Journal Menu

Obsessive Compulsive Disorder in Palestine: A Literature Review

*Israa M. Sawalha

Ba Midwifery, Ma in Community Mental Health, NNU, palestine

*Corresponding author

*Israa M. Sawalha, Ba Midwifery,Ma in Community Mental Health,NNU, palestine
Email: esraamsawalha@gmail.com

Abstract

Methods
A computerized literature searches (Google Scholar, PubMed, Science Direct, Springer Link, Elsevier, Semantic Scholar, and HINARI) was used to collect studies addressing the OCD in Palestine.

Results and Conclusion
OCD in Palestine is widely presented in adolescence and children at a young age. The most common type of OCD in Palestine is checking type. Set of risk factors increases developing OCD, including sexual abuse at any age as well as anxiety, depression, phobia and somatization disorders. In addition, the family incomes play a big role in presenting OCD, especially low income families. Most of the patients who have OCD were depressed and complaining of stigma and ignorance. Recommendations include getting rid of the stigma, creating a chance for low income families, further studies into OCD in Palestine, ending of the occupation and preventing children from following TV programs and war results.

Key words
OCD, Obsessive compulsive disorder, Palestinians Mental Health, Palestine, Gaza Strip, West Bank

Background

In this section the researchers highlighted the meaning of health, mental health and mental illness. Also, they showed the impact of Israeli occupation on Palestinians people since 1948 and lastly in 2019. Besides, the state of mental health services in Palestine.
A complete condition of physical, social and mental well-being and not purely disability or disease absence are the definition of the health, according to World Health Organization (WHO)(1). According to American Psychiatric Association (APA) the mental health is the foundation for learning, communication, emotions, thinking, self-esteem and resilience, also, it is the key to personal and emotional well-being, relationships, personal and contributing to the community or society(2). Therefore, the combination of behavioral, emotional or thinking process changes, or involving a change in one of them is called a mental health illness which is common and can be treatable(3).
Historically, Palestinians health affected because of the Israeli occupation of Palestine, which was divided into two areas (West Bank and Gaza Strip)(4). Those two areas were occupied by Israel in 1948, related to that about 60 percent of the Palestinians living in villages with 27 percent of them in refugee camps(5). Accordingly, Israel attacks the civilians in their places and they experience infringement of their human rights which impact their health(6).
Because of affection on the civilian health, especially the mental health, there is a need to develop mental health services(7). Therefore, in 2004 the mental health policy officially adopted for West Bank and Gaza Strip by Palestinian Ministry of Health (MoH) and in 2002-2003 it was formulated(5). As a result, Palestinians need to meet them human rights and develop the mental health policies and services(8).
In summary, the history that the researchers mentioned above about Palestine’s political condition, clearly showed that there are major challenges faced the civilians’ mental health, as well as, their social and economic state.

Methodology

A computerized literature searches (Google Scholar, PubMed, Science Direct, Springer Link, Elsevier, Semantic Scholar, and HINARI) was used to collect studies addressing the OCD in Palestine. Search terms included “obsessive-compulsive disorder,” “obsessive compulsive” “OCD Palestine” “Palestinians mental health” “Health in Palestine” “Mental health Palestine” in both Arabic and English languages. Additional papers, which did not appear clearly in the electronic database while searching, were obtained via an examination of reference lists of published papers. Relevant empirical studies are summarized and presented hither. This study included all studies about OCD in Palestine and excluded the studies talked about anxiety, PTSD, or other disorders. The search identified 33 articles. Duplicates and irrelevant articles were removed. Nine articles related to OCD in a Worldwide, fifteen in Arabic countries and nine articles related to OCD in West Bank and Gaza Strip in Palestine. Also the researcher used some Arabic studies and translated them to English language. Studies selected after critically appraised.

