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REVIEW ARTICLE
Year : 2015  |  Volume : 28  |  Issue : 2  |  Page : 289-294

Obsessive-compulsive disorder, an Islamic view


Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt

Date of Submission12-Apr-2014
Date of Acceptance18-May-2014
Date of Web Publication31-Aug-2015

Correspondence Address:
Said T Elzahar
Shebin Alkom Mental Hospital, 32512
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.163869

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  Abstract 

Objective
The aim of this work was to study obsessive-compulsive disorder (OCD) from the Islamic viewpoint and programs of Islamic cognitive behavioral therapy (CBT) in OCD.
Background
OCD in Arab and Islamic populations is mostly viewed and managed from a religious perspective, and these individuals are often more religious and more likely to seek out religious counseling and less likely to receive medical treatment. Most early Islamic scholars associated most cases of OCD to the devil and related it to religion; they established Islamic legislations on the basis of this concept. Research from the Islamic viewpoint on issues linked to these disorders can prevent exploitation of patients by swindlers and imposters on the basis of religion.
Methods
The authors performed a systematic review and a narrative synthesis of studies; relevant publications were identified, reference lists were examined, and citation searches were performed. No restrictions on date or type of study were applied.
Recent findings
Religious patients receiving religious psychotherapy showed significantly more rapid improvement, and required lower dosage of medications and for periods less than others. The role of religion as CBT could be significant in the Islamic culture.
Conclusion
OCD is quite different from the whispers of Satan or self-talk by the Islamic understanding. Islamic legislation for patients with OCDs has to be revised in accordance with changes in the concept of obsessions in Islamic considerate. The religious component in CBT can be effective for religion-oriented OCD patients in Islamic culture. Education on OCD and specialized treatment trainings in religious settings could be beneficial to providing therapies. The correct teachings of Islam provide adequate support for individuals with scrupulous obsessions.

Keywords: cognitive behavioral therapy, obsessive-compulsive disorder, obsessive-compulsive personality


How to cite this article:
Mohamed NR, Elsweedy MS, Elsayed SM, Rajab AZ, Elzahar ST. Obsessive-compulsive disorder, an Islamic view. Menoufia Med J 2015;28:289-94

How to cite this URL:
Mohamed NR, Elsweedy MS, Elsayed SM, Rajab AZ, Elzahar ST. Obsessive-compulsive disorder, an Islamic view. Menoufia Med J [serial online] 2015 [cited 2018 Nov 16];28:289-94. Available from: http://www.mmj.eg.net/text.asp?2015/28/2/289/163869


  Introduction Top


Many studies have shown that obsessive-compulsive disorder (OCD) is viewed and managed in Arab and Islamic populations mostly on the basis of religion [1] .

Religious thoughts can become intrusive and distressing in individuals with OCD. These thoughts can involve intrusive religious blasphemous thoughts, compulsive prayer, hypermorality, unwarranted concern about committing a sin, and cleaning/washing rituals [2] . These thoughts sometimes become problematic, and are referred to as 'scrupulosity'. Scrupulosity describes the relationship between religiosity and the symptoms of OCD, and individuals with these obsessions often focus on certain details of their religion while ignoring others. A measure called the Penn Inventory of Scrupulosity identifies the fear of sin and the fear of God as the two domains of scrupulosity [3] .

One large study found that scrupulous obsessions in OCD were ranked as the fifth most common obsession, with 6% of participants reporting these as their primary obsession; in addition, it has been estimated that religious obsessions occur in 25% of individuals with OCD [4] .

Another study showed that the presentation of OCD symptoms can be influenced by an individual's religion and culture [5] .

Individuals with scrupulous obsessions may have anxiety related to their religion, sinning, and guilt, which can lead to compulsive religious practices and rituals [6] . Also, these individuals are often more religious and more likely to seek out religious counseling and less likely to receive medical treatment [7] .

Considering the very limited research on many psychiatric disorders from the Islamic viewpoint, despite Islam being a major part of our cultural background, and as there has been considerable progress in the field of psychiatry, there is an urgent need to study the Sharia (Islamic legislation) view on issues linked to these disorders. This can enable the establishment of guidelines on programs of Islamic cognitive behavioral therapy (CBT) in OCD, facilitate the treatment and management of such patients, and prevent exploitation of patients by swindlers and imposters on the basis of religion.


