**4. Obsessive compulsive disorders**

In OCD, we witness obsession and compulsive rituals, usually both of them. Obsessions are repetitive and ongoing thoughts impulses or beliefs which are not as simple as worries of daily life, and individual tries to ignore them through coping mechanisms as they affect daily life and cause great anxiety. People with OCD realize that all of these thoughts only exist in their minds. Permanent impulses such as unwanted thoughts or beliefs that might hurt others, getting worked up over a turned on light or an open door, and suspicions over sexual impulses can be given as examples of obsession [38, 43].

Compulsions are repetitive behaviors and mental acts, as in washing hands consecutively, repeatedly checking the task at hand, praying, and counting. For the person to have rigid rules like counting to ten is a determining factor for the behavioral aspect. Individual would feel under pressure and "compulsed" to do. Compulsions have no relation with reality; their purpose is to decrease the stress and prevent bad things from happening in the person's eye [44].

OCD leads to major difficulties in daily functioning and causes significant personality problems and mental problems when not treated. It is not surprising that the quality of life is affected by the problems encountered in functions and the nature of OCD. The social functions affecting quality of life in OCD are affected rather poorly than other mental diseases. Problems associated with intensive obsessions and compulsions affect social functions. Symptoms cause the individual to spend time with his or her family or work life. For this reason, the possibilities of positive social interaction and functional experience are reduced [45]. Anxiety may accompany obsessions and compulsions. Individuals feel themselves anxious and nervous. For this reason, the physical and social environment has an important effect on the emotional state of the individual. Both the environmental parameters and the symptoms affect each other. The anxiety that may arise from symptoms of the individual can be controlled by physical environment facilities and positive social support.

announcements, books, flyers, films, videos, Web pages, podcasts, virtual reality, and

**2.** A second strategy for reducing stigmatization is interpersonal communication with the members of the stigmatized group. People with mental illness have the potential to reduce the prejudice levels of the general population who meet and interact with

**3.** Social activism or protest is the third type of stigmatization change we have examined. Protest strategies emphasize the injustices of various stigma criminals for stigmatization and discrimination: "There is protest anecdotal evidence, such as embarrassing us all to continue the idea that people with mental illness cannot look after them, are big children." Proposes that the protest can reduce harmful media representatives [41]. Psychiatry and medicine as a whole profession should develop effective methods against stigmatization of a group of mentally ill people and provide basic human rights. The relationship of psychiatry and the media, and especially the media, to psychiatry should be highly fair and professional, based on facts, not on sensation. Adequate and fair media coverage can significantly reduce the stigmatization of individual with mental disease. This can facilitate the functioning of the family and society. Therefore, changing attitudes will help people on medical care become more human and abandon negative attitudes that prevent us from

In OCD, we witness obsession and compulsive rituals, usually both of them. Obsessions are repetitive and ongoing thoughts impulses or beliefs which are not as simple as worries of daily life, and individual tries to ignore them through coping mechanisms as they affect daily life and cause great anxiety. People with OCD realize that all of these thoughts only exist in their minds. Permanent impulses such as unwanted thoughts or beliefs that might hurt others, getting worked up over a turned on light or an open door, and suspicions over sexual

Compulsions are repetitive behaviors and mental acts, as in washing hands consecutively, repeatedly checking the task at hand, praying, and counting. For the person to have rigid rules like counting to ten is a determining factor for the behavioral aspect. Individual would feel under pressure and "compulsed" to do. Compulsions have no relation with reality; their purpose is to decrease the stress and prevent bad things from happening in

OCD leads to major difficulties in daily functioning and causes significant personality problems and mental problems when not treated. It is not surprising that the quality of life is affected by the problems encountered in functions and the nature of OCD. The social functions affecting quality of life in OCD are affected rather poorly than other mental

other audiovisual support [39].

94 Anxiety Disorders - From Childhood to Adulthood

becoming better and fairer [42].

the person's eye [44].

**4. Obsessive compulsive disorders**

impulses can be given as examples of obsession [38, 43].

people [40].

Stigma is a social force associated with people with many different health situations, feature, and social structures. Moreover, literature review shows that mental problems, sexuality, race, and STDs can also be regarded as related subjects [46]. Symptoms are not the only reason for the problems that people with psychiatric illnesses face in life. When problems these individuals live through are taken into account, stigma can be called a "second illness" [47, 48]. Individuals with psychiatric problems experience discriminatory behaviors and emotional acts in different forms. These labeling acts and situations create barriers against life opportunities for individuals. People who go through with stigmas might internalize these prejudices, in which case they start to believe that these beliefs are completely true and that creates some more barriers for them [49].

Stigma affects the people with OCD, and individuals might find themselves feeling under the weather or feel fear due to mental problem diagnosis, which can later affect the attitude toward the treatment and their motivation [47]. We see stigma as one of the many barriers we encounter on OCD treatment. Individuals with OCD go through a fear of stigma which can be described as a behavior to avoid the necessary help due to fear of a psychiatric diagnosis [50, 51] (**Figure 4**).