An overview of OCD

In this following section the researchers explained the origin of Obsessive Compulsive Disorder (OCD) by writing its definition and clarified main class of OCD and from where it came. Also, this review showed studies about mental health in a worldwide then Arabic world later in Palestine. Moreover, the following sections focused on OCD in Palestine.

Definition of Obsessive Compulsive Disorder
This part of the study focused on the definition of Obsessive Compulsive Disorder as both of the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defined it.
According to ICD-10, the essential feature of OCD is recurrent Obsessional thoughts and Compulsive act(9), but according to DSM-5, OCD is the presence of obsessions, compulsions, or both of them(10).
Obsessional thoughts are images, impulses, or ideas that enter the patient's mind repeatedly in a vulgar form. They are almost fixedly distressing and the patient often tries, unsuccessfully, to endure them, this definition according to ICD-10(9). But DSM-5 defined the Obsessional thoughts as an intruder, unwanted and recurrent thoughts or impulses that most patients cause marked anxiety or distress and the patient trials to ignore such thoughts or images by performing a Compulsion(10).
Additionally, ICD-10 about Compulsive, an acts or rituals are stereotyped behaviors that are repeated over and over, these acts are not enjoyable, nor do they result in the completion of useful tasks(9). Also, the repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) is aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation, this definition according to DSM-5(10).
As the researchers mentioned above, the OCD is a mental health disorder associated with a change in behaviors and acts, as well as with thoughts changes.

History of Obsessive Compulsive Disorder

In this part the researchers showed the historical sequence of Obsessive Compulsive Disorder.
Al-Balakhi was the first one in the world mentioned a mental illness and he put the differentiation of OCD from other forms of mental illnesses nearly a millennium earlier(11).
Historically, as with any mental health condition, over time the conceptualization and treatment of OCD has changed(12). In the centuries sixteenth, seventeenth, eighteenth, nineteenth and the first half of the twentieth century the OCD passed through different conceptualizations.
Religious melancholy was in seventeenth century the description of Obsession and Compulsion(13), but they have likely been around since humans first roved the earth(12). OCD was associated with moral and spiritual issue in the seventeenth century.
Later, in eighteenth century many doctors saw that the Obsessions and Compulsions were caused by intellectual disordered(12).After this view, in the nineteenth century a modern concepts of OCD began to evolved(14),which is ‘neurosis’ implied a neuropathological condition. In the last quarter of the nineteenth century OCD was engulfed along with numerous other disorders(13).
Supplementally, in the twentieth century the OCD became with a new concept. Sigmund Freud (1856-1939) and Pierre Janet (1859-1947) isolated OCD from neurasthenia(14).Janet, was proposed in his highly regarded work, that obsessions and compulsions arise in the third (deepest) stage of psychasthenic(13). Freud’s view highlighted that this mental health disorder related to subconscious problems, and he sawed that both of obsessions and compulsions were often treated via psychoanalysis(14). Throughout the first half of the twentieth century Freud’s view dominated the mental health field(13).
Finally, the researchers back in the time since the appearance of Obsessive Compulsive Disorder until the new concept were appeared.

