never just right: solving the puzzle of obsessive-compulsive disorder
TRANSCRIPT
Never Just Right: Solving the Puzzle of Obsessive‐Compulsive Disorder Andrew Jacobs, Psy.D., C.Psych.
Psychologist, Anxiety Disorders Program
Jakov Shlik, MD, FRCPC
Psychiatrist and Clinical Director, Anxiety Disorders Program
Overview
• OCD: Impact
• What is OCD – and What Isn’t? • OCD Treatment • GePng Help in ORawa
• Online Resources
Rates of OCD
• ORawa Metro Area, 2011: 1,236,324 people
• LifeZme prevalence of OCD: 2.3% – 28,435 people in ORawa will have diagnosable OCD in their lifeZme
• One‐year prevalence of OCD: 1.2% – 14,836 people in ORawa have diagnosable OCD this year Based on data from NaZonal Comorbidity Survey (Ruscio et al, 2010) and StaZsZcs Canada (2012)
OCD & Other Mental Health Concerns
• Over the course of a lifeZme, individuals with OCD oben experience the following: – Other anxiety disorders: 76% – Mood disorders: 63% – Substance use disorders: 39%
– ANY disorder: 90% Ruscio, Stein, Chiu, & Kessler, 2010
What is OCD?
(and what isn’t…)
What are Obsessions?
• Intrusive, recurring, persistent thoughts, mental images, or urges that cause marked anxiety or distress
• More than “excessive worry”
• A person tries very hard to get rid of the obesssion with another thought or behaviour
• A person knows the obsession comes from his/her own mind
Based on DSM‐IV‐TR (2000)
Some Common Obsessions
• Excessive, intrusive thoughts about dirt, germs, illness, or contaminaZon
• Fears of having accidentally caused harm • Excessive doubZng of whether tasks were complete or accurate
• UpsePng, “nonsensical” need for specific order or exactness
• UpsePng aggressive, sexual, or religious thoughts that are out of character
What Aren’t Obsessions?
• InfatuaZon • Fantasies • Over‐thinking • UpsePng memories
• Worrying • Intrusive thoughts*
Intrusive Thoughts are NORMAL
• 90% of people report experiencing intrusive thoughts (Salkovskis, 1998)
• It is not the intrusion that makes an obsession or OCD; it is our anxiety, distress, and reacZon to it
So Why Not Just Stop Thinking About It?
An Experiment
What are Compulsions?
• RepeZZve behaviours or mental tasks a person must perform according to very set rules and/or in response to an obsession
• Compulsions aim to bring down distress or prevent a bad thing from happening, although they are either very excessive or wouldn’t realisZcally work
Based on DSM‐IV‐TR (2000)
Some Common Compulsions
• Checking doors, windows, locks, appliances many Zmes
• Washing and cleaning a great deal
• CounZng objects, words, etc • Arranging and rearranging objects • Following very specific “rituals” • Looking for reassurance excessively
What Aren’t Compulsions?
• Tidiness / orderliness • Habits • Impulses • AddicZons • SupersZZous behaviours (usually)
Avoidance
• Triggers become linked with obsessions and are avoided – Avoid due to fear of intrusive thoughts – Avoid to prevent need to do compulsions
The Cycle & Growth of OCD
• Obsessions are never saZsfied • Compulsions are never complete • Avoidance expands
What Makes it a Disorder?
• Impact – Very upsePng – Quality of life – Time‐consuming
Treatment of OCD
Exposure & Response PrevenZon (ERP)
MedicaZons
Exposure & Response PrevenZon
• Behavioural change‐based therapy • Learning through new experiences • EssenZally a process of reversing what the OCD is telling a person to think, feel, and do – IdenZfy OCD cycle in acZon – Face feared situaZons / triggers – Carry through without compulsions
– Allow the anxiety to change and fade on its own
Exposure
• Targets oben on a hierarchy of difficulty
• Gradually confront avoided items, situaZons, and thoughts
• Stay in the situaZon – Anxiety gradually declines
• Repeat
Response PrevenZon
• Stop compulsive behaviour – Very challenging – Leads to high anxiety at first • Declines with Zme
• Alternate: “ruin” compulsion – Example – touch something “contaminated” aber washing hands
Gains from ERP
• Learn new things – Feared outcome doesn’t happen – Ability to cope is beRer than expected
• Fear and anxiety gradually decrease • Avoidance gradually decreases • Urge to do compulsions decreases
• Thoughts become less upsePng
A Course of ERP
• Typically 10‐20 sessions, 60‐120 minutes
• Exposures are done both in session and on own • Client is never forced to do anything
ERP: The BoRom Line
• Very challenging, but it works – Extremely well‐researched, established, and effecZve treatment for OCD
– ERP and similar therapies are effecZve for approximately 2/3 to 3/4 of individuals
MedicaZons Used to Treat OCD
• Used to treat OCD: – SSRIs / SNRIs – Serotonin Reuptake Inhibitors – Tricyclic anZdepressants
• To help treatment – Atypical anZpsychoZcs / mood stabilizers
GePng Help for OCD in ORawa
At The Royal
• Physician referral to The Royal • Assessment by psychiatrist or psychologist
– Treatment is done both through medicaZons and through ERP
– ERP is usually done in a group
In the Community
• Look for therapists with the following: – Professionally qualified / licensed – OCD‐specific experience – Behavioural or cogniZve‐behavioural treatment approach
• Unless the pracZZoner is a physician, his/her services will likely not be covered by OHIP / RAMQ; however, private insurance may assist
Online Resources
• InternaZonal OCD FoundaZon – www.ocfoundaZon.org
• Anxiety & Depression AssociaZon of America – www.adaa.org
• Anxiety Disorders AssociaZon of Ontario – www.anxietydisordersontario.ca
• The Royal – www.theroyal.ca