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 Compulsive Disorder
(OCD)
Rotem Douer
Occupational Therapy Student
California State University, 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
Unwanted 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 Obsessive
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 some 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

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, Prozac, 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.