OCD in a worldwide

In this section the researchers showed a review of OCD from the worldwide view by showing the prevalence of OCD in a worldwide, also the effect of it on the patient’s life, as well as its types and the prevalence of each one. Later the researchers showed risk factors.
In the world, at some points in peoples’ lives, they have obsessive thoughts with or without compulsive behaviors, but that does not mean that all of them suffer from Obsessive Compulsive Disorder(15). Approximately 2% is the prevalence of in the general population in a worldwide(16).
During the past year, OCD in the U.S affected 1.2% of adults. But now it affects approximately 1 in 40 adults and 1 in 100 children in the U.S. According to the National Institute of Mental Health (NIMH)(17). In Australia around 2% of people have OCD(18). But in the UK population, OCD affects about 12 in every 1,000 people (1.2% of the population) from young children to adults, regardless of social, cultural background or gender(19). In China the prevalence of OCD is 3.17%, according to a study done by Guo et al., its title is “Meta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to 2015”(20).
In this condition the patient has an obsessive need to repeatedly do certain things and may have unwanted ideas, impulses or images(21). As Ayuso said in his paper “Global burden of obsessive-compulsive disorder in the year 2000” that these things such as checking, hand washing or cleaning the house and the ideas which enter the individual’s mind, all of them come over and over and trigger excessive anxiety that gets in the way of day-to-day functioning(15). People with OCD are usually aware that their symptoms are illogical and excessive, but they find the obsessions ungovernable and the compulsions unattainable to resist(18).
There are many forms of OCD, Checking, Contamination/Mental Contamination, Symmetry and ordering, Ruminations/Intrusive thoughts and Hording(22). About the prevalence of each type the checking obsessive has the highest prevalence which is 79.3%, the second high prevalence is Hoarding obsessive which has 62.3%, later Ordering 3%, Morality 5%, Sexual/Religious 2%, Contamination/Washing 3%, Harming/Aggression 5% and Illness ratios 8% to 10% (23).
A study done by J. Henderson and C. Pollard in greater ST. Louis showed that the overall prevalence rate of OCD was 2.8%. The most prevalent type of Obsessive Compulsive Disorder involved checking (1.6%), followed by a multiple category that included counting, repeating and collecting rituals (1.0%) and, finally, washing compulsions (0.8%)(24) According to National Comorbidity Survey Replication (NCS-R), many people with Obsessive Compulsive Disorder have more than one OCD form(23).
The risk factors which may increase the incidence of getting an OCD are divided into three ranks, factors that the person born with, factors outside human control and modifiable risk factors(25).
Factors person born with like genetics 50%, gender male at more risk to develop childhood OCD than female, brain structure and socioeconomic status as a study showed that there is an association between OCD and low socioeconomic status(25).
But about the factors outside human control are included age life events and mental illness. The risk of OCD drops with age and the late adolescence has the greater risk(25). Those who have stressful life and suffer from physical or sexual abuse are a major risk factor to get OCD, also having another mental illness such as anxiety or depression increase the risk of having OCD (26).
According to Owen and Adrian, the third rank is the modifiable risk factors such as drugs, marital status and employment. Drug uses cans causing a neurotransmitter changes in the brain, which create a chance for developing OCD, and being unmarried increase the risk too as well as being unemployed.
However, there are many risk factors may increase the incidence to develop an OCD. OCD at higher risk to present comorbid major depression or another anxiety disorder across all areas(27). Peoples suffering from OCD also end up suffering from a lack of self-esteem and self-confidence, relationship problems, very weak willpower, and social withdrawal(28).

OCD in the Arabic countries

In this section the researchers showed a review about OCD in Arabic countries. From one hand, they pointed out that the first one highlighted the OCD was an Arabian psychiatrist and he wrote about it since 1000 years ago. And from other hand, they reviewed different studies about OCD prevalence, Islamic view, culture view and stigma in the Arabic world.
In the 9th century Abou Zaid Al-Balakhi(29) in his book “Masalih Al-Abdan Wa Al-Anfus” talked about mental health and mental illness The Muslim physician Abu Zayd Al-Balakhi was a pioneer of psychotherapy, Psychophysiology and psychosomatic medicine and he is an Arabian(30). There is a long chapter (Chapter 8) discussed the OCD in Al-Balakhi book, in this chapter he said that there are some obsessive thoughts come normally to the human mind but do not affect on his daily life, contrariwise of those obsessive thoughts which come and leave an effect on a daily life and need a treatment those unwanted thoughts associated with compulsive disorder and known in this day as an OCD(31). Furthermore, the first one discussed the Obsessive Compulsive Disorder was an Arab in Psychiatrist.
Statistics mentioned that the frequency of most mental disorders does not have much difference from country to country around the world(32). The prevalence of OCD in Egyptian adolescent population is 2.2%(33). Also, 0.1 % in Lebanon(34). In Iraq, the peak age for OCD was from 21 to 30 years old, females were predominating (63.2%), singles were (47.3%) and the family history of OCD and any mental illness was observed in 20.5% and 52.9%, respectively(35). The few statistics coming out of certain Arab countries assert the reality of having no difference from country to country in the frequency of mental disorders specially OCD(32).
The issue in the Arab world is more to do with stigma and ignorance than it is lack of mental health problems(32). Despite the complication and the importance of the mental health problems, the Arab world still shows a lack of awareness; patients in Arab countries tend to express their psychological issues in terms of physical symptoms, thereby avoiding the stigma attached to mental illness(36).

