command in the West. Lawrence: University Press of Kansas, 1990 ——————————————– [ 1 ]. James Ford Rhodes, â€Å"The Battle of Gettysburg† (1899): pg. 665-677 [ 2 ]. Rhodes, James Ford. â€Å"The Battle of Gettysburg. † (1899): pg. 665-677 [ 3 ].Bearss, Edwin C. Fields of Honor: Pivotal Battles of the Civil War. Washington, D. C: National Geographic Society, 2006 [ 4 ]. Edwin C. Bearss,  Fields of Honor: Pivotal Battles of the Civil War, (Washington, D. C: National Geographic Society, 2006) [ 5 ]. Hoehling, A. Vicksburg: 47 Days of Siege. Stackpole Books, 1996. 400. Print. [ 6 ]. Bearss, Edwin C. Fields of Honor: Pivotal Battles of the Civil War. Washington, D. C: National Geographic Society, 2006 [ 7 ]. Thomas Robson Hay, â€Å"Confederate Leadership at Vicksburg,†Ã‚  The Mississippi Valley Historical Review, 11, no. 4 (1925): pp. 543-560 [ 8 ]. Edwin L. Sabin, Vicksburg, and after: Being the Experience of a Southern Merchant and Non-Combatant during the Sixties,†Ã‚  The Sewanee Review, 15, no. 4 (1907): pg. 485-496 [ 9 ]. Thomas Robson Hay, â€Å"Confederate Leadership at Vicksburg,†Ã‚  The Mississippi Valley Historical Review, 11, no. 4 (1925): pp. 543-560 [ 10 ]. Steven E. Woodworth,  Jefferson Davis and His Generals: The Failure of Confederate Command in the West, (Lawrence: University Press of Kansas, 1990) [ 11 ]. Hoehling, A. Vicksburg: 47 Days of Siege. Stackpole Books, 1996. 400. Print [ 12 ]. Hoehling, A. Vicksburg: 47 Days of Siege. Stackpole Books, 1996. 400. Print

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