Obsessive compulsive disorder

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1. OBSESSIVE COMPULSIVE
DISORDER
NABINA PANERU

3. INTRODUCTION
•OCD is characterized by the presence of obsession and/or compulsions.
•An obsession is defined as an unwanted, intrusive, persistent ideas, thoughts, impulses or
images that cause marked anxiety or distress.
•The most common ones include repeated thoughts about contamination, repeated doubts, a need
to have things in a particular order, aggressive or horrific impulses.

4. CONTD.
•A compulsion is defined as unwanted repeated behavior patterns or mental acts (e.g., praying,
counting, repeating words silently) that are intended to reduce anxiety, not to provide pleasure
or gratification.
•They may be performed in response to an obsession or in a stereotyped fashion.

5. DEFINITION
•Obsessive –compulsive disorder (OCD) is defined as, “ as recurrent obsessions or
compulsions that are severe enough to be time consuming or to cause marked distress or
significant impairment.
•The individual recognizes that the behavior is excessive or unseasonable but, because of the
feeling of relief from discomfort that it promotes, is compelled to continue the act.
•The most common compulsions involve washing and cleaning, counting, checking, requesting
or demanding assurances, repeating actions and ordering.

7. EPIDEMIOLOGY
•One in 40 adult
•Life time prevalence: 2-3 %
•The average age of onset is late third decade (late 20s), while in the Western countries the onset
is usually earlier in life (adolescence or early adulthood).
•More common in unmarried males (India) while in other countries, no gender differences are
reported.
•Common in person from upper social strata with high intelligence.

8. ETIOLOGY
1.Biological Theories
-Genetics: First degree relatives with OCD have a three to fivefold higher probability of having
OCD. Twins have higher concordance rate for monozygotic twins than for dizygotic twins.
-Neurotransmitters: Serotonin, nor –adrenaline and dopamine have been implicated in the
etiology of OCD.
-Neuro –immunology: A positive link between streptococcal infection (Group A beta
hemolytic streptococcal infection) and OCD.

9. CONTD.
2. Psychoanalytic Theory:
•OCD is considered a defensive regression (defense mechanism) from the oedipal phase to the
anal –sadistic phase of psychosexual development with the use of isolation, undoing and
displacement.
•The traumatic event produces anxiety and discomfort and the individual learns to prevent the
anxiety and discomfort by avoiding the situation with which they are associated.

10. CONTD.
3. Behavioral Theories/ Learning theories: Obsessive –compulsive behavior is a conditioned
response to a traumatic event.

12. SIGN AND SYMPTOMS
•Obsessive compulsive thoughts:
a.Contamination: The most common type of obsessions in OCD. They are typically characterized
by a fear of dirt or germs.Exposure to any contaminants causes intense anxiety and distress
which in turn results in excessive cleaning and washing.
b.Need for symmetry, order and exactness: Patients typically describe an urge to repeat itself
until they feel “just right”.
c.Hoarding: Hoarders have an urge to hoard or save things.
d.Religion: Patients with religious obsessions typically experience intrusive unacceptable thoughts
or images about God or religion. For example, intrusive thoughts of abusive nature towards God
whenever one try to pray or on seeing the photographs or when one visits places or worship.

13. CONTD.
•Obsessive Compulsive images:
-Patients with these obsessions are plagued by thoughts, images or urges that are sexual or
aggressive in nature.
-Patients often fear that they may commit a sexually unacceptable act such as touching the
private parts of immediate family members .
-This can cause shame, guilt and anxiety because of the abhorrent nature of the thoughts.

14. CONTD.
•Obsessive Compulsive ruminations: These involve internal debates in which arguments for
and against even the simplest everyday actions are reviewed endlessly
•Obsessive Compulsive doubts: Those may concern actions that may not have been completed
adequately. The obsession often implies some danger such as forgetting to turn off the stove or
not locking a door. Followed by compulsive acts such as a person making multiple trips back
into the house to check if the stove has been turned off.

15. CONTD.
•Obsessive compulsive impulses: These are the urge to perform
acts usually of a violent or embarrassing kind, such as injuring a
child, shouting in a church etc. Aggressive obsessions: fear of
stabbing with a knife, jumping in front of the car, leaping out of
the open window.
•Obsessive compulsive rituals: These may include both mental
activities such as counting repeatedly in a special way or
repeating a certain form of words and repeated but senseless
behaviors such as washing hands 20 or more times a day.

16. CONTD.
•Obsessive Compulsive slowness: Severe obsessive ideas or extensive compulsive rituals
characterized by obsessional slowness in the relative absence of manifested anxiety. This leads
to marked slowness in daily activities.

17. DIAGNOSIS
•History taking
•Physical examination
•Mental status examination

18. TREATMENT
•Pharmacotherapy
•Cognitive bio-behavioral self treatment
•Behavioral therapy

19. CONTD.
•Pharmacotherapy:
-Clomipramine: The standard approach is to start treatment with
Serotonin –Specific Reuptake Inhibitors (SSRI) or chlomipramine.
-Other Drugs: If treatment with chlomipramineor an SSRI is
unsuccessful, segment the first drug by the addition of valproate
(Depakene), lithium (Eskalith), Or carbamazepine (Tegretol).

20. CONTD.
•Cognitive Bio-behavioral Self-Treatment
-Step 1: Relabel: Recognize that the intrusive obsessive thoughts and urges are the result of
OCD.
-Step 2: Reattribute: Realize that the intensity and intrusiveness of the thought or urge is caused
by OCD; it s probably related to a biochemical imbalances in the brain.
-Step 3: Refocus: Work around the OCD thoughts by focusing your attention on something else,
at least for a few minutes; do another behavior.
-Step 4: Revalue: Do not take the OCD thought at face value. It is not significant in itself.

22. CONTD.
•Behavioral therapy in OCD:
Exposure and
response
prevention
Thought
stoppage
Systemic
Desensitization
Relaxation
techniques
Aversive
conditioning

23. CONTD.
-Other therapies
-Supportive psychotherapy
-ECT –for patients’ refractory to other forms of treatment.

24. NURSING MANAGEMENT