  Aim Top


The aim of this work was to study OCD in the Islamic legacy and programs of Islamic CBT in OCD.


  Methods Top


The authors performed a systematic review, and a narrative synthesis of studies was carried out; relevant publications were identified through computerized searches of the databases ScienceDirect and PubMed and manual searches, reference lists were examined, and citation searches were carried out. No restrictions on date or study type were applied.

Review of the literature

Obsessive-compulsive disorder in the Islamic legacy

Most early Islamic scholars have associated most cases of OCD to the devil and relate it to religion or to madness as Imam Jouini considered (which occurs because of a lack of rule of reason or ignorance of Sharia ways).

Obsessions in the Arabic language

The word 'Alwiswas' is the Arabic translation of the common English word 'Obsession'. The definition of the English word according to both the Oxford Students Dictionary of Current English and the new Method English Dictionary is as follows (English-English): the idea or feeling occupies the mind, which causes distress or a persistent preoccupation, idea, or feeling.

This meaning differs somewhat from the meaning of the word obsession in the Arabic translation dictionaries.

The translation that we found in Almawrid Dictionary (English-Arabic) is acquisition and this was more accurate.

In Arabic dictionaries it has several meanings like self-talk, the voice of the jewelry, which is also the name of the Satan (devil), and fisherman whispered.

In the Holy Koran, it is defined as self-talk or attributed to Satan. It should be noted that if the meaning of the word obsessive is associated with the devil, then it should be followed with the term 'Al Khanas' as a whisperer that disappears for a period and then reappear, so by Islamic understanding, there are important points:

  1. Firstly: That the Satan is an obsessive whisperer.Accordingly not all obsessions are Satan and not all Khanas is demon. On the other had Satan is neither obsession alone nor whisperer also alone. So it is better to stick to the Quran term.
  2. Secondly: That the devil stops the whispers on seeking refuge in God Almighty and this point is very important because the obsessions does not fade or disappear after seeking refuge with Allah from Satan. This has had a significant impact on the Muslims understanding for the meaning of the whispers and the events of confusion between the meaning in Islamic legacy and psychiatry.
As for the whispers of self (self-talk), it is experienced normally by everyone; everyone whisper to themselves about the things they desire, and this does not cause the kind of harm that is caused by OCD.

The whispers of Satan are considered to be different from OCD, where the Satan whispers are of limited capabilities of its capacity, and every Muslim can overcome this by the remembrance of Allah Almighty and seeking refuge in the Almighty. The themes of whispers of Satan may take on the form of disruption of doing good and the performance of religious duties, and are different from OCD.

However, the concept of domination and compulsion, intrusion of ideas and being despoiled the ability to get rid of them weren't present in the Arabic language; thus, the typical expression is the inclusion of the description (compulsive) in the word obsessive, which does not always occur.

Therefore, there are three types of obsessives according to the Islamic understanding:

  1. First: self-talk, which relates to pleasure, self-love, wishes, and desires, irrespective of whether it is halal or forbidden.
  2. Second: the whispers of Satan, the obsessive whisperer, who is the enemy of man in command of his religion.
  3. Third: OCD is the most important characteristic that is contrary to the nature of the individual and it is not sufficient to seek refuge with Allah from Satan to get rid of those obsessions.


Different uses of the word obsession (Alwiswas) among Arabic speakers

  1. Doubt: it may be related to acts to be carried out perfectly or even in terms of dos and donts; people link it to self-confidence. Perhaps, doubt relates to the intentions of the individuals who deal with an individual in his/her family or neighbors or colleagues at work and possibly relates to the fidelity of the partner; this was termed obsession.
  2. The first may be related to OCD or obsessive-compulsive personality disorder, but the second and third may be related to paranoid personality, paranoid personality disorders, delusional disorders, delusion of jealousy, or delusion of infidelity
  3. Excessive fear about health: believing that one has a disease, and seeking medical care for just having a simple transient symptom may be related to hypochondriacal fears or hypochondriasis.
  4. Extremism in religion: this is another use that may also be related to obsessive-compulsive personality or obsessive compulsive personality disorder, where individuals place pressure on themselves by exaggerating their religious rituals or preparations to perform a ritual, which may be related to OCD or an obsessive compulsive personality.
  5. Over-concern which could be considered as the backbone for all the former meanings.
Many people in our country are not aware of OCD; thus, many patients do not consult a psychiatrist, except after their symptoms have exacerbated and worsened, with marked impairment in functioning. Especially in our society, if individuals have a disorder and they do not know whether it is a psychiatric disorder, they seek remedies from swindlers and imposters, who exploit patients on the basis of religion. The patients do not seek psychiatric advice, which results in treatment delay, exacerbation of symptoms, and deterioration in the patient's condition, which makes the task of the psychiatrist very difficult. A large proportions of patients in Arab societies associate OCD with the devil; due to the nature of the symptoms that appear with OCD in some cases in addition to the religious content. So it can be easily understood the confusion between OCD in psychiatry and Islamic legacy.

