OBSESSIVE

COMPULSIVE

DISORDER (OCD)

Dr. Aftab Asif

MRCPsych, London

Associate Professor of Psychiatry,

Fatima Jinnah Medical College /

Sir Ganga Ram Hospital, Lahore

Obsessions Recurrent, Persistent ideas, thoughts,images, or impulses that are egodystonic i.e., they are not asvoluntarily produced. Attempts aremade to ignore or suppress them.

Compulsions

Repetitive & seemingly purposefulbehavior actions that are performedaccording to certain rule or is astereotyped fashion

The obsessions or compulsions are asignificant source of distress to theindividual.

OCD Cycle

OBSESSIONS

COMPULSIONS

BELIEF ANXIETY

1970 1975 1980 1985 1990

OC

D

%

Rate of Diagnosis of OCD

Years

EPIDEMIOLOGY

General Population = 2-3% =

Mean Age of Onset = 20 yrs. Adolescent = Adults.

Unmarried, divorced / separate = 60-70%

Life Time Prevalence

50-75% pt. with OCD

CLINICAL FEATURES

Contamination 45 %

Pathological doubt 42 %Somatic 36 %Aggressiveness 28

%Sexual 26 %

Obsessions Affective Disorder

Checking 63 %Washing 50 %Counting 36 %Symmetry & precision 28 %

Compulsions Affective Disorder

Cognitive Differentiations

BehavioralDifferentiations

•Impulsions•Meticulousness or perfectionism•Pathologic atonement•Repetitive displacement behavior•Stereotypic behavior•Self-injurious behavior•Pathologic overinvolvement•Pathologic persistence•Hoarding•Complex tics

•Anxous ruminations & excessive worries•Pathologic guilt•Degressive ruminations•Fantasies•Paranoid fears•Flashbacks•Pathologic attraction•Rigid thinking•Pathologic indecision•Realistic fears or concerns 

Differential Symptomatology

ETIOLOGY

Neurobiological

PsychologicalEnvironmental

Neurobiological

PsychologicalEnvironmental

Causes of OCD in short

Neurobiological factors

A. Neurotransmitter Levels

Serotonin

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C S F 5HIAA

Platelet 5HT

B. Brain Imaging Studies

CT/MRI: Decrease size of caudate nuclei

PET: Increased activity in frontal lobe & basal

ganglia

C. Genetics

35% in first degree relation.

Psychological factors

• Cognitive appraisal of intrusive thoughts.

• Overestimation of danger.

• Inflated personal responsibility.

• Thought-action fusion.

• Thought-suppression.

• Cognitive deficits in selective attention. 

• Deficits in inhibiting irrelevant stimulI (particularly internal ones such as intrusive thoughts).

Environmental factors

Early childhood conflicts:

• This is an early theory that suggests conflicts or problems during childhood are the roots of OCD.

• This is specifically looking at either permissive or mainly unengaged parenting techniques.

• Major life transitions such as moving schools have been reported to contribute to triggering OCD symptoms.

• Stressful events, just as a traumatic event of losing a loved one, can trigger OCD.

Major life transitions / Stressful events

Differential Diagnosis

Tourette's disorder (TD)

Motor or vocal tics disorder

90% of TD OCD

5-7 % OCD TD

Cont….

Schizophrenia

Major Depression

Personality Disorder

Phobias

Dysmorphic Disorder

Other Illnesses Close to OCD

Obsessive compulsive personality disorder

Generalized Anxiety disorder Anorexia Nervosa Hypochondriasis Pathologic skinpicking Trichotillomania

TREATMENT

Pharmacotherapy

1. TCA/Clomipramine 2. SSRI3. Adjunctive medicationsSertralineCitalopramFluoxetine etc.

Psychotherapy

Thought stopping Response prevention Exposure etc.

Most effective for OCD.

Supportive therapy is always helpful

Cognitive Behavioral Therapy

Neurosurgery

For chronic, uncontrollable,deterioratepatient only. Anterior cingulotomy Limbic leucotomy Anterior capsulotomy Subcaudate tractotomy

Not used in Pakistan