Introduction
Anxiety Disorders And Obsessive-Compulsive Disorders
Obsessive-Compulsive Disorders (OCD)
Types of Obsessive-Compulsive Disorders
Obsessive-Compulsive Disorders
- obsessive-compulsive disorder,.
- body dysmorphic disorder,
- hoarding disorder,
- Trichotillomania
- excoriation disorder
Obsessions and Compulsions in OCD
OCD
- OBSESSIONS:
- Recurrent and persistent thoughts
- COMPULSIONS:
- Repetitive behaviors or mental acts
- Distress/Dysfunction
Examples of OCD Concerns and Compulsions
OCD
- Contamination concerns → hand-washing
- Possible harm concerns → checking
- Symmetry concerns → symmetry behaviours
Diagnosis of Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder
- Diagnosis is called for when symptoms:
- Feel excessive or unreasonable
- Cause great distress
- Take up much time
- Interfere with daily functions
Distinguishing OCD from Other Conditions
NOT OCD
- Obsessive-compulsive personality disorder
- Pathological or problem gambling, compulsive sexual disorder, problematic internet use
- Hoarding concerns → hoarding behaviors
- Being a meticulous professional or student
Prevalence and Impact
- 4th most common psychiatric disorder in one USA study
- 10th most disabling of all medical disorders in WHO BoD study
- Subclinical washing, checking, symmetry, symptoms are common
OCD Spectrum Disorders
OCD Spectrum
- Range of disorders with intrusive thoughts and repetitive behaviors
- Tourette’s syndrome
- Body Dysmorphic Disorder
- Hypochondriasis
- Hoarding Disorder
- Trichotillomania
- Skin Picking Disorder
Epidemiology
Epidemiology The lifetime prevalence of OCD is between 2 and 3%. Child/adolescent prevalence is 1-2.3%.
There is similar epidemiology among diverse cultures (studies in Europe, Asia and Africa have confirmed rates).
In adults, male and female prevalence is the same. In children and adolescents, males are more likely than females to be affected.
Onset
- Mean age of onset is approximately 20 years old (males with mean around 19 and females around 22).
- Two-thirds of affected people have onset before age 25. Less than 15% have onset after age 35.
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Biological Etiology of OCD
Biological Serotonin Hypothesis Clomipramine, SSRI’s, mCPP Neuroimmunology PANDAS, autoimmune Genetics 1st degree relatives 35%, Monozygotes 80-87% Neuroimaging Orbital Frontal Cortex, Basal Ganglia, Anterior Cingulate Gyrus
Screening Questions for OCD
Screening Questions
- Why Screen?
- Lag time from onset to diagnosis, shame
- Do you have repetitive thoughts that make you anxious and that you can’t get rid of no matter how hard you try?
- Do you keep things extremely clean or wash your hands frequently?
- Do you check things to excess?
- Check for comorbidity
- Lifetime MDD in adults is 2/3. OCD often precedes MDD in kids and adults
Treatment of OCD
Treatment
- Pharmacotherapy
- Cognitive-Behavioral Therapy
- Psychosurgery
- Deep Brain Stimulation
Biological Perspective on OCD Treatment
OCD: Biological Perspective Serotonin-based antidepressants (sertraline; Paroxetine, clomipramine)
- Bring improvement to 50–80% of those with OCD
- Relapse occurs if medication is stopped
Research suggests that combination therapy (medication + cognitive behavioral therapy approaches) may be most effective
Behavioral Perspective on OCD Treatment (ERP)
OCD: Behavioral Perspective
- In fearful situation, perform a particular act (washing hands)
- When threat lifts, associate improvement with random act
- After repeated associations, believe compulsion is changing situation
- Act becomes method to avoiding or reducing anxiety
OCD: Behavioral Perspective
- Behavioral therapy
- Exposure and response prevention (ERP)
- Clients are repeatedly exposed to anxiety-provoking stimuli and told to resist performing compulsions
- Therapists often model behavior while client watches
- Exposure and response prevention (ERP)
