CHAPTER ONE
INTRODUCTION
- Background of the Study
Obsessive-Compulsive Disorder (OCD) is one of the ObsessiveCompulsive and Related Disorders (OCRD) that is observed relatively frequently and appears to be among the conditions related to youths (American Psychiatric Association, 2013; Uguz, Kaya, Gezginc, Kayhan, & Cicek, 2011). In the DSM-5 OCD is recognized as a disorder distinct from anxiety and it is characterized by the presence of obsessions and/or compulsions. Obsessions are then 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).
A number of researchers (Abramowitz, Schwartz, Moore, & Luenzmann, 2003; Fairbrother & Abramowitz, 2007; Fenske & Petersen, 2015; Gangdev, Stein, & Ruzibiza, 1996; Guglielmi et al., 2014; Niehaus, 2004; Vousoura, 2012) report that the lifetime prevalence of OCD in the general population is approximately 2–3%, making it one of the most common psychiatric disorders. Interestingly, estimates of the prevalence rates of OCD in students have been found to be greater than the estimated prevalence in the general population (Uguz & Ayhan, 2011; Uguz, Kaya, Gezginc, Kayhan, & Cicek, 2011). Current empirical evidence suggests that the perinatal period is the time of high risk for the onset of OCD, with studies reporting that up to 40% of students of childbearing age have onset of symptoms during this period (Abramowitz et al., 2003; Fenske & Petersen, 2015; Frías et al., 2015; Kaya, Uguz, Sahingoz, & Gezginc, 2015; Russell, Fawcett & Mazmanian, 2013; Sharma & Sharma, 2015; Uguz & Ayhan, 2011; Vythilingum, 2009). Moreover, studies indicate that up to 50% of students suffering from OCD recall the onset or worsening of their symptoms during the perinatal period (Lord, Reider, Hall, Soares, & Steiner, 2011).
Amongst the students with OCD, the most common obsessions are germ contamination, and symmetry or exactness, while the most common compulsions are cleaning and checking (Abramowitz et al., 2003; Chaudron & Nirodi, 2010; Kaya et al., 2015). Perinatal obsessions and compulsions are very specific in content and are frequently directed towards the baby’s health and well-being, and the environment. The symptoms thus create immense distress and impair not only the mother’s social, occupational and personal life, but may also affect the ability of the mother to care for her baby, leading to negative fetal outcomes, long-term behavioural challenges and disrupts the mother-infant bonding process (Chaudron & Nirodi, 2010; Fairbrother & Abramowitz, 2007; Gezginç et al., 2008; Lord et al., 2011; Vythilingum, 2009). Furthermore, the quality of life in patients with OCD seems to be worse than that in patients with depressive disorders, and similar to those with patients with Schizophrenia (Gezginc et al., 2008).
Researchers have also noted that there is a substantial overlap between general OCD and depressive symptoms, with comorbidity studies indicating that as many as a third of adults with OCD also meet criteria for major depressive disorder (Abramowitz et al., 2003). According to van Heyningen et al. (2016), depression during the perinatal period is of particular concern because of the disabling effect on maternal functioning and the negative consequences for the health and development of infants and children. A study by Chaudron and Nirodi (2010) revealed that 32% of the students who reported high levels of anxiety also reported experiencing depressive symptoms, suggesting that OCD is related to depression. Moreover, Whitehead and Abromawitz (2005) found that patients with OC symptoms experience more anger, have a tendency to suppress it inwardly and express anger outwardly. Patients also report more difficulty in controlling their anger, with anger correlating with the presence of comorbid depression.
Although the relationship between education and OCD has been extensively explored amongst Western students, the prevalence and factors related to OCD during education amongst African students do not seem to be investigated frequently. The incidence of OCD symptoms in blacks is considered to be low (Gangdev et al., 1996). This is surprising since the DSM-5 itself recognizes that OCD is common globally and its prevalence patterns, with respect to onset age, comorbidity and distribution by gender, are the same cross-culturally (American Psychiatric Association, 2013, p. 240). Thus, the proposed study focuses on OCD amongst African students. This study focuses on the issue of prevalence as a starting point. Thereafter, some related variables are also included. These include anxiety, depression and anger.
1.2 RESEARCH PROBLEM
Recent research suggests that the onset of OCD symptoms amongst students is a reality and occurs frequently (Uguz et al., 2011). Apparently, many students suffer from either new onset or worsening of existing OCD symptoms during education (Vythilingum, 2009). The occurrence of OCD symptoms tends to interfere with the students’s daily functioning and often disrupts the study process as OCD symptoms are directed to the health and well-being of the individual. OCD leads to definite anxiety and disturbs social and occupational capacity, wastes time, and also causes severe disturbance in the quality of life of students (Gezginc et al., 2008; Uguz et al., 2007a).
In a study by Uguz, Gezginc, Kayhan, Sarı, and Büyüköz (2009) OCD and depression were found to be the most common two disorders in most students with the prevalence rate of OCD being 5.5% and depression being 5.2%. On the other hand, Whitehead and Abramowitz (2004) found that patients with severe OCD symptoms present with increased levels of anger than patients with low OCD symptoms. Moreover, those with severe obsessive-compulsive symptoms also experience depressive symptoms. The literature concerning anxiety disorders such as OCD in education is limited and there are also contradictory reports as to whether anxiety disorders are more or less common during education (Adewuya, Ola, Aloba, & Mapayi, 2006). Although there is evidence that OCD does occur among South Africans, including Blacks (Gangdev et al., 1996), I have not come across a study of OCD directed at students in Nigeria. Therefore, it is necessary to investigate the prevalence of OCD amongst students at College of Nursing and Midwifery, Birnin Kudu, Jigawa state.
1.3 Study aim
The aim of the study is to present rates of OCD amongst students at 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.
1.4 Study objectives
1.4.1 To determine rates of OCD amongst students at amongst students at College of Nursing and Midwifery, Birnin Kudu, Jigawa state
1.4.2 To establish if OCD is related to depression, youthful anxiety and anger during education.
1.5 Hypotheses
Rates of OCD amongst students in the community education clinic:
1.5.1 High rates of OCD will be reported.
Factors related to OCD among students in the community education clinic:
1.5.2 Students who report high levels of depression, education-related anxiety and anger will also report experiencing symptoms of OCD.
1.5.3 OCD symptoms will be positively predicted in a model that includes depression, youthful anxiety and anger as predictors.
1.6 SIGNIFICANCE OF THE STUDY
The research outcomes of this study will indicate if OCD exists during education. The study will also help to determine whether OCD exists amongst African students in the Nigerian
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