From religious point, in Islam, such undesirable thoughts are called wasawis (plural of waswasah), which are whispered into the minds and hearts of people by Shaitan (Satan) according to Dr. Nafisa. These wasawis play a significant role in many mental disorders that include anxiety and cognitive misrepresentation(28).
Recurring thoughts about being unclean, contamination, and questioning one’s faith appear to be the most common form of OCD amongst Muslim men and women, in Muslims view the Shaitan try to distract them from Quranic verses and insert unwanted religious thoughts in their minds, to enhance them to lose their religion faith(28).
A study done by Mohamed et al., 2015 in Egypt showed the following result:
“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.”(37).
Recently, the relationship between mental health, religiosity, and personal beliefs (Such as magical ideation) has been studied extensively, and the results have showen significant associations among these variables(38).
Psychiatry is depending on culture more than any other medical discipline, therefore, it is not well known in developing countries the frequency of mental illness such as anxiety, OCD or depression, even doctors themselves may not know the problem size, on the contrary of the developed countries which are well characterized in determining mental diseases(32).

An overview of OCD in Palestine

In this section the researchers showed a review of OCD in Palestine. They mentioned the prevalence of OCD in Palestine, and showed the all available studies about OCD.
A 15.3% is the prevalence of Obsessive Compulsive Disorder among Palestinian university students in Gaza Strip, in assessing OCD and sociodemographic variables such as family income and type of college, study showed that the OCD is more in students coming from families earning 250$ and leases more than students from families earning 500-750$ and there is no statistical significant in OCD and type of college. In addition to that, this study showed there is no statistically significant correlation between OCD and age and grade average of the students. Also, this study clarifies that the OCD correlate with anxiety (R=0.63), with depression (R=0.66, P=0.001), with Phobic anxiety (R=0.44) and with Somatization (R=0.51). However, in assessing the OCD statue with sex, the T independent test according to the same study showed statistically significant in female than in male (Mean 15.39 vs. 15.20) (T= -50)(39).
Additionally, a descriptive study done by Amira Abu Shaban in Jerusalem zone by using self-reported questionnaire and the Yale-Brown Obsessive Compulsive Scale (CY-BOCS) among Palestinian school children grade 11 (public and private), this study showed that the prevalence of OCD among Palestinian school students is 15.6%: 19.1 for females and 10.2 for males. Also, the study showed significant associations among OCD and females, students with low academic level, school achievements and less educated parents. Moreover, this study showed a strong relationship between OCD and social-demographic variables and a weak relationship with social environmental factors(40).
A review paper done by Abdel Aziz Thabet “Evaluation of the psychological well-being of Palestinians in Gaza Strip and West Bank” aimed to investigate the Palestinians psychological well-being indicators, causes of mental illness, available services for primary, secondary, and territory intervention, university and other institution training in the field of mental health. This study discussed Haj-Yahia and Tanusgm cross-sectional study, which aimed to explore sexual abuse rate in Palestinian society at varying ages divided into three groups (12 or less, 12-16 years, and 16 years) and to assess psychological implications of sexual victimization. Yahia and Tanusgm study, which included 652 Palestinians undergraduate students showed that those who were sexually abused by a family member at any age expressed significantly higher level of Obsessive Compulsive Disorder(41).
20.6%, according to Spence anxiety scale reported Obsessive Compulsive Disorder problems among children working due to low family income. This study, which was done by Mater et al (2007), aimed to identify the impact of work on children general mental health and anxiety in a total number of 789 children in the Gaza Strip. Also, it showed that 79.2% of children rating themselves as a psychiatric patient(42).
Another study done by Thabet and Thabet was aimed to discover the consequences of trauma, in particular the extent to which children suffering from a range of behavioral and emotional disorders become the primary driver of violence in individual, family and community level. This study showed that Obsessive Compulsive Disorder mean was 8.4 and there was no gender difference in OCD, but it was more in children age 13-16 years old compared to younger age groups(43).
However, Obsessive Compulsive Disorder was more reported in females and in Palestinians lives in refugee camps as a study done by Thabet and Abu Tawahina showed. Also, is offered that the OCD symptoms mean=11.30. Thabet and Abu Tawahina study included a sample of 386 adults and it aimed to investigate the impact of the siege of the Gaza Strip on Palestinians feelings of anger and the state of anger in relation psychological symptoms and other socioeconomic variables(44).
Thabet et al (2009) in a study aimed to investigate the effectiveness of community base intervention program, including counseling and vocational training on coping and mental health of battered women in the Gaza Strip. The study sample included 99 women and their ages ranged between 16 years to 42 years with mean age 25.5. In this study pre and post assessment for women who got counseling and vocational training. Accordingly, the study showed that there was improvement in Obsessive Compulsive Disorder for the women(45).
In the summary for the OCD in Palestine, the OCD is higher in women than men, in adolescent and children than older ages. The risk factors that increase the OCD separation between Palestinians are low income families, stigma, and Israeli occupation, and violence, sexual abuse of the children, depression disorder and anxiety disorder.

