Obsessive Compulsive Disorder presentation

One of my assignments in graduate school was to pick a topic about mental health. I chose to research Obsessive Compulsive Disorder (OCD) since so many have to endure this terrible illness. In addition, I was fascinated by how the brain works in people diagnosed with OCD and excited to share my findings with my colleagues. This project required me to implement evidence-based research by reviewing articles and books on the topic. I had to familiarize myself with the findings, create and present a comprehensive power point slide to my professors and fellow students.

1. Obsessive C ompulsive Disorder (OCD) Rotem Douer Occupational Therapy Student California State U niversity, Dominguez Hills

2. What is OCD? Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts ( obsessions ) and behaviors ( compulsions ) that he or she feels the urge to repeat over and over National Institute of Mental Health

3. Main Elements of OCD Obsessions U nwanted and intrusive thoughts which cannot be cleared from the mind Compulsions Repeated and compelling ritualistic behaviors and routines

4. Types of OCD Checkers Washers and Cleaners Orderers Pure obsessionals Hoarders

5. Statistics “National Institute of Mental Health” 1% of US Population Suffers from OCD 50% of these cases are severe

6. Diagnosis Studies show that 80% to 99% of all people experience unwanted thoughts But…..OCD tends to be diagnosed only when these behaviors and thoughts result in significant impairment, distress, anxiety or are too time consuming Formal assessment tools: Yale Brown O bsessive Compulsive Scale (Y-BOCS), Compulsive Activity Checklist (CAC), and the Leyton Obsessional Inventory (LOI)

7. Criteria According to DSMV A. Presence of obsessions, compulsions, or both: Obsessions are defined by (1) and (2 ): 1. Recurrent and persistent thoughts, urges, or images that are experienced , at som e time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. 2 . The individual attempts to ignore or suppress such thoughts , urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion ).

8. Criteria According to DSMV (continued) Compulsions are defined by (1) and (2): 1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g ., praying , counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. 2.The behaviors or mental acts are aimed at preventing or reducing anxiety or distress , or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. .

9. Criteria According to DSMV (continued) B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day ) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning . C . The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. D . The disturbance is not better explained by the symptoms of another mental disorder

10. Causes: Genetic /Neurological /Anatomical : Abnormalities in thalamus, caudate nucleus, orbital cortex and cingulate gyrus all send messages to the brain at once More common in identical twins Higher rate among relatives Abnormal regulation of brain Serotonin

11. Causes Environmental Factors Psychological and physical trauma, childhood neglect, abuse, family stress , illness, death, and divorce. Transitions in life: adolescence, moving out, marriage , parenthood and retirement.

12. Brain Imaging in OCD

13. OCD and Occupation High levels of social and occupational impairment Interference with normal routine, schoolwork, job, family, or social activities. Everyday obsessing, preforming rituals trying to concentrate on daily activities may be difficult Side effect from medication affect occupation

14. OCD and Occupation: Work Repeatedly checking the office door: occupational stress, low productivity, lack of focus, disorganization , an inability to manage time, does not get things done in time or late for work due to constant checking Symptoms get worse with stress at work Many employers and co-workers are unaware of disorder Education and awareness programs in the work place (early recognition) Work accommodations: Modifying work schedule, using public transportation, taking breaks, having a mentor at work, allowing time to meet with therapist (collaboration between employee and employer Women at the work place see article

15. OCD and Anxiety * The OCD Cycle *OCD is characterized under anxiety disorders

16. OCD and Shame Unlike many mental illnesses, in OCD, patients are usually aware of their inappropriate behaviors and thoughts OCD is kept a secret due to stigma and prevents the diagnosis and referral to a consult by a mental health professional Often unaware that OCD can be treated (onset to seek treatment is 7.5 years) Non-psychiatric physicians or “knowledgeable” family/ friends may get involved in diagnosis Stigma and shame lead to depressions at the time they seek treatment (one third) and at least one episode of major depression in their lifetime (two thirds ) OCD stigma prevents people from seeking help

17. Treatment Medication: Anafranil , P rozac , Luvox , Paxil, Celexa , Lexapro, Zoloft Cognitive-Behavior Therapy (CBT) Exposure and response prevention (ERP ) Habituation Research by Meyer Cognitive restructuring: replace faulty beliefs with more realistic ones. CBT combined with medication is most effective Medications reduce anxiety and help with CBT .

