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 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. 4 th 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 OCD CHECKERS 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? (

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 Helps Use 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.

Pitfalls of Medication Therapy Not all SSRIs work and a trial & error process is sometimes necessary Side effects include weight gain, sleep loss, and sexual dysfunction Takes 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 & beliefs by 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 Therapy Desired 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 Therapy Exposure and Ritual Prevention Therapy Anxiety 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.S Subjective Units of Distress/Discomfort Scale A roadmap for ERP A list of situations that you fear and avoid –an Anxiety/Exposure list

Pitfalls to Behavior Therapy Blocking feelings Avoiding exposure Ritualizing privately

Recommended Treatment According 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).