Discussion

In this section the researchers discussed the reviewed studies about OCD worldwide, in Arabic countries, and in Palestine by showing the differences in prevalence, stigma, and risk factors.

Prevalence

The studies showed that the prevalence of OCD in a worldwide is 2%-3% (16) Convergent to the prevalence in Arabic countries 2.2% (32), but there is no general prevalence of OCD in Palestine because of lack in studies. But some studies showed 15.3% the prevalence of Obsessive Compulsive Disorder among Palestinian university students in Gaza Strip (16, 32).
Checking Obsessive is the most common type in the world, 79.3% of the OCD patients are checking obsessively and 62.3% suffer from Hording Obsessive (23). The studies in Arabic countries also support this prevalence of checking obsessive 1.6%, then hording then contamination obsessions (23, 22), after that the contamination obsessions in Arabic countries and in Palestine (22, 34).

Stigma

The issue in the Arab world is more to do with stigma and ignorance than it is lack of mental health problems and the stigma attached to the illness (34, 35). Also the Palestinians studies showed that the patients suffer from community view to them and their mental health (38). The Arab world still shows a lack of awareness; patients in Arab countries tend to express their psychological issues in terms of physical symptoms, thereby avoiding the stigma attached to mental illness (36).

The risk factors

The risk factor which may increase the incidence of getting an OCD are divided into three ranks, factors that the person born with, factors outside human control and modifiable risk factors (26). The genetic factor prevalence is 50% and the male more than female in childhood (25, 28) in the world view, but in comparison with Arabic countries view the risk factors were in female more than in male in ages between 21 to 30 years old (34, 31) . Finally, in Palestine the low family income earning 250$ and less were the basis for having an OCD among Palestinians, also the studies in Palestine showed that the female more than male with mean age 15.39 for female Verses 15.20 for male(38, 31). In addition to the OCD risk factor in Palestine the sexual abuse at any age play a major role in having OCD as well as Anxiety, depression, Phobic anxiety and Somatization disorders (31, 38, 40, 44).