**Figure 4.** Obsessions and compulsions are related to anxiety and beliefs.

In society, general attitude toward people with mental issues is basically seen as "keeping away," "observation," and lastly isolation. Much of the mentioned compulsive rituals might seem unusual to the people unaware of the process individual with OCD go through. Society labels these individuals as people with strange behavior or people who act madly. The fact that labeling has started indicates that process goes to social stigma. If the person's actions are found weird but can be tolerated, they are labeled as nervous people. Stigmatized people should be evaluated according to underlying reasons behind their illnesses and their belief in themselves. Rejection of a stigmatized person depends on etiology of the illness and its interpretation [52]. CD has great significance in lives of people with OCD and their families. As the people experience increasing obsessive and compulsive thoughts, they become socially isolated, and by time, their illness gets worse and they might need to be taken care of [53, 54]. Illnesses that are treated by psychiatrists are generally regarded as mental illnesses. This term traditionally used to describe serious mental problems, and it stigmatizes people with this problem via society and themselves. Many individuals with OCD refrain from receiving necessary support because of the risk of being stigmatized. They would often look for somatic explanations such as it being a dermatological problem in order to ignore the mental problem that they have [52]. Self-stigma is a term used in the case where the individual internalizes the negative approach he/she receives. Therefore, a person with OCB who internalizes the societal prejudices would feel a flaw in themselves and therefore would expect to be rejected by the society [1, 2]. Livingston and Boyd [46] show that self-stigma affects—very strongly and negatively—the psychosocial status such as empowerment and self-esteem as much as it affects individual's psychiatric status.

can cause problems in self-esteem, seeking treatment, benefiting from social opportunities, criminal justice system, and problems in family and friends' relations. Families of individuals with OCD and close friends live difficult situations due to stigma. Self-stigma and the social stigma have a negative impact on their participation in daily life activities, their functional-

Stigma in Obsessive Compulsive Disorder http://dx.doi.org/10.5772/intechopen.83642 97

In individuals with OCD, emotions such as shame, guilt, and fear emerge during the first appearance of the disease. The first reaction is usually a tendency to reject. Individuals try to cope with the symptoms alone. They start to live with disease by trying to hide their symptoms. It is usually later that they perceive this as a disease. For this reason, it can be shown that they have no previous knowledge about the disease. The lack of insight causes them not seeking treatment, not getting help, and not doing research. They acknowledge that there is a trouble when it comes to coping with the symptoms, but the search for treatment with emotional factors such as shame, guilt, and fear is delayed again. OCD, like other mental disorders, is a psychiatric disorder that needs to be diagnosed and treated early. OCD diagnosis is usually delayed for such reasons. Individuals with OCD are resistant to interviewing health personnel and postpone treatment seeking. Treatment with the cause of hesitation in seeking treatment begins at a later stage of the disease. The delay in the onset of treatment affects the treatment process negatively in OCD, just as it is in other diseases. As well as having problems in seeking treatment with the cause of stigma, after the treatment starts, the treatment can also have problems with regular participation, continuity, and concluding the treatment. At the beginning of the treatment, the rate of cessation treatment in individuals is very high. Stigma slows down the process and causes them to have negative emotions. The treatment phase can be long-lasting, sometimes challenging and painful. While this process is difficult enough to cope with, the stigma makes this process even harder. **The self-perception can be changed and his belief that he is a successful cure is shaken**. The negative effect of stigmatization on patience and perseverance prevents the steady maintenance of treatment.

Individuals with OCD experience feelings of shame, guilt, fear, and anxiety when they are diagnosed with the disease and prefer to **fight alone in the treatment process**. Fear of exposure to stigmatization prevents individuals from giving information about their illness to their relatives. In general, individuals tend to keep it confidential from the family and those close to them. This situation causes environmental support to fail. As with all other illnesses, it is important that environmental support is available to deal with the disease during the treatment process [60]. Concerns about accusations and exclusion by those who are close to the family in **relation to other people** cause problems and distances away from others [1, 61]. The tendency to keep the disease secret is caused by the inability to receive support from family members or close associates, and the prognosis of the disease is adversely affected. This is

Studies show that violence and sexual obsessions are not shared in particular and that it is **more difficult to seek help** in this regard. Because of the feeling of embarrassment in these obsessions, it is delaying the search for treatment that cannot be shared with health personnel [61]. In another study, 738 adults were asked about pollution, symmetry, damage, and taboo

ities, their occupational lives, their productivity, and their social lives [33].

These affect the prognosis of the disease negatively [3, 8].

why getting help is important.

Before obsessive and compulsive behaviors develop, individuals experience great trauma and intense stressful processes. Individuals' responsibilities and the value they give to events determine the significance and importance of this process. Their fear of stigma causes to hide their experiences. This situation hampers help requests, including educators and health professionals. Symptoms of OCD cause time and energy loss in the individual's life. This situation negatively affects the performance of the individuals in the activity areas that require social participation in particular. As a result, individuals isolate themselves from others [55]. Individuals with OCD often hide bullying and shame [56, 57]. They try to keep their obsessions and compulsions against future hurdles and that do not go to places that generate stress and anxiety. The presence of OCD can increase the risk of substance abuse and suicidal thoughts [58]. Attitudes and behaviors of peers are important for OCD children. As a result of negative attitudes and behaviors of peers, the possibility of exclusion of OCD children is very high. A study shows that 25% of participants are being excluded by their peers. Examples of behaviors such as kicking, hitting, rumor spreading, and social isolation are examples of peer attitudes [59].
