BY Doon Psychothearaputic Centre

Doon_Psychotherapeutic_centre
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DOON PSYCHOTHEARAPUTIC CENTRE
Introduction
 It is an anxiety disorder.
 The person has recurring thoughts
or images(obsessions) and/or
repetitive, ritualistic-type behaviours
that the individual is unable to keep from
doing(compulsions).
 The person may try to suppress these thoughts or
behaviours but is unable to do so.
 The individual knows that the thoughts or behaviours are
irrational but feels powerless to stop.
Obsessive-Compulsive Disorder
 An obsession is a recurrent and intrusive thought,
feeling, idea, or sensation.
 In contrast to an obsession, which is a mental event, a
compulsion is a behaviour.
 Specifically, a compulsion is a conscious, standardized,
recurrent behaviour, such as counting, checking, or
avoiding.
 A patient with OCD realizes the irrationality of the
obsession and experiences both the obsession and the
compulsion as ego-dystonic.
Obsessive
 It is defined as unwanted, intrusive, persistent ideas,
thoughts, impulses or images that cause marked distress.
Compulsions
 It denote unwanted repetitive behaviour patterns or
mental acts that are intended to reduce anxiety, not to
provide pleasure or gratification.
Obsessive-Compulsive Disorder
 Affects almost 3% of world’s population
 Start anytime from preschool to adulthood
 Typically between 20-24 many different forms of OCD
– differ from person to person
 Cause of OCD is still unknown
 Better when diagnosed early
COMORBIDITY
 Lifetime prevalence for major depressive disorder in
persons with OCD is about 67 percent and for social
phobia, about 25 percent.
 The incidence of Tourette's disorder in patients with
OCD is 5 to 7 percent, and 20 to 30 percent of patients
with OCD have a history of tics.
 Other common co morbid psychiatric diagnoses in
patients with OCD include alcohol use disorders,
generalized anxiety disorder, specific phobia, panic
disorder, eating disorders, and personality disorders.
ETIOLOGY
Psychoanalytical Theory
Learning Theory
Biological Aspects
 Neuroanatomy
 Physiology
 Biochemical Factors
Psychoanalytical Theory
OCD have:
 weak, underdeveloped egos.
(Reasons: unsatisfactory parent-child relationship,
conditional love etc.).
 Regression to the pre-Oedipal anal-sadistic phase,
combined with use of specific ego defence
mechanisms (isolation, undoing,displacement,
reaction formation), produces the clinical symptoms
of obsessions and compulsions.
Learning Theory
 It explains- OCD pts. as a conditioned response to a
traumatic event.
 Traumatic event produces anxiety and discomfort.
 passive avoidance(staying away from the source)
 active avoidance(staying with the source)
Biological Aspects
 Neuroanatomy: Neuroimaging techniques have shown
abnormal metabolic rates in the basal ganglia and orbital
frontal cortex of individuals with the disorder(Hollander
&Simeon, 2008).
 Physiology.
Electrophysiological studies, sleep electroencephalogram
studies, and neuroendocrine studies have suggested that
there are commonalities between depressive disorders and
OCD (Sadock & Sadock,2007). Neuroendocrine
commonalities were suggested in studies in which about
one third of OCD clients show nonsuppression on the
dexamethasone-suppression test and decreased growth
hormone secretion with clonidine infusions.
Biochemical Factors
 The neurotransmitter serotonin as influential in the
etiology of obsessive-compulsive behaviours.
 Drugs that have been used successfully in alleviating
the symptoms of OCD are clomipramine and the
selective serotonin reuptake inhibitors (SSRIs), all of
which are believed to block the neuronal reuptake of
serotonin, thereby potentiating serotoninergic activity
in the central nervous system.
Diagnostic criteria
 Specific criteria to be clinically diagnosed
 Anxiety disorder with presence of obsessions
 or compulsions
 ego dystonic – realize thoughts and actions are
irrational or excessive
 Must take up more than 1 hour a day
 Must disrupt daily routine
 Symptoms can’t result from effects of other medical
conditions or substances
Symptoms of Obsessions
 Repeated thoughts about contamination
(e.g. may lead to fear of shaking hands or
touching objects).
Repeated doubts(e.g. repeatedly
Wondering if they locked the door or
turned off an appliance).
 A need to have things in a certain order(e.g.feels
intense anxiety when things are out of place).
 Thought of aggression (e.g. to hurt a loved one).
 Sexual imagery.
Symptoms of Compulsion
 Washing and cleaning(e.g
excessive hand washing or
house cleaning).
 Counting (e.g. Counting

number of times that
something is done).
 Checking (e.g. checking something that one has done,
over and over).
 Requesting or demanding assurances from others.

 Repeating actions(e.g. going in and out of
 door or up and down from a chair).
 Ordering(e.g. arranging and rearranging
 cloths or other items).
 Note : the obsessions and compulsions seem
 to be worse in the face of emotional stress.
Clinical Features
 Obsessional thought
 Obsessional ruminations
 Obsessional doubts
 Obsessional impulses
 Obsessional rituals
 Obsessional slowness
Diagnosis
 Suggested by demonstration of ritualistic behaviour
that is irrational or excessive.
 MRI and CT shows enlarged basal ganglia in some
patients.
 PET scanning shows increased glucose metabolism in
part of basal ganglia.
PET scans indicate differences in
brain activity of OCD patients versus
normal
OCD found excessive with other diseases
 Common diseases: Depression, Schizophrenia…
 Depression is the most common
• Many people with OCD suffered from depression first
• 2/3 of OCD patients develop depressionmakes
OCD symptoms worse and more difficult to treat
People with OCD common diagnosed as
Schizophrenic hard to separate obsessions from
delusions
Treatment
 Only completely curable in rare cases
 Most people have some symptom relief with
 treatment
 Treatment choices depend on the problem and
patients preferences
 Most common treatments:
 Behavioural Therapy
 Cognitive Therapy
 Medication
Cognitive-Behavioral Therapy
 Should be done when people are ready for it
 Must be customized for each person’s specific form of OCD
and their needs
 No side affects except increased anxiety
with exposure to fear
 Often lasts about 12 weeks
 Positive effects off CBT last longer than
those of medication
 If OCD returns can successfully treat again with same
therapy
 Best treatment approach for most is CBT combined with
medication
Medication
 Anxiolytic benzodiazepine such as chloradiazepoxide or
diazepam give temporary relief from anxiety but not really
effective on obsessions and compulsions
 Antidepressants because of common depression
 Selective Serotonin Reuptake Inhibitors (SSRIs):
alter the levels of neurotransmitter serotonin in
the brain which helps brain cells communicate with one another
 Prevents excess serotonin from being pumped back into original
neuron that released it
 Then can bind to receptor sites of nearby neurons and send
chemical message that can help regulate anxiety and obsessive
compulsive thoughts
 Most effective drug treatment helping about 60% of patients
 Ex: Prozac, Zoloft, Lexapro, Paxil

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 Counting (e.g. Counting

 Requesting or demanding assurances from others.

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