Definition

From the Islamic view OCD is undesirable thoughts are called wasawis (plural of waswasah), which are whispered into the minds and hearts of people by Shaitan (Satan) according to Dr. Nafisa. These wasawis play a significant role in many mental disorders that include anxiety and cognitive misrepresentation (29). But according to ICD-10 (WHO, 2014) OCD is Obsessional thoughts are images, impulses, or ideas that enter the patient's mind repeatedly in a vulgar form. They are almost fixedly distressing and the patient often tries, unsuccessfully, to endure them while DSM-5 defined the Obsessional thoughts as an intruder, unwanted and recurrent thoughts or impulses that most patients cause marked anxiety or distress and the patient trials to ignore such thoughts or images by performing a Compulsion (15).

Results and Conclusion

In this section, the researchers conclude the results of this review. According to the studies that the researchers reviewed and discussed above, they found that there is a difference between the prevalence of OCD in Palestine in comparing with Arabic countries as well as with a worldwide. Also, they discovered that there is a lack of studies about OCD in Palestine especially in West Bank. The most common type of OCD in Palestine is checking type; in addition to that, OCD patients suffer from the stigma so the prevalence of it was significantly high related to fear from the community. However, there is a religious view about OCD as well as cultural view.
Palestinians because of Israel occupation faced a lot of barriers standing in front of their mental health status. OCD in Palestine is widely presented in adolescence and children at a young age. The family incomes play a big role in present of OCD, especially low income families as well as a stigma. In concluding, Palestinians with OCD have a related disorder, the most common one is depressed.
Also the researchers found that there was a lack in studies about OCD in Palestine and other mental health disorders, and they discovered that there is a study in specific areas of Palestine such as Gaza Strip

Recommendations

Recommendations include get rid of the stigma and create a work chances for a low income family, apply more and more studies about OCD in Palestine, ending of the occupation and prevent the children from following TV programs and war.

Limitations

The literature review has discussed an Obsessive Compulsive Disorder in Palestine. Palestine is a state that is seeking independence with a scare of resources; therefore, the research is underdeveloped. As a result, there is a lack of detailed data regarding Obsessive Compulsive Disorder in Palestine. Due to lack the complete data, all literature that was found, including a thesis study done in Al-Quds Open University about the OCD among school students in 11 grade was included.

Acknowledgments

Special thanks to all authors in the field of mental health in Palestine who equipped us with the relevant information for this literature.

Mediastinal adenopathies due to peripheral T cell-lymphoma are rare1,2. This case represents an unusual example of extrinsic esophageal compression due to lymphoma1,2 leading to severe pill- induced esophagitis3.

