Supporting the Person with OCD Lynne M Drummond Copyright L M Drummond

What is OCD? A condition where the individual is plagued by nasty, horrible, frightening intrusive thoughts These thoughts cause the individual distress and often anxiety To overcome this anxiety/distress the individual seeks some relief by….. Copyright L M Drummond

Individual seeks relief from horrible intrusive thoughts by:- Performing anxiety reducing compulsions (rituals) –Eg washing; counting; undoing; cancelling et c. Asking for reassurance –From family; friends even health professionals Copyright L M Drummond

Compulsions/Rituals/Reassurance Copyright L M Drummond

Education about the role of Compulsions/ Reassurance/ Rituals (Adapted from Stern and Drummond, 1991) Copyright Lynne M Drummond

Theoretically then treatment is easy!!!!

Hang on!!! First things first!!

Does the OCD Sufferer want Treatment? Remember it is their problem (and should not be yours) They need to be ready to undergo treatment –Psychological treatment require commitment and also is TOUGH as involves facing up to fear –Drug treatment may lead to some side-effects and again needs commitment Sometimes an individual has not reached their own “rock bottom ” Copyright L M Drummond

What can you do if your loved-one does not want treatment at this point??

Consider your own health and that of other family members first –You are the “healthy people” and need to set the “house rules” of what you will or will not tolerate –You may need to consider asking sufferer to leave. You have a right to your own life!! –Consider any children first and foremost. They need protection from OCD!!! They need to not be subjected to OCD restrictions and involvement in rituals. If there is any doubt then need to request a Child Safeguarding Assessment –Your safety is vitally important and must be protected at all times!! In some cases Police need to be involved Copyright L M Drummond

Your own health and safety Can be very difficult as it may feel you are being unpleasant to the OCD sufferer Remember it is the OCD you abhor and NOT the OCD sufferer Looking after yourself and other family members is in the OCD Sufferer’s interests too!!!!! Copyright L M Drummond

What can you do if your loved-one does not want treatment at this point?? Be encouraging and supportive but not over- involved (which may lead them to “dig in their heels ” –People with OCD may have restricted lives and live in a way normally see with a much younger individual –They may rebel –Some OCD Sufferers are desperate to have control and vehemently resent anyone seen as trying to restrict this Copyright L M Drummond

What can you do if your loved-one does not want treatment at this point?? Try not to get swept up with performing more and more OCD compulsions and rituals for them –It will often seem easier and better to do things in an OCD way or give repeated reassurance. It will stop the distress in the short-term but will undoubtedly escalate and lead to increasing requests in time Try to get support and help for yourself. YOU NEED TO REMAIN STRONG!! Copyright L M Drummond

What can you do if your loved-one does not want treatment at this point?? Set out “ground rules” of what is and what is not acceptable to you and discuss these with the OCD Sufferer –Make these clear and simple and STICK BY THESE RULES (just as you would with a child, this establishes the boundaries of the relationship) Copyright L M Drummond

What can you do if your loved-one does not want treatment at this point?? Learn what you can about OCD so that you understand what is going on. –It can be useful to know about both the drugs and also about ERP so that you can help and support Copyright L M Drummond

What are the treatments?? Drug Treatments (generally starting with SRIs) Cognitive Behaviour Therapy involving Exposure and Response Prevention Copyright L M Drummond

Drug Treatments for OCD

ACTION OF THE SRIs Fronto-Septo- Hippocampal Circuits LACK of SEROTONIN IN OCD Copyright L M Drummond

Serotonin Reuptake Inhibiting (SRI) drugs CLOMIPRAMINE (225mg/day) FLUVOXAMINE (300mg/day) PAROXETINE (60mg) FLUOXETINE (60mg) SERTRALINE (200mg) (CITALOPRAM and ESCITALOPRAM) Copyright L M Drummond

Response to SRI Drugs Needs to be higher doses than those used for depression....generally low dose has little/no effect whereas high dose does. Can take up to 3 months to see benefit Benefits can continue to grow up to 2 years Copyright L M Drummond

Side-effects and SRI drugs The older drug, Clomipramine, has more side-effects than the newer ones (dry mouth; tiredness et c.) Newer SSRIs have fewer side-effects and most of these will settle after a short while (Energising so need to be taken in morning; can occasionally have minor GI effects) None are addictive BUT if you stop them then need to come off slowly and under medical supervision Copyright L M Drummond

