Obsessive-Compulsive Disorder (OCD)


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Obsessive-Compulsive Disorder (OCD)

  1. 1. Obsessive-Compulsive Disorder OCD An anxiety disorder affecting 2-3% of adults
  2. 2. Prevalence of OCD <ul><li>Lifetime prevalence, 2-3% </li></ul><ul><li>One-year prevalence, 1-2% worldwide </li></ul><ul><li>Equal in males and females </li></ul><ul><li>Equally distributed among races/ethnicities </li></ul>
  3. 3. Course of the Disorder <ul><li>Onset in childhood or early adulthood </li></ul><ul><li>Progressive course </li></ul><ul><li>Intensity of symptoms can vary over time </li></ul>
  4. 4. Key Features of OCD <ul><li>A disorder in which obsessions and compulsions dominate and disrupt the person’s life. </li></ul><ul><li>Obsessions: persistent thoughts , ideas, impulses, or images that invade a person’s consciousness. </li></ul><ul><li>Compulsions: repetitive and rigid behaviors or mental acts in which the person engages in an effort to reduce anxiety </li></ul>
  5. 5. <ul><li>These symptoms feel strongly compelling, excessive and unreasonable to most patients. </li></ul><ul><li>The person engages in compulsive rituals that consume significant time and energy. </li></ul><ul><li>If these rituals are blocked or interfered with, the person experiences intense anxiety. </li></ul><ul><li>The person feels they have no control over the obsessive thoughts, and feels a powerful urge to perform the compulsive rituals. </li></ul>
  6. 6. These Tendencies Exist on a Continuum. <ul><li>Many people experience intrusive thoughts and urges to engage in checking or superstitious behaviors. </li></ul><ul><li>When these come to dominate the person’s life and disrupt their ability to function, a diagnosis of OCD is made. </li></ul>
  7. 7. Obsessive Thoughts & Impulses <ul><li>Feel intrusive and foreign </li></ul><ul><li>Are highly anxiety producing and unwelcome </li></ul><ul><li>Display common themes: </li></ul><ul><ul><li>Dirt or contamination </li></ul></ul><ul><ul><li>Violence & aggression </li></ul></ul><ul><ul><li>Orderliness </li></ul></ul><ul><ul><li>Religion </li></ul></ul><ul><ul><li>sexuality </li></ul></ul>
  8. 8. Compulsive Rituals <ul><li>Person feels they MUST engage in specific behaviors in order to be safe. </li></ul><ul><li>Engaging in compulsions reduces anxiety and controls obsessions for a brief time. </li></ul><ul><li>Common compulsive rituals: </li></ul><ul><ul><li>Cleaning compulsions </li></ul></ul><ul><ul><li>Checking compulsions </li></ul></ul><ul><ul><li>Counting, touching, verbal compulsions </li></ul></ul>
  9. 9. Biological Causal Factors in OCD <ul><li>Family pedigree studies suggest biological factor: </li></ul><ul><ul><li>concordance rate for MZ twins = 53% </li></ul></ul><ul><ul><li>Concordance rate for DZ twins = 23% </li></ul></ul><ul><li>Low serotonin strongly implicated </li></ul><ul><ul><li>Antidepressants that specifically increase serotonin are uniquely effective </li></ul></ul><ul><ul><li>Other antidepressants are less effective. </li></ul></ul>
  10. 10. Research implicates abnormal (excess) activity in specific brain circuit <ul><li>Orbitofrontal cortex: sexual, violent, and other primitive impulses arise. </li></ul><ul><li>Caudate nuclei (of the basil ganglia) </li></ul><ul><ul><li>Act as filters, send impulses on to thalamus. </li></ul></ul><ul><li>These areas are part of a brain circuit that converts sensory information into thoughts and actions </li></ul>
  11. 11. Research Evidence… <ul><li>Onset of OCD symptoms has followed injury to these brain areas. </li></ul><ul><li>Neuroimaging studies show increased activity in these brain areas in OCD patients as compared with controls. </li></ul><ul><li>Serotonin plays a key role in this brain area. </li></ul>
  12. 12. Is OCD a neurological disorder on a continuum with Tourette’s Syndrome?
  13. 13. Treatment for OCD <ul><li>Exposure and Response Prevention </li></ul><ul><li>Cognitive and Supportive Therapy </li></ul><ul><li>Antidepressant Medication </li></ul><ul><li>Combined Approaches </li></ul>
  14. 14. Behavior Therapy: Exposure and Response Prevention <ul><li>Client is repeatedly exposed to the anxiety-arousing situation or stimulus while being prevented from performing rituals. </li></ul><ul><li>A therapist supports and coaches the client through this challenge. </li></ul><ul><li>For some clients, homework assignments can accomplish this. </li></ul><ul><li>Effective in 55-85% of patients. </li></ul>
  15. 15. Psychotherapy <ul><li>Cognitive techniques are helpful to learn other ways to manage anxiety and build confidence. </li></ul><ul><li>Clients need support to confront anxiety without engaging in compulsions. </li></ul><ul><li>Clients need to process the emotions that were tied up in their behaviors. </li></ul>
  16. 16. Medication <ul><li>Antidepressant drugs that increase serotonin dramatically reduce symptoms in 80% of patients (Prozac, Luvox). </li></ul><ul><li>Clients must be maintained on medication to manage the symptoms over time. </li></ul>
  17. 17. Combined Treatments <ul><li>Behavioral, cognitive, and drug therapies in combination offer effective and lasting improvement. </li></ul><ul><li>Combined treatments are shown to be more effective and lasting than any one approach. </li></ul>
  18. 18. To Learn More: <ul><li>Wilensky, Amy. (1999). Passing for Normal: A Memoir of Compulsion. New York: Broadway Books. </li></ul><ul><li>The feature film, “As Good As It Gets.” with Jack Nicholson </li></ul>