Obsessive Compulsive Disorder

What is OCD?A neurobiological disorder characterized by obsessions and/or compulsions that are time-consuming, distressing, and/or interfere with normal routines, relationships with others, or daily functioning.

Obsessions

Are persistent impulses, ideas, images, or thoughts that intrude into a person’s thinking and cause excessive worry and anxiety.

Compulsions

Are mental acts or repetitive behaviors performed in response to obsessions to relieve or prevent worry and/or anxiety.

History of OCD Treatment

Sigmund Freud believed OCD was a psychological disorder used the talking cure to attempt treatment.

Psychoanalysis was routinely used until the 1960s.

1966 psychologist Victor Meyer began using behavioral therapy and intensive exposure to treat OCD patients (14 of 15 patients were successful).

Who does it affect?Over 6.6 million men, women, and children in the U.S.

4th most common psychiatric diagnosis in the U.S.

65% of people with OCD develop it before the age of 25

15% develop it after the age of 35

Slightly more common in females

Basic Types of OCDCHECKERS

Live with an excessive, irrational sense of being held responsible for possible dangers and catastrophes that may befall others if they fail to repeatedly check objects such as doors, locks, and off settings.

WASHERS

Obsess about the possibility of contamination by dirt, germs, viruses, and foreign substances. They live with constant dread of either being harmed or causing harm to others by the actions of those agents of contamination.

ORDERERS

Feel they must arrange certain items in a particular, exact, or “perfect” way. They become extremely distressed if their things are moved, touched, or rearranged.

PURE OBSESSIONALS

Experience unwanted, intrusive, horrific thoughts and images of causing dangerous harm to others. Instead of behavioral rituals, many engage in repetitive thoughts, such as counting, praying, and word repetition in order to counteract anxious thoughts. They may also mentally review situations obsessively to ward off doubt and relieve anxiety.

HOARDERS

Collect insignificant items and have difficulty throwing away things that most people would consider “junk.”

SCRUPULOSITY

Obsess about religious or moral issues. Their compulsions may involve prayer and seeking reassurance from others regarding their moral purity

What OCD is not...• Cultural Superstition

• Religious Prayer

• Cultural/Social Rituals

• Addictive disorders like gambling or drinking because pleasure is gained from these whereas in OCD behaviors are engaged in to reduce anxiety

“Growing evidence is proving that abnormal

levels of serotonin, a vital chemical messenger of the

brain, are creating dysregulation in the brain

and behavior.”

Causes & Treatments of OCD

How does this happen? (http://www.zoloft.com/index.asp?pageid=18)

An explanation in words…Normally serotonin is released from one nerve cell and then picked up by the next nerve cell. Some of this serotonin also taken back up into the first nerve cell.

An explanation in words…

However, people suffering from OCD, depression, PTSD, and panic disorders may have an imbalance of serotonin so the nerve cells cannot communicate properly.

Treatment Options

Medication Therapy

Cognitive Behavioral Therapy

Medication Therapy(Antidepressants)

How Medication HelpsUse of SSRI (Selective Serotonin Reuptake Inhibitors) help regulate the transfer of nerve cells from nerve a to nerve b by slowing down the “reuptake” process thus, creating an opportunity for normality in thought process.

NHCH3

Cl

Cl

Sertraline

Pitfalls of Medication Therapy

Not all SSRIs work and a trial & error process is sometimes necessarySide effects include weight gain, sleep loss, and sexual dysfunctionTakes a few weeks to begin working, often times creating discouragement to patient.

Cognitive Behavioral Therapy

Made up of two parts:Cognitive Therapy- goals are to change patterns of thought

Behavioral Therapy- goals are to change patterns of action

Part 1: Cognitive

Client changes distorted thinking & beliefsby identifying inaccurate or faulty thoughts/attitudes and replaces them with healthier ones with the help of a psychologist.

Faulty Thinking Includes:Examples:

(Magical thinking) “If I think of a bad, horrible thought, it will certainly case something bad or horrible to happen.”

(Hyper morality) “I’ll certainly go to hell or be punished severely for even the slightest mistake, error, or miscue.”

Result of Cognitive TherapyDesired Results: patient challenges dysfunctional thought patterns to make the consequences of feared events unacceptable.

“I must do this many times.”

Becomes

“I can do it once, and that’s ok.”

Pitfalls to Cognitive Therapy

Anxiety & depression often interfere with the OCD patients ability to concentrate on his/her faulty beliefs sufficiently and effectively enough to change them.

Part 2: Behavioral TherapyExposure and Ritual Prevention TherapyAnxiety is reduced and the

discomfort associated with obsession through habituation or the process of getting used to repeated stimuli.

Carefully done by means of creating a S.U.D.S

Exposure & Ritual Prevention(behavioral component)

Example: patient may actually touch or otherwise directly contact some feared object.

Desired Result: patient realizes that the feared disastrous consequences do not occur thus decreasing severe anxiety association.

S.U.D.SSubjectiveUnits ofDistress/DiscomfortScale

A roadmap for ERPA list of situations that you fear and avoid –an Anxiety/Exposure list

Pitfalls to Behavior Therapy

Blocking feelings

Avoiding exposure

Ritualizing privately

Recommended TreatmentAccording to The Expert Consensus Guideline

Series,

“Combined treatment is favored suggesting that overall it may be the most acceptable treatment approach for the majority of adolescent & adult patients” (1997).