Despite this some people still do not respond to SRIs or ERP Fronto-Septo- Hippocampal Circuits LACK of SEROTONIN IN OCD Basal ganglia circuits. Mediated by DOPAMINE Copyright L M Drummond

Efficacy of augmentation for OCD with Dopamine Blockers Overall only 1/3 of SRI refractory patients improve with addition of Dopamine Blockade (Bloch et al 2010). These drugs are sometimes named “anti-psychotics”. This is because they are same drugs as used in psychosis BUT IN MUCH LOWER DOSES ( e.g I may use 2.5-5mg Aripiprazole as opposed to up to 30mg!!) Copyright L M Drummond

CBT Treatment for OCD

Psychological Treatment of OCD. Gold Standard = ERP –Prolonged graduated exposure in real life to the feared situation with self-imposed response prevention Copyright L M Drummond

Compulsions/Rituals/Reassurance Copyright L M Drummond

Exposure and Response Prevention (Adapted from Stern and Drummond, 1991) Copyright Lynne M Drummond

When undergoing ERP, the OCD Sufferer will be: Anxious++ –The treatment works by the patient becoming anxious and taking the risk. This is the way to overcome the OCD fear Maybe agitated Maybe more preoccupied than usual Maybe very tired Maybe depressed to begin with Copyright L M Drummond

What is it like to be the Carer in these situations? Difficult to accept your “loss of role” Difficult to watch your loved one undergoing stress and not step in You may be the person who receives the “brunt” of the stress Copyright L M Drummond

What can you do to help? Ask the OCD Sufferer what they need you to do TO ASSIST THERAPY –This is likely to mean NOT helping them perform OCD Compulsions et c. And letting them “get on” themselves. Ask the OCD Sufferer about REASSURANCE and how to respond –May agree a form of words such as “The hospital has advised me not to answer questions like that in order to help you overcome your OCD” Copyright L M Drummond

What can you do to help? Be helpful and supportive without performing “OCD tasks” –Can be difficult as: “Old Habits Die Hard” It is difficult to watch someone struggling (remember that you are not intervening as a way to help them overcome their OCD) Aggression and violence are TOTALLY UNACCEPTABLE and you must always look after yourself first and foremost !! Copyright L M Drummond

Your own health and safety Can be very difficult as it may feel you are being unpleasant to the OCD sufferer Remember it is the OCD you abhor and NOT the OCD sufferer Looking after yourself and other family members is in the OCD Sufferer’s interests too!!!!! Copyright L M Drummond

What about other Psychological Therapies?? Psychotherapy –This is the more “old-fashioned” talking therapy. IT IS NOT USEFUL FOR OCD Family Therapy –Not generally useful for OCD but may help in the problems which develop as a result of the OCD Cognitive Therapy Mindfulness Copyright L M Drummond

What about other Psychological Therapies?? Cognitive Therapy –Not useful on it’s own and only in combination with ERP. Mindfulness –A more recent therapy. This can be used to reduce general stress levels HOWEVER IT IS NOT A TREATMENT FOR OCD Copyright L M Drummond

What happens to the Family and Carers AFTER OCD??? Copyright L M Drummond

What happens to the Family and Carers AFTER OCD??? Readjustment of roles within the family/relationship –Carers lose their role as carer which can be difficult –There needs to be adjustment in family members responsibilities –This can lead to resentment and even depression in the carer Learn or relearn what the loved one is actually like as a person –Previously the OCD has been masking the personality –Can lead to relationship difficulties and even divorce Copyright L M Drummond

What happens to the Family and Carers AFTER OCD??? Parents can lose their “child” –The OCD sufferer may have been living in the parental home and being cared for when they are well into adulthood –After all these years can be difficult to see your offspring “fly the nest” One of the partners in a relationship may have assumed most of the roles in eg Child- Care; Housework and Employment –Can be hugely difficult to relinquish some of these roles Copyright L M Drummond

In Summary:

Summary There are effective treatments for OCD The OCD Sufferer needs to take control of when and how they do their treatment Carers may be asked to assist (or may not!!) At all times Carers need to ensure their own safety and wellbeing (and that of family members) Carers can help by being supportive and understanding Life after OCD treatment may require considerable adaptation too!! Copyright L M Drummond

In other words it is a journey when we know the desired destination but when we get there.... it may not look exactly as we imagined!! Copyright L M Drummond