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

1. Obsessive Compulsive Disorder EARNEST
LAMUEL

2. Definition

3. Definition
Obsessive-compulsive disorder
(OCD) is a mental illness that
causes repeated unwanted
thoughts or sensations
(obsessions) or the urge to do
something over and over again
(compulsions). Some people can
have both obsessions and
compulsions.

4. Classification

5. Classification
•F42.0 Predominantly obsessional thoughts or ruminations
•F42.1 Predominantly compulsive acts [obsessional rituals]
•F42.2 Mixed obsessional thoughts and acts
•F42.8 Other obsessive-compulsive disorders
•F42.9 Obsessive-compulsive disorder, unspecified

6. Signs &
Symptoms

7. Signs & Symptoms
• Recurrent unwanted thoughts referencing contamination, sexuality,
aggression, need for perfection, or abnormal doubt.
• Attempts to reduce the effect of the thoughts with other thoughts.
• Repetitive acts, impulses or rituals such as washing hands, checking,
rearranging things for perfect alignment, repeating words or phrases.
• Recognition that the thoughts are produced in his or her own mind.
• Lack of concentration and task completion.
• Impaired social or work functioning.

8. Etiology

9. Genetic Factors
Twin studies have consistently found a
significantly higer concordance rate for
monozygotic twins than for dizygotic twins.
Family studies of these patients have shown that
35% of the first degree relatives of obsessive
compulsive disorder patients are also affected with
the disorder.

10. Biochemical Influences
A number of studies suggest that the neurotransmitter
serotonin (5-HT) may be abnormal in individuals with
obsessive compulsive disorder.

11. Psychoanalytic Theory
The psychoanalytic concept views patients with
obsessive compulsive disorder as having regressed
to developmentally earlier stages of the infantile
superego, whose harsh exacting punitive
characteristics now reappear as part of the
psychopathology.

12. Behavior Theory
This theory explains obsessions as a conditioned
stimulus to anxiety. Compulsions have been
described as learned behavior that decreases the
anxiety associated with obsessions. This decrease
in anxiety positively reinforces the compulsive acts
and they become stable learned behavior. This
theory is more useful for treatment purposes.

13. Clinical
Features

14. Obsessional Thoughts
These are words, ideas and beliefs that intrude forcibly
into the patient’s mind. They are usually unpleasant
and shocking to the patient and may be obscene or
blasphemous.

15. Obsessional Images
These are vividly imagined scenes, often of a violent
or disgusting kind involving abnormal sexual
practices.

16. Obsessional Ruminations
These involve internal debates in which arguments for
and against even the simplest everyday actions are
reviewed endlessly.

17. Obsessional Doubts
These 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 the door. It may
be followed by a compulsive act such as the person making
multiple trips back into the house to check if the stove has
been turned off. Sometimes these may take the form of
doubting the very fundamentals of beliefs, such as, doubting
the existence of God and so on.

18. Obsessional Impulses
These are urges to perform acts usually of a violent or
embarrassing kind, such as injuring a child, shouting in
church, etc.

19. Obsessional Rituals
These may include both mental activities such as counting
repeatedly in a special way or repeating but senseless behaviors such
as washing hands 20 or more times a day. Sometimes such
compulsive acts maybe preceded by obsessional thoughts, for
example, repeated handwashing may be preceded by thoughts of
contamination. These patients usually believe that the contamination
is spread from object to object or person to person even by slight
contact and may literally rub the skin off their hands by excessive
hand washing.

20. Obsessional Slowness
Severe obsessive ideas or extensive compulsive rituals
characterize obsessional slowness in the relative
absence of manifested anxiety. This leads to marked
slowness in daily activities.

21. Diagnosis

22. Diagnosis
• Suggested by demonstration of ritualistic behavior that is
irrational or excessive
• MRI and CT shows enlarged basal ganglia in some patients
• Position – emission tomography scanning shows increased
glucose metabolism in part of the basal ganglia
• Based on ICD 10 Criteria.

23. Treatment

24. Pharmacotherapy
•Antidepressants (for example, fluvoxamine,
sertraline, etc.)
•Anxiolytics (for example, benzodiazepines)

25. Behavior Therapy
•Exposure and response
prevention
•Thought stoppage
•Relaxation techniques
•Desensitization
•Aversive conditioning

26. Nursing
Management

27. Nursing Assessment
Assessment should focus on the collection of physical,
psychological and social data. The nurse should be particularly
aware of the impact of obsessions and compulsions on physical
functioning, mood, self-esteem and normal coping ability. The
defense mechanisms used, thought content or process potential
for suicide, ability to function and social support systems
available should also be noted.

28. Nursing Interventions
• Work with patient to determine types of situations that
increase anxiety and result in ritualistic behaviors.
• Initially meet the patient’s dependency needs. Encourage
independence and give positive reinforcement for
independent behaviors.
• In the beginning of treatment, allow plenty of time for rituals.
Do not judgemental or verbalize disapproval of the behavior.

29. Nursing Interventions
• Support patient’s efforts to explore the meaning and purpose
of the behavior.
• Provide structured schedule of activities for patient, including
adequate time for completion of rituals.
• Gradually begin to limit amount of time allotted for ritualistic
behavior as patient becomes more involved in unit activities.
• Give positive reinforcement for non – ritualistic behaviors.

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