OBSSESSIVE COMPULSIVE
DISORDER (OCD)
An anxiety disorder (DSM-IV )
characterized by recurrent
unwanted thoughts (obsessions)
and/or repetitive behaviors
(compulsions) that cause
problems in information
processing.
PREVALENCE
• About 3.3 million American adults ages 1854 have OCD. (National Institute of Mental
Health) www.nimh.nih.gov.
• Equally common in both males & females.
GENERAL REQUIREMENTS
• The person must have recognized at some point
that the obsessions or compulsions are
excessive or unreasonable.
• These recurrent obsessions or compulsions
must be severe enough to be time consuming
(taking up more than 1 hour per day).
• The obsessions/compulsions must cause a
marked distress or significantly interfere with the
individuals normal routine, occupational
functioning, or usual social activities or
relationships with others.
COMMON OBSESSIONS
(Thoughts)
• Repeated thoughts about contamination
(public restrooms or shaking hands).
• Repeated doubts (leaving lights on or
leaving the door unlocked)
• Things or objects need to be in a particular
place or order (intense distress when
objects are disordered or asymmetrical)
COMMON COMPULSIONS
(Behaviors)
• Hand washing (so repetitive that they
become raw).
• Counting (how many cards in a deck, over
and over again).
• Cleaning (spots on windows)
• Checking (the lights to make sure they’re
off; locked doors every few minutes.
• Request/demand assurances
• Repeat actions & ordering.
CHILDREN: (associated with)
• Learning Disorders
• Disruptive Behavior Disorders
ADULTS: (associated with)
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Major Depressive Disorder
Specific Phobia
Social Phobia
Panic Disorder
Generalized Anxiety Disorder
Eating Disorders (Anorexia/Bulimia Nervosa)
Personality Disorders: (Obsessive Compulsive
Personality Disorder, Avoidant Personality
Disorder, Dependent Personality Disorder)
FEATURES
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Age Range: Males (6-15 years) Females (20-29 years).
Equal occurrence in both genders.
Obsession with dirt/germs: Avoid using public restrooms.
Hypochondriacal concerns: make repeated visits to the doctor for
reassurance.
Obsession with guilt: have a pathological sense of responsibility.
(Depressed because they don’t want to feel this way but can’t stop
because of guilty feelings).
Excessive use of alcohol or sedatives, hypnotic or anxiolytic
medications (Xanax, Valium, Librium, Rivotril, Ativan).
Avoidance of situations; keep to themselves mostly; stay at home
(so others don’t see odd behaviors).
Those with mild cases may be quite successful in life because they
are overly conscientious and are perfectionists.
Obsessions may not be as obvious as compulsions.
OCD DSM-IV CRITERIA
OBSESSIONS
• Recurrent & persistent thought, impulses, or images that
are experienced, at some time during the disturbance, as
intrusive and inappropriate & that cause marked anxiety
or distress.
• The thoughts, impulses, or images aren’t simply
excessive worries about life problems.
• The person attempts to ignore or suppress such
thoughts, impulses, or images, or to neutralize them with
some other thought or action.
• The person recognizes that the obsessional thoughts,
impulses, or images are a product of his/her own mind
(not imposed from without as in thought insertion).
COMPULSIONS
• Repetitive behaviors (e.g., hand washing,
ordering, checking) or mental acts (e.g., praying,
counting, repeating words silently) that the
person feels driven to perform in response to an
obsession, or according to rules that must be
applied rigidly.
• The behaviors or mental acts are aimed at
preventing or reducing distress or preventing
some dreaded event or situation; however, these
behaviors or mental acts either are not
connected in a realistic way with what they are
designed to neutralize or prevent or are clearly
excessive.
The Onset of OCD
• Usually begins in adolescence or early
adulthood
• Occasionally in childhood
• Obsessions or cleaning rituals only vs.
checking or mixed rituals
• Males vs. Females
• Onset is usually gradual. Some acute
cases have been diagnosed
Course of OCD
• May experience a waxing and waning course
• About 5% have an episode course with minimal
or no symptoms between episodes.
• Progressive deterioration in occupational and
social functioning
• 90% of patients can expect to have moderate to
marked improvement with optimum treatment.