REFERENCES

  1. WHO. What is the WHO definition of health? 2019 [cited 2019 18/10]. Available from: https://www.who.int/about/who-we-are/frequently-asked-questions.
  2. APA. What Is Mental Illness? 2018 [cited 2019 12/11/2019]. Available from: https://www.psychiatry.org/patients-families/what-is-mental-illness.
  3. APA. What Is Mental Illness? 2019 [cited 2019 18/10]. Available from: https://www.psychiatry.org/patients-families/what-is-mental-illness.
  4. WHO. Country cooperation strategy for WHO and the Occupied Palestinian Territory: 2017–2020. World Health Organization. Regional Office for the Eastern Mediterranean, 2017.
  5. WHO. WHO-Aims report on mental health system in west bank and Gaza. A report of the assessment of the mental health system in west bank and Gaza using the World Health Organization-Assessment instrument for mental health systems (WHO-AIMS). 2006.
  6. Yara Asi. The Conditional Right to Health in Palestine: Al-Shabaka: The Palestinian Policy Network; 2019 [cited 2019 12/11]. Available from: https://al-shabaka.org/briefs/the-conditional-right-to-health-in-palestine/.
  7. Jabr S, Morse M, El Sarraj W, Awidi B. Mental Health in Palestine: Country Report= الصحة النفسية في فلسطين. The Arab Journal of Psychiatry. 2013;44(873):1-6.
  8. Marie M, Hannigan B, Jones A. Mental health needs and services in the West Bank, Palestine. International journal of mental health systems. 2016;10(1):23.
  9. WHO. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version: 2014. 2014.
  10. BeyondOCD. Clinical Definition of OCD 2019. Available from: http://beyondocd.org/information-for-individuals/clinical-definition-of-ocd.
  11. Awaad R, Ali S. Obsessional Disorders in al-Balkhi′ s 9th century treatise: Sustenance of the Body and Soul. Journal of Affective Disorders. 2015;180:185-9.
  12. Bradshaw J. OCD: A BRIEF HISTORY 2017 [cited 2019 23/10]. Available from: http://marketstreetpsychotherapy.com/blog/ocd-a-brief-history/.
  13. Stanford Medicine. History of Obsessive-Complusive and Related Disorders 2019 [cited 2019 23/10]. Available from: http://med.stanford.edu/ocd/treatment/history.html.
  14. OCD-UK. The history of OCD 2013 [cited 2019 23/11]. Available from: https://www.ocduk.org/ocd/history-of-ocd/.
  15. International OCD Foundation. What is OCD? 2019 [cited 2019 11/11]. Available from: https://iocdf.org/about-ocd/.
  16. Sasson Y, Zohar J, Chopra M, Lustig M, Iancu I, Hendler T. Epidemiology of obsessive-compulsive disorder: A world view. The Journal of clinical psychiatry. 1997.
  17. ADAA. Obsessive-Compulsive Disorder (OCD) 2018 [cited 2019 18/11]. Available from: https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd.
  18. SANE. Obsessive compulsive disorder (OCD) 2018 [cited 2019 18/11]. Available from: https://www.sane.org/information-stories/facts-and-guides/obsessive-compulsive-disorder.
  19. OCD-UK. Occurrences of OCD 2019 [cited 2019 18/111]. Available from: https://www.ocduk.org/ocd/how-common-is-ocd/.
  20. Guo X, Meng Z, Huang G, Fan J, Zhou W, Ling W, et al. Meta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to 2015. Scientific reports. 2016;6:28033.
  21. Ayuso JL. Global burden of obsessive-compulsive disorder in the year 2000. World Health Organization. 2006.
  22. OCD UK. Types of OCD 2019 [cited 2019 18/11]. Available from: https://www.ocduk.org/ocd/types/.
  23. England OCD Institute. OCD TYPES Obsessive-Compulsive Disorder Comes In Many Forms 2019 [cited 2019 18/11]. Available from: https://www.ocdtypes.com/.
  24. Henderson Jr JG, Pollard CA. Three types of obsessive compulsive disorder in a community sample. Journal of Clinical Psychology. 1988;44(5):747-52.
  25. Owen Kelly. Understanding Risk Factors for OCD 2018 [cited 2019 18/11]. Available from: https://www.verywellmind.com/ocd-risk-factors-2510484.
