1.Obsessive Compulsive (Spectrum) Disorder OCD David Rosenstein

2. What is OCD Obsessions: Intrusive and repetitive thoughts, images and/or impulses which produce distress (anxiety). Unwelcome and irrational Compulsions Repetitive behaviors or rituals (physical and/or mental actions) in an attempt to reduce distress (anxiety) Difficult to control 3. OCD as a spectrum OCD is being considered as a spectrum disorder: Degrees of severity Overlapping anxiety conditions/disorders Different kinds of OCD subtypes (one persons OCD is different from another) 4. OCD as a spectrum Other conditions considered to be more like OCD such as: Hair pulling (Trichotillomania) Skin Picking (Dermatillomania) Compulsive Hoarding/Acquiring Some forms of Social Anxiety Disorder Pathological Gambling (Sub-forms)? Body Dysmorphic Disorder 5. Obsessions and Compulsions: Obsessions Compulsions Contamination Cleansing Scrupulosity Eliminating Harm/Sexual Checking Symmetry/Order Equalizing Pure Doubt Reassurance Responsibility Magical/Superstitious Jealousy Counting/Arranging Magical/Superstitious Hoarding/Acquiring Picking/Pulling Voluntary Tick/Movement 6. Why it can be a problem Time consuming Causes significant psychological distress Interferes: social, work, family or other important area Disabling Leads to depression and/or substance use disorders 7. OCD in South Africa Prevalence is believed to be the same as overseas (SASH study) 3(-5%) Often misdiagnosed or not diagnosed Poor training about OCD and not many individuals trained to treat OCD 8. OCD in South Africa Some areas (SES) have little/no awareness Apparently no difference in culture or race in prevalence (more research needed) 60% of all persons with a diagnosable anxiety disorder never see a mental health professional they may turn to their family physician, religious leader or another family member for help 9. When does it begin? Mean age of onset = 20 y/o However strong evidence for developmental origins (childhood) Fluctuating course through life Stress brings it out On average, people with OCD see 3-4 doctors and spend over 9 years seeking treatment before they receive a correct diagnosis 10. What causes OCD Genetic causes. No single gene identified, but a number of genes play a role Anxiety sensitivity Often a family member will have OCD or an anxiety disorder (occasionally another psychiatric condition) Differences in brain functioning 11. PET of OCD Brain 12. What causes OCD Some classical conditioning models OCD as learned responses to stressors and anxiety 13. Serotonin and OCD 14. Stress as onset Stress is not a cause of OCD, but an aspect of its onset Stress or early life traumas are linked to the onset and development of OCD and related disorders 15. Treatment Most effective treatment currently is cognitive behavior therapy (CBT) and specifically exposure and response prevention (ERP) Medication treatments (SSRIs) Combination treatment Third wave approaches (mindfulness) 16. CBT for OCD Exposure and response intervention Exposure person remains in contact with something they usually fear until their anxiety is diminished (habituation) 17. ERP Response prevention Ritual postponement Roll it over Ritual/Compulsion abstinence Ritual/Compulsion interference (mess it up) 18. ERP Exposure In Vivo (to life) Exposure Imaginal Exposure Scripting Diffusion (for thought fusions) Interoceptive Exposure 19. OCD Manager 20. iCounselor: OCD 21. OCD Test: YBOCS 22. How families can help Family can assist by: Not judging or becoming angry with OCD behavior Reduce the amount of reassurance Assist with exposures and fear approach behaviors Empathy 23. OCD and the family 24. Disclosure OCD can be very difficult to disclose Some call it the secret illness Disclosure to the right individuals can provide tremendous relief Reduces suicidality Provides greater access to support Demystifies and reduces stigma associated wit mental illness overall