1. OCD Facts *All facts obtained through DynaMed Database or ocdeducationstation.org

2. Definition obsessions are recurrent and persistent thoughts, impulses or images experienced as intrusive and inappropriate compulsions are feelings of being driven to perform repetitive behaviors or mental acts in response to obsession or according to rules that must be applied rigidly

4. Common Obsessions and Compulsions ObsessionsCompulsions contamination safety fear of committing sin need for order sexual/aggressive thoughts cleaning checking counting/repeating arranging touching objects hoarding seeking reassurance making lists

5. Who is most affected? OCD more common in women than men in most countries Onset onset peak age 13-15 years, female onset peak age 20-24 years Many adults diagnosed with obsessive compulsive disorder report symptoms began in childhood (Weissman, M. et al., 1994)

6. Prevalence Many research reports cite OCD as the fourth most common mental illness after phobias, substance abuse, and major depression. Lifetime prevalence of OCD in young people: o worldwide, is approximately 1-2% o (lifetime prevalence of OCD refers to the percentage of individuals in a given statistical population who, at some point in their lives, have experienced a case of OCD). Another figure commonly referred to in the OCD research is that at any one given point in time, OCD affects approximately 1 in 100 children. Overall, OCD has been found to be one of the most common psychiatric illnesses affecting children and adolescents. http://www.nimh.nih.gov/statistics/1ocd_adult.shtml

7. Celebrities with OCD http://www.rethink-anxiety-disorders.com/famous- people-with-ocd.html http://www.rethink-anxiety-disorders.com/famous- people-with-ocd.html

8. Causes Direct cause uncertain Evidence points to genetic component to susceptibility to OCD…particularly involving genes that that work to tone down glutamate. (Arnold, et al., 2006) Abnormalities (as seen in fMRI studies) in the prefrontal cortex….esp. areas that control activity from the amygdala (emotional processor) o See Abstract – OCD causes - Biological

10. Diagnosis Some factors: presence of obsessions or compulsions that o are time-consuming (take > 1 hour/day) o cause distress or impairment o are recognized by the patient as excessive or unreasonable o not due to medication, drug abuse or medical condition o if another Axis I disorder present, the content of obsessions or compulsions not restricted to it Use of Yale-Brown Obsessive Compulsive Scale (Y- BOCS) Irregularity on PET scans (esp. in prefrontal cortex)

12. Treatment - Counseling Behavior therapy most studied is exposure and response prevention (ERP) Behavior therapy ERP appears more effective than progressive muscle relaxation ERP appears more effective ERP appears more effective than clomipramine alone or pill placebo ERP appears more effective clinician-guided behavior therapy more effective than computer- guided behavior therapy which is more effective than relaxation clinician-guided behavior therapy more effective than computer- guided behavior therapy cognitive-behavioral therapy (CBT) appears effective compared to no therapy, sertraline alone or pill placebo cognitive-behavioral therapy (CBT) appears cognitive therapy and behavioral therapy appear to have similar efficacy over 4-16 weeks (level 2 [mid-level] evidence)similar efficacylevel 2 [mid-level] evidence

13. Behavior Therapy effective exposure and response prevention (also called exposure and ritual prevention, ERP, EX/RP) o exposure may include in vivo exposure - gradual, prolonged confrontation with anxiety provoking stimuli imagined exposure o continue exposure until anxiety decreases (habituation) o response prevention - abstinence from rituals as opposed to active blocking o duration of therapy 1-3 months

14. Predictors of better outcome with behavioral therapy early adherence to exposure homework employment living with family no previous treatment having fear of contamination overt ritualistic behavior absence of depression

15. Cognitive Behavioral Therapy (CBT) May include: o psychoeducation, cognitive training, mapping OCD target symptoms and exposure and response therapy (EX/RP) therapy is more intense, involving individual or group sessions with trained therapists, homework, and monitoring procedures Cognitive-behavioral group therapy appears highly effective compared to no therapy o 47 patients with OCD (DSM-IV criteria) randomized to 12 weekly sessions of cognitive- behavioral group therapy vs. waiting list control o 70% treatment vs. 4% control patients had improvement (p < 0.001, NNT 2) Also works better with SSRIs o ***See Abstract – OCD Treatment – Group treatment and SSRIs

16. CBT (cont.) cognitive therapy and behavioral therapy appear to have similar efficacy over 4-16 weeks on 6 randomized trials exposure and response prevention reported to result in higher recovery rates (45% vs. 13%) than cognitive behavioral therapy at 3 months after treatment based on follow-up of 62 patients in one of these trials o See Abstract: OCD treatment – CBT vs. Beh therapy

17. Prognosis typically chronic course with waxing and waning of symptoms patients who respond to medications may experience significant improvement in symptoms but are rarely cured of illness ***See Abstract – OCD Prognosis