Causes of OCD
• Parental influence and family rituals
• Not learned
• Causes now focus on neurobiological
factors and environmental influences
Causes of OCD
• Elevated activity in
the Frontal Lobe and
Basal Ganglia
• Activity is not typical
in people without
mental illness
• PET (Positron
emission
Tomography) scan
used in brain imaging
Brain Activity
Assessment Techniques
• Office Visits
• The Anxiety Disorder Interview Schedule –
Revised (ADIS-R)
• The Yale-Brown Obsessive-Compulsive
Symptom Checklist (Y-BOC)
• The Leyton Obsessional Inventory (Lol)
• The State Trait Anxiety Inventory of
Children (STAIC)
Differential Diagnosis
• Anxiety disorder Due
to a General Medical
Condition
• Substance induced
Anxiety Disorder
• Body Dysmorphic
Disorder
• Specific or Social
Phobias
(Trichotillomania)
• Major Depressive
Episode
• Generalized Anxiety
Disorder
• Hypochondriasis
• Specific Phobia
• Delusional Disorder
• Psychotic Disorder Not
Otherwise Specified
Differential Diagnosis Con’t.
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Schizophrenia
Tic Disorder
Stereotypic Movement Disorder
Eating Disorders, Paraphilias, Pathological
Gambling, Alcohol Dependence or Abuse
• Obsessive Compulsive Personality
Disorder
• Superstitions and Repetitive Checking
Behaviors
OCD Treatment Strategies
• About 1 in 50
Americans (about 5
million people) have
or will develop
Obsessive
Compulsive Disorder
at some point on their
lives
OCD Treatment Strategies
• Today, the
ObsessiveCompulsive
Foundation says that
the average OCD
individual spends
more than 9 years
searching for help,
and is diagnosed by
3 to 4 doctors before
finally getting the
right diagnosis.
OCD Treatment Strategies
• Many ODC sufferers
didn’t have access to
information about
their disorder and
were too ashamed or
embarrassed to seek
medical help
OCD Treatment Strategies
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People with OCD usually have
considerable insight into their own
problems.
Most of the time, they know their
obsessive thoughts are senseless
or exaggerated, and that their
compulsive behaviors are not
really necessary
However, this knowledge is not
sufficient to enable them to stop
obsessing or carrying out their
rituals
Education is one of the most
powerful weapons needed to win
the battle over OCD
OCD Treatment Strategies
Types of Treatment
Pharmacotherapy
Serotonin Reuptake Inhibitors
Clomipramine
(Anafranil)
Fluoxetine
(Prozac)
Sertraline
(Zoloft)
Fluvoxamine
(Luvox)
Paroxatine
(Paxil)
OCD Treatment Strategies
• Behavior Therapy
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Traditional therapy which helps the client gain insight to his or her problem
is not recommended for OCD
A specific behavior therapy approach called “exposure and response
prevention” is effective
In this approach, the patient is deliberately and voluntarily exposed to the
feared object or idea, either directly or by imagination, and then is
discouraged or prevented from carrying out the usual compulsive response
When treatment works well, the patient gradually experiences lass anxiety
form the obsessive thoughts and becomes able to do without the
compulsive actions for extended periods of time
A therapist will usually refer an OCD client to a specialist in this kind of
therapy
It Comes Down to Numbers
• The dual cornerstones of
effective treatment for
OCD are a combination
of therapy and
medication
• 90% of patients who
underwent behavior
therapy had at least a
30% reduction in
obsessions and
compulsions
OCD Treatment Strategies
• Long term results from 16 studies showed that,
at a mean follow-up of 29 months, 76% of
patients were “very much” or “much” improved
• Patients who are unwilling to participate in
behavior therapy do benefit from only
pharmacotherapy treatment, but symptoms
reoccur when the medication is stopped.
• The effective component of both types of
therapy is exposure and ritual prevention
OCD Prognosis
• Studies have shown that OCD
patients who participate in both
types of therapy will be able to
function well in both their work
and social lives if the following
factors are included:
• The patient must be highly
motivated
• The patient’s family must be
cooperative
• The patient must be faithful in
fulfilling “homework
assignments”
What Can the Family Do?
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OCD affects not only the sufferer, but
the whole family
Family and friends often have a hard
time accepting the fact that the person
with OCD cannot stop the distressing
behavior
Family members may show anger or
resentment, resulting in an increase in
the OCD behavior
Other times, to keep the peace, they
may assist or enable the rituals
Education about OCD is as important
for the family as it is for the patient
*Commit to
family
therapy
*Self-help
books
*Join
support
groups
OCD Prognosis
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OCD tends to last for years, even
decades. The symptoms may
become less severe from time to
time, and there may be long
intervals where symptoms are
mild
For most, the symptoms are
chronic
With a combination of
pharmacotherapy and behavior
therapy, symptoms can be
controlled