  26. Adrian Preda. Risk Factors for Obsessive-Compulsive Disorder (OCD) 2019 [cited 2019 18/11]. Available from: https://www.winchesterhospital.org/health-library/article?id=19910.
  27. Caraveo Anduaga JJ, Bermúdez, Eduardo Colmenares,. The epidemiology of obsessive-compulsive disorder in Mexico City. Salud Mental. 2004;27(2):65-73.
  28. Dr. Nafisa Sekandari. OCD: Obsessive Compulsive Disorder And Scrupulosity In Islam 2017 [cited 2019 19/11]. Available from: http://mentalhealth4muslims.com/ocd-obsessive-compulsive-disorder-and-scrupulosity-in-islam/.
  29. Tamim Mobayed. Abu Zayd Al Balkhi: The 9th Century Psychologist Centuries Ahead of His Time 2017 [cited 2019 11/11]. Available from: https://ilmfeed.com/abu-zayd-al-balkhi-the-9th-century-psychologist-centuries-ahead-of-his-time/.
  30. Wikipedia. Abu Zayd al-Balkhi 2019 [cited 2019 11/11]. Available from: https://en.wikipedia.org/wiki/Abu_Zayd_al-Balkhi.
  31. Mustapha A, Badri, Malik,. مصالح الأبدان والأنفس لأبي زيد البلخي نفساني سبق عصره بعشرة قرون Al Balkhi Book (Arabic Text)2003.
  32. Mohammed Yahia. Dealing with mental illness in the Middle East 2012 [cited 2019 19/11]. Available from: https://www.natureasia.com/en/nmiddleeast/article/10.1038/nmiddleeast.2012.103.
  33. Rady Ahmed HW, Mervat Ketat and  Ahmed Salama,. Obsessive compulsive phenomenology in a sample of Egyptian adolescent population. The European Journal of Psychiatry. 2013;27(2):89-96.
  34. Karam. EG, Mneimneh., Zeina N Karam., Aimee N Fayyad., John A Nasser., Soumana C Chatterji., Somnath Kessler and Ronald C,. Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey. The Lancet. 2006;367(9515):1000-6.
  35. Al-Hemiary NJA, Salih M Al-Diwan, Jawad K,. Obsessive Compulsive Disorder in Karbala, Iraq: a preliminary Report. Kerbala Jorunal of Medicine. 2014;7(2).
  36. Al-Krenawi A. Mental health practice in Arab countries. Current Opinion in Psychiatry. 2005;18(5):560-4.
  37. Mohamed NR, Elsweedy MS, Elsayed SM, Rajab AZ, Elzahar ST. Obsessive-compulsive disorder, an Islamic view. Menoufia Medical Journal. 2015;28(2):289.
  38. Nicolini H, Salin-Pascual R, Cabrera B, Lanzagorta N. Influence of culture in obsessive-compulsive disorder and its treatment. Current psychiatry reviews. 2017;13(4):285-92.
  39. Abadsa A, Thabet, Abdel Aziz,. Mental health problems among Palestinian university students in the Gaza Strip. Mental health problems among Palestinian University Students in the Gaza Strip. 2012.
  40. Amira Sh. درجة انتشار الوسواس القهري عند طلبة الصف الحادي عشر في محافظة القدس وعلاقته ببعض المتغيرات: AL-Quds University; 2010.
  41. Abdel Aziz. <Evaluation of the psychological well-being of palestinians in gaza strep and west bank.pdf>. 2010.
  42. Thabet A, Matar S, Carpintero A, Bankart J, Vostanis P. Mental health problems among labour children in the Gaza Strip. Child: care, health and development. 2011;37(1):89-95.
  43. Thabet A, Thabet S. Coping with trauma among children in South of Gaza Strip. Psychol Cogn Sci Open J. 2017;3(2):36-47.
  44. Abdel AzizThabet. Evaluation of the psychological well-being of Palestinians in Gaza Strip and West Bank.
  45. Thabet A, Abu Tawahina A, El Sarraj E, Vostanis P. Effectiveness of school-based debriefing sessions for Palestinian children affected by war and trauma. Arabpsynet EJ. 2009;24:46-9.

Journal of Clinical Case Reports, Medical Images and Health Sciences (ISSN 2832-1286) is a peer-reviewed journal dedicated to publishing clinical images from all sectors of medicine. The goal of this magazine is to disseminate information about new discoveries and treatments in science and medicine.

Menu

Contact Us

Journal of Clinical Case Reports, Medical Images and Health Sciences

Frisco, Texas 75070, USA

support@jmedcasereportsimages.org

https://jmedcasereportsimages.org/

+1 (318) 786-0006

jcrmhs issn

Copyright ©2022 All rights reserved | Journal of Clinical Case Reports, Medical Images and Health Sciences

TOP