1. Introduction OCD is an anxiety disorder.
For diagnosis, either obsessions and/or compulsions must be present.
Although many different types of cognitive and behavioral symptoms are present in OCD, anxiety appears to underlie both obsessive thoughts and compulsive behaviors.

2. Obsessions? Compulsions?
Obsessions – repetitive and unwelcome thoughts, images, or impulses that are difficult to dismiss or control.
Compulsions – repetitive behavioral responses – can be resisted only with great difficulty ; mounting anxiety .

3. Obsessions
Thoughts, images, or impulses that repetitively occur to become out of one’s own control.
Person suffering from these obsessions finds them intrusive and disturbing – recognizes they don’t make sense.

4. Obsessions - continued
Obsessions often accompanied by uncomfortable feelings such as fear, disgust, or doubt.
For example, people with OCD may worry excessively about dirt and germs, and obsessed with the idea that they are contaminated or may contaminate others

5. Compulsions
These are acts that are continually performed to provide relief from discomfort caused by obsessions.
OCD compulsions do not give the person pleasure .
For example, a person may repeatedly check to see if their stove was left on in fear of burning the house down.

6. Most people with OCD have multiple OCD symptoms

7. Multiple Compulsions

9. Categorizing Obsessions and Compulsions
Commonly Associated Compulsions
Fear of contamination
Washing, cleaning
Need for symmetry, precise
arranging
Ordering, arranging, balancing, straightening until "just right"
Unwanted sexual or aggressive
thoughts or images
Checking, praying, “undoing” actions, asking for reassurance
Doubts (eg, gas jets off, doors locked)
Repeated checking behaviors
Concerns about throwing away
something valuable
Hoarding

10. Prevalence 2% to 3% afflicted worldwide.
The rates are consistent across most cultures.
Males with an earlier onset - have a worse course than females.
Symptoms are present an average of 10 years prior to clinical presentation.
Patients with OCD often feel shame regarding their symptoms and put great effort into concealing them from family, friends, and health care providers.

11. Prevalence Sex: Equal in males and females.
Childhood-onset OCD is more common in males and more likely to be linked genetically with ADHD and Tourette syndrome.
Age:
Symptoms usually begin in individuals aged years.

12. Compulsivity vs Impulsivity
Compulsivity Drive : Discomfort
(Ego dystonic)
Impulsivity Drive: Pleasure/Pain
(Ego syntonic)
Inability to delay Repetitive Behavior

13. Worry vs Obsession Worry
Perceived, as triggered by internal or external event.
Content – normal everyday experiences (family, finances etc) - Worry: is in the form of a thought.
Obss. : as thoughts, images or impulses.
Worry does not appear to be resisted as strongly nor it is as intrusive, as obsessional thinking.

14. Scientist split into 2 groups
Theories
Scientist split into 2 groups
Psychological disorder where people are responsible for feelings they have
Abnormalities in the brain

15. Causes Serotonin is involved in regulating anxiety
Abnormality in the neurotransmitter serotonin
In order to send chemical messages serotonin must bind to the receptor sites located on the neighboring nerve cells
OCD suffers may have blocked or damaged receptor sites preventing serotonin from functioning to full potential
Possible genetic mutation
Some people suffering have mutation in the human serotonin transporter gene

16. OCD and the Brain
PET scans show people with OCD have different brain activity from others
Another theory: miscommunication between the orbital frontal cortex, the caudate nucleus, and the thalamus
Caudate nucleus doesn’t function properly and causes thalamus to become hyperactive and sends “never-ending” worry signals between OFC and thalamus  OFC responds by increasing anxiety

17. Psychiatric co-morbidities
Estimated prevalence
63 %
Personality disorders
28 to 31%
MDD
Simple phobia
7 to 48%
11 to 16%
Social phobia
Bipolar disorder
15%
Eating disorders
8 to 13%
Alcohol abuse 8%
Panic disorder
6 to 12 %

20. Prognosis
Without treatment, symptoms may wax and wane in intensity, but they rarely remit spontaneously.
70% of patients entering treatment experience a significant improvement in their symptoms.
OCD remains a chronic illness, with symptoms that may wax and wane during the life of the patient.
15% of patients can show a progressive worsening of symptoms or deterioration in functioning over time.
5% of patients have a complete remission of symptoms between episodes of exacerbation.
relapse is not uncommon during or after the course of treatment .
patients who successfully complete a course of CBT (perhaps as few as sessions) may experience enduring relief even after the treatment .
certain percentage of patients may have disabling, treatment-resistant symptoms.
A small subgroup of these patients may be candidates for neurosurgical intervention.