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.

PREVALENCEAbout 3.3 million American adults ages 18-54 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 theyre off; locked doors every few minutes.Request/demand assurancesRepeat actions & ordering.

CHILDREN: (associated with)

Learning DisordersDisruptive Behavior Disorders

ADULTS: (associated with)

Major Depressive DisorderSpecific PhobiaSocial PhobiaPanic DisorderGeneralized Anxiety DisorderEating Disorders (Anorexia/Bulimia Nervosa)Personality Disorders: (Obsessive Compulsive Personality Disorder, Avoidant Personality Disorder, Dependent Personality Disorder)

FEATURESAge 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 dont want to feel this way but cant 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 dont 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

OBSESSIONSRecurrent & 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 arent 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).

COMPULSIONSRepetitive 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 OCDUsually begins in adolescence or early adulthoodOccasionally in childhoodObsessions or cleaning rituals only vs. checking or mixed ritualsMales vs. FemalesOnset is usually gradual. Some acute cases have been diagnosed

Course of OCD

May experience a waxing and waning courseAbout 5% have an episode course with minimal or no symptoms between episodes.Progressive deterioration in occupational and social functioning90% of patients can expect to have moderate to marked improvement with optimum treatment.

Causes of OCD

Parental influence and family ritualsNot learnedCauses now focus on neurobiological factors and environmental influences

Causes of OCDElevated activity in the Frontal Lobe and Basal GangliaActivity is not typical in people without mental illnessPET (Positron emission Tomography) scan used in brain imaging

Brain Activity

Assessment TechniquesOffice VisitsThe 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 DiagnosisAnxiety disorder Due to a General Medical ConditionSubstance induced Anxiety DisorderBody Dysmorphic DisorderSpecific or Social Phobias (Trichotillomania)Major Depressive EpisodeGeneralized Anxiety DisorderHypochondriasisSpecific PhobiaDelusional DisorderPsychotic Disorder Not Otherwise Specified

Differential Diagnosis Cont.SchizophreniaTic DisorderStereotypic Movement DisorderEating Disorders, Paraphilias, Pathological Gambling, Alcohol Dependence or AbuseObsessive Compulsive Personality DisorderSuperstitions and Repetitive Checking Behaviors

OCD Treatment StrategiesAbout 1 in 50 Americans (about 5 million people) have or will develop Obsessive Compulsive Disorder at some point on their lives

OCD Treatment StrategiesToday, the Obsessive-Compulsive 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 StrategiesMany ODC sufferers didnt have access to information about their disorder and were too ashamed or embarrassed to seek medical help

OCD Treatment StrategiesPeople 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 necessaryHowever, this knowledge is not sufficient to enable them to stop obsessing or carrying out their ritualsEducation is one of the most powerful weapons needed to win the battle over OCD

OCD Treatment Strategies

OCD Treatment StrategiesBehavior TherapyTraditional 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 effectiveIn 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 responseWhen 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 timeA therapist will usually refer an OCD client to a specialist in this kind of therapy

It Comes Down to NumbersThe dual cornerstones of effective treatment for OCD are a combination of therapy and medication90% of patients who underwent behavior therapy had at least a 30% reduction in obsessions and compulsions

OCD Treatment StrategiesLong term results from 16 studies showed that, at a mean follow-up of 29 months, 76% of patients were very much or much improvedPatients 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 PrognosisStudies 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 motivatedThe patients family must be cooperativeThe patient must be faithful in fulfilling homework assignments

What Can the Family Do?OCD affects not only the sufferer, but the whole familyFamily and friends often have a hard time accepting the fact that the person with OCD cannot stop the distressing behaviorFamily members may show anger or resentment, resulting in an increase in the OCD behaviorOther times, to keep the peace, they may assist or enable the ritualsEducation 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 PrognosisOCD 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 mildFor most, the symptoms are chronicWith a combination of pharmacotherapy and behavior therapy, symptoms can be controlled