Trials to find the source of the first intrusive idea

Muslims believe that Satan plays role in the development of obsessions in some individuals, who are susceptible to OCD. It is believed that this can be overcome this idea by seeking refuge in Allah and by mechanisms of distractions commanded by religion, and the simplest form of obsessions and compulsions results in human distraction from benefit to him in this world and the hereafter, and that is the essence of what the devil doing.

We are thus unable to answer the question that we cannot find an answer for it about the source of the first intrusive idea.

Relationship between religiosity and obsessive traits in an obsessive-compulsive personality

The relationship between religiosity and obsessive traits in an obsessive-compulsive personality has been examined in many studies [8] , and the existence of an association between these two dimensions of personality dimensions has already been proven. It has also been proven that there is no relationship between religiosity and symptoms of OCD [9] , but the differences between the rituals compelling for patients with OCD and between religious rituals far from similarities between them [10] , as we do not have studies that have enough results to prove to be the religious upbringing role in the formation of compulsive personality traits.

Although it may be easy to assume that individuals with these types of worries come from very religious or strict traditions, these worries can develop in religious and nonreligious individuals. Scrupulosity should not be confused with being obsessed with religion or being very devout. Individuals with this type of OCD do not feel more spiritual or fulfilled by the performance of OCD-related rituals, which may include repeating prayers, seeking reassurance, or mental rituals.

Programs of Islamic cognitive behavioral therapy in obsessive-compulsive disorder

Many scientific studies carried out in Malaysia [11] on some patients with generalized anxiety disorder and depression showed that those receiving religious psychotherapy showed significantly more rapid improvement in anxiety symptoms than those who received supportive psychotherapy and drugs only (religious patients needed a lower dosage of medications and for periods less than others); also, the religious component in CBT can be effective for religion-oriented OCD patients [12] .

Another study [13] reflects the role of religion, which gives rise to various obsessions and compulsions that may be helpful in early diagnosis of OCD in our culture. Furthermore, the impact of these findings in terms of psychological methods of treatment such as CBT could be significant in Islamic culture.

Elliott and Radomsky [14] suggest that through collaboration, members of the religious community and psychologists could provide adequate support for individuals with scrupulous obsessions. Therefore, the correct teachings of Islam can determine which rituals are extreme and which are appropriate, and they may be able to offer guidance and treatment. In addition, highly religious individuals often consult their religious leaders rather than clinicians for help [15] ; thus, provision of education on OCD and specialized treatment trainings in religious settings could be useful for the development of therapies that have been shown to be effective for individuals with these obsessions.

Therefore, religious patients may require a different form of psychotherapy.

The program of CBT developed by Abu Zaid Al-Balkhi in the 9th-10th century will be discussed here with some commentary:

