Obsessive compulsive disorder

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Transcript of Obsessive compulsive disorder

  • 1. Obsessive CompulsiveDisorder (OCD) An anxiety disorder

2. Obsessions Are recurrent and persistent ideas,impulses or images that are experiencedas intrusive and inappropriate and causeanxiety and distress. The patientrecognises them as his/hr own thoughts,and may try to resist, but may find themimpossible to remove. 3. In adults the most commonobsessions are- Thoughts of contamination Pathological doubt (such as, if whethersimple tasks have been properlycompleted) Thoughts of having physical symptoms Symmetry, for instance, of householdobjects Aggressive thoughts. 4. COMPULSIONS Are recurrent and persistent behaviours ormental acts undertaken to prevent, orreduce, anxiety or distress in the beliefthat they will prevent a dreaded event fromoccurring. They do not produce pleasure, and thetasks performed do not bring pleasure. If they are resisted, anxiety can increase. 5. Common compulsions Checking Washing Counting Needing to ask questions or makeconfessions Creating symmetry and order Needing to be precise. 6. Obsessions and compulsions are often linked, as thedesire to resist an obsessional thought produces acompulsive act.Linked obsessions and compulsions ObsessionCompulsionContamination Hand washing, avoidanceof dust, germs or urine.Doubt (eg have I switched Repeated checking of thethe iron off?)object (iron) in doubt.Need for symmetry Compulsive slowness inmaintaining symmetry. 7. Other obsessions Fear of being responsible for someonesdeath or illness. Obsessive thoughts such as anendlessly repeated chain of thought, oftenabout a possible event in the future. 8. Other compulsions Counting - such as counting up to 6 overand over again, doing everything 6 times. Touching the need to touch a part of thebody as part of a ritual 9. Obsessions and compulsions have some features in common The ideas or impulses are recurrent. They are a product of their own mind They are accompanied by feelings ofdread The sufferer tries to fight them off Although Attempts to resist them may fadeover time, the patient remains aware thatthey are both absurd. 10. OCD- a subject for humour? OCD has been used in films as ahumorous device, such as by JackNicholson in the film As Good as it Gets http://www.youtube.com/watch?v=4yOpEMqnsCQ 11. OCD in film A more realistic portrayal of the illness wasshown by Leonardo diCaprio in the filmThe Aviator http://www.youtube.com/watch?v=8dR8xVqSfXc 12. OCD The Reality However, OCD is a disorder that causesgreat distress, as this clip shows http://www.youtube.com/watch?v=Rn1OYlYzgm8 13. Criteria for diagnosis Repetitive and unpleasant obsessions orcompulsions occur on most days for at least 2weeks. They are acknowledged to originate from thepatients own mind. At least one obsession or compulsion is seen asexcessive or unreasonable Resistance is (or has been) attempted and atleast one obsession or compulsion has beenresisted unsuccessfully. 14. Although obsessions andcompulsions may relieve anxiety,they are not pleasurable and impairfunctioning, usually by wastingtime. 15. The difference from other anxietydisorders Phobias the stimulus that provokes theanxiety comes from an external object orsituation. Panic disorder or Generalised AnxietyDisorder panic attacks are unpredictableand not linked to obsessional thoughts. 16. Depression Over two thirds of patients with OCDexperience major depression during theirlives. In fact, having an obsessive compulsivepersonality leads to depressive disordersmore than to the development of OCD. 17. Who gets OCD? Lifetime risk of developing the disorder -2% Males and females are equally at risk Most common age of onset under 25years old. 18. Prognosis (progression of the disorder) OCD can be long lasting for about a thirdof sufferers. They remain incapacitated inspite of treatment. This is associated with- Development of this disorder at a young age The need for hospitalisation Severe depression 19. Causes of the disorder These may be either- Physiological or psychological 20. Physical causes We will look at possible physiologicalcauses first 21. Genetic factors Family and twin studies have shown that there isa strong family link for the disorder. People with a first degree relative (parent orsibling) with OCD have a 5 times greater risk ofhaving the illness. Identical twins were more then twice as likely todevelop OCD if their twin had OCD than werefraternal twins. A variation in the COMT gene has beenidentified in OCD sufferers. 22. Biochemical factors Serotonin deficiency perhaps OCD sufferershave too little serotonin for their nerve cells tocommunicate effectively. SSRIs (drugs to increase the movement ofserotonin between cells) have been shown toreduce OCD symptoms. PET scans show OCD sufferers have lowerlevels of serotonin. After taking SSRIs, PET scans show a return tonormal levels of serotonin. 23. Brain dysfunction There is evidence of abnormal brain structureand activity in patients with OCD. These abnormalities are found in the pathwaylinking the lobes (responsible for judgement)with the basal ganglia (which are part of thesystem frontal for planning behaviour) PET scans support this and show SSRIs affectthe metabolism in this area, reducing OCDsymptoms. 24. Psychological causesPsychodynamic Freud- OCD arises when unacceptablewishes and impulses from the id are onlypartially repressed so cause anxiety. Egodefence mechanisms are used to reducethe anxiety. These defence mechanismsare used unconsciously and acts, such ashand washing, are thought to be an act tosymbolically undo the unacceptable idimpulses. 25. Cognitive explanation This can help to explain how the behaviourscontinue. The thoughts like if I dont do this somethingawful will happen cannot be controlled by thesufferer. Such as compulsive hand washing to avoidbecoming ill. Also - the possibility that compulsive behaviouris linked to a poor memory for having carried outactions is being investigated. 26. Behavioural explanation OCD develops as a way of reducinganxiety. Operant conditioning offers anexplanation for this. negative reinforcement- washing handsreduces fear, so is repeated. Superstition hypothesis such asfootballers who have to be last on the pitch this is associated with past success sofailure to carry them out causes anxiety. 27. Famous people with OCD 28. Johnny Wilkinson, the England Rugby Union starsays-I always wear the same t-shirt under my Englandshirt. And I always go out to warm up, come back, putmy shoulder pads on before my England shirt.Ill never warm up in my England shirt.But this is more routine rather than thinking "if I dontdo this, todays going to go horribly wrong".People like to have their own routines to fight back thenerves to keep them sane. 29. Bjorn Borg Five times Wimbledon champion, nevershaved during a tournament, because thefirst time he won, he hadnt shaved. 30. John Terry Wore the same pair of shin pads for 10years. 31. Serena Williams Claimed she lost the 2007 Paris openbecause "I didnt tie my laces right and Ididnt bounce the ball five times and Ididnt bring my shower sandals to the courtwith me." 32. Paul Ince Had to be the last player to put on his shirtbefore the game. This was fine, until another player with thesame ritual joined the team! 33. David Beckham Always wears long sleeved football shirts. Wears a new pair of boots for each game. David is aware he has OCD "I have to have everything in a straightline, or everything has to be in pairs. Ill putmy Pepsi cans in the fridge and if theresone too many then Ill put it in anothercupboard somewhere." 34. Treatment Cognitive Behavioural Therapy is thecurrently the most effective treatment forthis disorder. http://www.ocdaction.org.uk/ocdaction/index.asp?id=132 35. Message board of rituals http://www.healthboards.com/boards/showthread.php?t=281134&page=1