OCD & Other Anxiety Disorders_Dr Rochelle

7/30/2019 OCD & Other Anxiety Disorders_Dr Rochelle

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Obsessive Compulsive

Disorder and other AnxietyDisorders

Dr. Rochelle KinsonRegistrar

Department of Psychological Medicine

Tan Tock Seng Hospital



Overview for today

Normal anxiety

What are the common anxiety disorders?

How common are they?

Features of the individual anxiety disorders

More about Obsessive Compulsive Disorder



Normal anxiety? Everyone experiences varying degrees

Diffuse, unpleasant, vague sense of fear/uneasiness that is associated with

physical symptomsHeadache

Sweating

RestlessnessStomach discomfort

Giddiness

Nausea……



Can anxiety be good?

Normal and adaptive

Warns us of threat



When does normal become abnormal?

Intensity Duration

Frequency

Disorder



What are the anxiety disorders?

Panic disorder

Agoraphobia

Specific phobia

Social phobia

Obsessive compulsive disorder (OCD)

Posttraumatic stress disorder (PTSD)

Generalized anxiety disorder (GAD)



Is it common?

Singapore Mental Health SurveyGAD – 0.9%

OCD – 3%

Internationally Panic disorder - 1-4%

Specific phobia – 5-10%Obsessive compulsive disorder – 2-3%

PTSD – 8%

GAD – 5%




Panic disorder

Agoraphobia

Specific phobia

Social phobia

Obsessive compulsive disorder Posttraumatic stress disorder

Generalized anxiety disorder



What is a panic attack?

Discrete period of intense

fear/discomfort Symptoms develop

abruptly

Peaks within 10mins

Lasts about 30mins



What is a panic attack?

Psychological

symptoms

Feel as if surroundingsare not real

Feel as if you are

detached from yourself

Fear of losing control

going „mad‟

dying

Physical symptoms

Racing heart

Trembling Breathless

Choking

Chest pain

Nausea

Dizzy

Sweating



What is a panic disorder ?

Panic attacks are recurrent

Persistent worry about having more

attacks

Worry about consequences

Change in behaviour due to the attacks

Ongoing for at least a month



Female > male (2 - 3:1)

Age of onset

Bimodal distribution

15 – 24 yrs

45 – 54 yrs




Panic disorder

Agoraphobia

Specific phobia

Social phobia





What is agoraphobia?

Anxiety symptoms

Occur when restricted to places where

escape maybe difficult/embarrassing

Resulting in avoidance



What is agoraphobia?

Females > males

3:1

Age of onset

15 – 35 yrs




Panic disorder

Agoraphobia

Specific phobia

Social phobia





What is a specific phobia?

Marked fear in the presence/anticipation of

a specific object

Exposure results in anxiety

Avoidance

Recognition that it is excessive



How many different types are there?

Many different types of phobias

Heights

NeedlesBlood

Lightening

Spiders

Flying

Etc etc….



Male : female ratio and age of onset is

variable

For exPhobia of animals 15 yrs

Claustrophobia 20 yrs




Panic disorder

Agoraphobia

Specific phobia

Social phobia

Obsessive compulsive disorder

Posttraumatic stress disorder




What is social phobia?

Marked fear of social/performance situations

Recognition that it is excessive

Fears humiliation

Exposure provokes anxiety Avoidance/endured with distress



Males = females

Two peaks5yrs

11 – 15 yrs

Presentation to a psychiatrist is usuallydelayed




Panic disorder

Agoraphobia

Specific phobia

Social phobia






What is PTSD?

Exposure to a traumatic event

Response was intense fear/helplessness

Re-experiencing of the traumatic event Intrusive recollections

Dreams

Reliving the experience

Avoidance

Hypervigilant, poor sleep, irritability, poor concentration

Ongoing for at least a month



Risk of developing PTSD after a traumatic

event8 – 30%

Female > males




Panic disorder

Agoraphobia

Specific phobia

Social phobia






What is GAD?

Excessive anxiety and worry about a number of issues

„Free-floating anxiety‟

Difficult to control

Results in a combination of physical and psychologicalsymptoms.

Ongoing for at least 6 months Restlessness

Difficulty concentrating Fatigued

Irritability

Muscle tension

Sleep disturbance



Females > males

Mean age of onset 21 years

Large age range




Panic disorder

Agoraphobia

Specific phobia

Social phobia






What is OCD?

Characterized by persistent obsessional thoughts and/or compulsive acts

Recognized to be excessive or unreasonable

Distressing

Time consuming

Affects functioning

School

Work

Relationships



What are obsessions and compulsions?

Obsessions: Mental event

Recurrent thoughts,images or impulses

Intrusive

Cause markeddistress/anxiety

Attempts to ignore or suppress, or to neutralizethem with another thoughtor action

Product of his/her ownmind

Compulsions: Behaviour

Repetitive behaviours

Feel driven to performthese in response to anobsession, or according torules that must be appliedrigidly

Aimed at preventing or reducing distress



In essence…

OBSESSIONS

ANXIETY

COMPULSIONS

RELIEF



Historical perspective

In the early days - mental illness was commonlythought of as due to devils, demons or supernatural forces

Most sought help from religious healers

By the 1700‟s slow shift away from religioushealers to physicians

Physicians too were ill equipped to treat Blood letting

Admission into „asylums‟




19th century – emerging classification of

mental illness

Neurosis vs psychosis

Increased opposition to institutionalize

Treatments tried – sedatives, opium,

morphine, arsenic




Early 20th century –

Sigmund Freud‟spsychological theories

became increasingly

accepted

Resulted in purely„talk‟ therapy




Late 20th century – parallel advancement

in behavioural treatments and medication

First medication introduced in 1960‟s – clomipramine

Others followed…..



Is it common?

Life time prevalence of 2-3%

Male = female Mean age of onset 20 yrs



Why does it happen?

Brain neurochemicals & structure

Genetics

Personality factors Learning theory

Obsessions: neutral stimulus becomes anxietyprovoking when paired with a anxiety provokingstimulus

Compulsions: a specific action may reduce anxietyand gets reinforced



What are the common presentations?

Diverse

Can change over time Much overlap




Contamination

Commonest

Fear of dirt/germs

Results in avoidance of objects/places that

are „dirty‟

Compulsive washing/cleaning




Pathological doubt

Second commonest

“Did I switch off the lights?”

“Did I turn off the oven?”

“Is my car locked?”

More checkingChecking Even more checking




Intrusive thoughts

Third commonest

Unpleasant repetitive thoughts

Aggressive/sexual in nature




Symmetry

Fourth commonest

May lead to pathological slowness



Should we watch out for other illnesses?

Other anxiety disorders

Depression

Substance abuse

Suicide



How do patients with OCD fare over time ?

Presentation to a psychiatrist may be

delayed One third have significant improvement,

one third moderate and the remaining one

third remain the same/worsen



In summary

Anxiety can be normal and adaptive

Becomes a problem when intensity, duration

and frequency is increased There are several different anxiety disorders

with unique symptom patterns

OCD is characterized by obsessions and

compulsions and presents in different ways

Most importantly: they are treatable

OCD & Other Anxiety Disorders_Dr Rochelle

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