  1. The patient must be aware that he/she has symptoms, and the people he/she knows should testify that they are just obsessions, and do not entail any harm, they are just silly ideas that he/she should not turn to it. These same ideas are the subject of an article published [16] on the role of a life partner in the treatment of OCD by offering support to his/her partner cognitively and behaviorally.
  2. To concentrate on to the importance of organic causes of OCD. Where the patient should think that every symptom with no apparent reason is something related to the mood of his body, and that confirm for the patient with OCD that obsessions is just an annoying thoughts, like bad dreams that do not come true. Later on he/she realizes after woke up from sleep that it was mere dreams. The previous description was how Abu Zayd explained d the way of fantasy or magical thinking in patient with OCD.
  3. Using a combination of religious and cognitive therapy by emphasizing that sick obsessive body heal itself better than the doctor beside the fact that the disease dose not kill This is supported by many studies [17],[18] .
  4. Balkhi suggested accentuating the importance of positive thoughts like Allah the Almighty had built the universe and determined the survival of its people thus the Allah created a safety reasons more than destruction reasons consequently healing is the origin of all diseases. Therefore Allah created therapy for each illness. That assist when deciding to use medication which we rely on it a lot today in the treatment of OCD.
  5. To make the patient contemplate that the disease has its causes, and can't happen suddenly without introductions, so body does not die without reasonable introductions.
  6. To avoid loneliness and isolation because it irritates the human subconscious. This confirms the important role of the social support and group treatments which had proved its effectiveness in recent years of the 20th century in the treatment of OCD [19] .
  7. Trying to fill leisure with worthy work. This approach of moderation and centrism, which called by the Islamic religion was also advised by scientists of mental health at the same time.
  8. To use the personnel whom are Abu Zaid Al-Balkhi advised using those who loves the patient and trusting in their opinion to stop symptoms.
Despite the fact that cognitive therapy itself did not benefit patients with OCD and the first steps for the treatment of patients with OCD were not successful, methods of behavioral therapy in patients with OCD were applied with great success in patients with phobias; encouraging results were not found in patients with OCD [20] until 1966 [21] . These results can be divided into the following categories:

  1. Compulsions axis: Where the patient is subjected to the 'response prevention' and 'exposure and response prevention' method. It is considered the best choice for cooperative patient with compulsive rituals, and perhaps in the sayings of the prophet Muhammad (peace be upon him) shows direction for us to prevent the response - that is, prevent to get out of the mosque or out of the prayer this method is useful in some cases of OCD, and also the words of Ali Bin Abi Talib which support such direction.
  2. [22] .
  3. Obsessions axis : The fact that the methods of behavioral therapy here did not prove successful like with compulsions and one of the methods was 'thought stopping' and there is also a 'thought satiation', as we said, the methods of behavioral therapy of these and others have not yet attained great success in dealing with the obsessions [23] , where such directions is showed from Hadith of the Prophet and may help in some cases of mild cases of OCD, but it does not solve the problem of severe cases.
  4. Obsessive slowness axis : Also the methods of behavioral therapy here did not prove successful like with compulsions [24] . Recently, cognitive therapy has shown success in the treatment of OCD after researchers identified thoughts strongly affecting their patients and their actions such as exaggerated risk assessment or inflated sense of responsibility, and studies proved the effectiveness of cognitive therapy in the treatment of patients with OCD [25] , and the fact that Beck [26] did not differentiate between obsessive ideas in OCD and between fears ideas in phobic disorders, and there are who saw that 'intrusive thoughts' in general, possible to go unnoticed, but in patients with OCD change to 'negative automatic thoughts' [27] .
It is important to state that all methods of cognitive therapy, which have been applied and studied so far, including 'thought stopping', 'challenging obsessive thoughts', and 'challenging negative automatic thoughts', whether used in the context of individual or collective therapy, achieved some success at the level of case studies, but have not yet been proven to be effective through enough studies that have completed the terms of the exact scientific research [28] .

In fact, numerous clinical studies carried out over the past 15 years have conclusively found that CBT, either with or without medication, is markedly superior to all other forms of treatment for OCD [29] .

However, no well-designed single case studies have been published on interventions other than CBT [30] . Further work is needed to validate alternative treatments for OCD.

More work also needs to be carried out to determine how to best tailor treatment to individual needs. Most studies do not have sufficient power to break down treatment response by OCD subtype such as 'washers,' 'checkers', 'orderers', and 'hoarders'. Some subtypes have been studied more than others and some subtypes are typically excluded from randomized-controlled trials.


  Conclusion Top


  1. OCD is quite different from the whispers of Satan or self-talk from the Islamic considerate.
  2. Islamic legislation for obsessives should be revised to according to the concept of obsessions on the basis of Islamic understanding.
  3. The religious component in CBT can be effective for religion-oriented OCD patients in Islamic culture.
  4. Education on OCD and specialized treatment trainings in religious settings could be beneficial in the development of therapies.
  5. The correct teachings of Islam can provide adequate support for individuals with scrupulous obsessions.
  6. More work also needs to be carried out to determine how to best tailor religious treatment to individual needs

  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.



 
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