18. Cognitive Restructuring Faulty Belief Fight Back With Realistic Appraisal (self talk) “Unless I’m sure everything is perfectly safe, I’m certain I or my loved ones are in terrible danger” “What is and where is the evidence of harm? There is no proof that something bad is inevitably going to happen” “Merely thinking bad thoughts will cause something bad to happen” “It’s only a thought , I am not my thoughts. It’s just an OCD thought, and therefore means nothing. Only actions can harm, not thoughts”

19. How OT can Help? Empowerment - prevent shame and feeling incompetent by engaging clients in meaningful occupations that will build self-esteem Support groups – encourage people to share struggles Time management (use charts) Use timer to be aware when to complete task OCD Diary Relaxation techniques Yoga has the potential to complement other non-pharmacological approaches (Gupta ) Deep breathing OCD education and awareness programs (early recognition is important)

20. OCD Diary Date/Time Trigger Obsession Emotions What did you feel? 0-100% Coping Strategy Mon 04-18-16 Locked door at work Go back to check, if I don’t’ check someone will break in and I will get fired Anxiety= 50% Deep breathing

21. Work Time Management Sheet Task Deadline Completed Yes/No 1. Complete typing a memo 15 minutes Yes 2. 3. 4. 5. 6. 7. 8.

22. Home Time Management Sheet Task Deadline Completed Yes/No 1. 2. 3. 4. 5. 6. 7. 8.

23. OCD and Technology https://ocdchallenge.com/ Can be done with therapist or on one’s own Explanation about OCD Personalized profile: identify triggers, obsessions and compulsions Perform exposure Record number of exposures and rituals Success: exposure task without ritual

24. Are OCD patients dangerous?

25. Resources International OCD Foundation Support groups: https://iocdf.org/supportgroups / OCD Center of Los Angeles Support groups: http:// ocdla.com/ocdtherapygroups Self-help books Baer, Lee. 2001. Getting control: overcoming your Obsessions and Compulsions, Revised Edition . New York: Plume. Crawford, Mark. 2004. The Obsessive Compulsive Trap . Ventura, CA: Regal Books.  

26. References American Psychiatric Association. (2013).   Diagnostic and statistical manual of mental disorders   (5th ed.). Arlington, VA: American Psychiatric Publishing . Barnett . A., N., & Mendelson L., L.(2003). Obsessive Compulsive Disorder in the Workplace: An Invisible Disability. Women and Therapy, 26(1), 169-178. Bavaro , S.M. (1990). Occupational Therapy and Obsessive Compulsive Disorder. The American Journal of Occupational Therapy, 45(5), 456-458. Brown C., & Stofell V.C. (2010). Occupational Therapy in Mental Health: A Vision for Participation . Philadelphia: Davis Company . Gupta , N.C., Baldassarre ., & Vrkljan , B.H. (2013). A systematic review of yoga for state   anxiety : Considerations for occupational therapy. The Canadian Journal of   Occupational Therapy, 80(3), 150-170. Hyman B.M. & Pedrick C. (2005). The OCD Workbook: Your Guide to breaking free from Obsessive Compulsive Disorder. Oakland: New Harbinger publications.

27. References Obsessive Compulsive Disorder Among Adults. ( n.d. ). Retrieved from http :// www.nimh.nih.gov/health/statistics/prevalence/obsessive-compulsive-disorder-among- adults.shtml Obsessive-Compulsive Disorder. ( n.d. ). Retrieved, from http:// www.nimh.nih.gov/health/topics/obsessive- compulsive-disorder- ocd /index.shtml Obsessive-Compulsive Disorder (OCD). ( n.d. ). Retrieved from http:// www.adaa.org/understanding- anxiety/obsessive-compulsive-disorder- ocd Publication Manual of the American Psychological Association (6th ed.) (2010). Washington, D.C.: American Psychological Association.