This document provides information about obsessive compulsive disorder and related disorders. It discusses OCD, body dysmorphic disorder, hoarding disorder, trichotillomania, excoriation disorder and their symptoms. It also covers the etiology, clinical features, diagnosis and treatment of OCD, including psychotherapy, pharmacotherapy, ECT and self-help strategies. Nursing management focuses on reducing anxiety and compulsive behaviors, improving role performance and sleep disturbances. Related disorders like body dysmorphic disorder, hair pulling disorder and skin picking disorder are also summarized.

1. OBSESSIVE COMPULSIVE DISORDER
(OCD) AND RELATED DISORDERS
PRESENTED BY: Ms Mamta Bisht
Lecturer
(Psychiatric Nursing)

2. OBSESSIVE COMPULSIVE AND RELATED
DISORDERS (DSM -5)
• Obsessive compulsive disorder
• Body dysmorphic disorder
• Hoarding disorder
• Trichotillomania (hair pulling disorder)
• Excoriation disorder (skin picking)
• Substance/medication induced OCD and related disorders
• Obsessive compulsive disorders due to medical condition
• Other specified obsessive compulsive disorder
• Unspecified obsessive compulsive disorder
Presented By Ms Mamta Bisht

3. INTRODUCTION
Obsessive-compulsive disorder is neurotic disorder
whose main symptoms include obsessions and
compulsions, driving the person to engage in
unwanted, often-times distressing behaviors or
thoughts.
It’s treatment is done through a combination of
psychiatric medications and psychotherapy.
Presented By Ms Mamta Bisht

4. DEFINITIONS
Obsessions:
Obsessions are recurrent and persistent thoughts,
impulses, or images that cause distressing emotions
such as anxiety or disgust.
These intrusive thoughts cannot be settled by logic
or reasoning.
Typical obsessions include excessive concerns
about contamination or harm, the need for
symmetry or exactness, or forbidden sexual or
religious thoughts.

5. COMPULSIONS
Compulsions are repetitive behaviors or mental acts
that a person feels driven to perform in response to
an obsession.
Although the compulsion may bring some relief to
the worry, the obsession returns and the cycle
repeats over and over.
Some of the common compulsions include cleaning,
repeating, checking, ordering and arranging ,
Mental compulsions e.t.c

6. DEFINITION OF OCD
Obsessive-Compulsive Disorder (OCD) is a 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.
These obsessions and compulsions are severe
enough to cause significant distress or impairment
in the social, occupational and other important areas
of functioning.
Presented By Ms Mamta Bisht

7. ETIOLOGICAL FACTORS
1.Biological Factors:
• First degree relatives.
• Identical twins
2.Neurotransmitters
Imbalance in serotonin , dopamine and glutamate
3.Neuroanatomical Factors:
There is evidence of abnormal brain structure and
activity in patients with OCD.

8. 4.Psychoanalytic Theory:
OCD arises when unacceptable wishes and
impulses from the id are only partially repressed.
They cause anxiety. Ego defence mechanisms are
used to reduce the anxiety. These defence
mechanisms are used unconsciously used in the
form of acts, such as hand washing.
5.Cognitive Theory:
Dysfunctional beliefs are the route cause for OCD
and the strength with which it is held determines
the risk of developing OCD

9. ETIOLOGICAL FACTORS
6.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 the Obsessions.
This decrease in anxiety positively reinforces the
compulsive acts and they become stable learned
behavior.

10. ETIOLOGICAL FACTORS
7.PSYCHOSOCIAL FACTORS:
• Disturbed mother child relationship
• Fear of abandonment
• Recent object loss
• Emotional neglect
• Childhood abuse (physical, emotional or sexual)

11. CLINICAL FEATURES OF OCD
1. Washers (obsessional rituals)
This is the most common type. Here the obsession is
of contamination with dirt,germs, body excretions
and the like. The compulsion is washing of hands or
the whole body, repeatedly many times a day. It
usually spreads onto washing of clothes, bathroom,
bedroom, door knobs and personal articles,
gradually. The person tries to avoid contamination
but unable to, so washing becomes a ritual.
Presented By Ms Mamta Bisht

12. 2. Checkers (obsessional doubt)
In this type the person has multiple doubts that the
activities may not have been completed
adequately. for example the door has not been
locked, kitchen gas has been left open, counting
of money was not exact and etc.the compulsion, of
course, is checking repeatedly to remove the
doubt.
Presented By Ms Mamta Bisht

13. 3. Pure obsessions (intrusive thoughts)
This syndrome is characterized by repetitive
intrusive thoughts, impulses or images which are
not associated with compulsive acts.
The distress associated with these obsessions is
dealt usually by counter thought for e.g praying,
undoing actions etc
a. Obsessional thoughts: these are words . ideas
and beliefs that intrude forcibly into the patients
mind. They are usually unpleasant and shocking
to the patient and may be obscene and
blasphemous. E.g. Orderliness, sexual imagery
repeated doubts et.c.
Presented By Ms Mamta Bisht

14. b. Obsessional images:
These are vividly imaginary scenes often of a
violent or disgusting kind involving abnormal
sexual practice
c. Obsessional impulses:
These are the urges to perform acts usually of a
violent or embarrassing kind, such as injuring a
child, shouting in church etc
c. Obsessional ruminations:
These involve internal debates in which
arguments for and against even the simplest
everyday actions are reviewed endlessly.
Presented By Ms Mamta Bisht

15. 4. Primary obsessive slowing(symmetry)
It is characterized by several obsessive ideas and
or extensive compulsive rituals , in the relative
absence of manifested anxiety. this leads to
marked slowness in daily activity. usually the
person demand on being need for symmetry and
precise arranging so in order to neutralize it they
will continue ordering, arranging, balancing,
straightening until "just right" or perfect in their
eyes.
Presented By Ms Mamta Bisht

16. DIAGNOSIS OF OCD
• DSM-5
• Suggested by demonstration of realistic behavior
that is irrational or excessive.
• MRI and CT shows enlarged Basal Ganglia in
some patients.
• PET(Positron emission Tomography) shows
increased glucose metabolism in part of the basal
ganglia.
• ICD-10 criteria
Presented By Ms Mamta Bisht

17. TREATMENT MODALITIES
1. Psychotherapy
• Psychodynamic therapy
• Individual psychotherapy
• Cognitive Behavior therapy
• Supportive therapy
2. Pharmacological treatment
3. ECT
4. Self help and coping
5. Psychosurgery
Presented By Ms Mamta Bisht

18. PSYCHODYNAMIC THERAPY
• This can be used for the patients who are
psychologically oriented.
• The therapy is based on psychoanalysis in which
the patient is made conscious about their
unconscious thoughts and motives and thus
gaining insight about the condition.
• It is focussed on client’s self awareness and
understanding of the influence of the past or
present behavior.
Presented By Ms Mamta Bisht

19. PSYCHODYNAMIC PSYCHOTHERAPY
A woman comes to therapist stating that she is
chronically late and has done everything that she can to
change this through a variety of organizational tools and
methods but to not avail. Her behavior is interfering
with her work and relationships.
The therapist and client discover that being early or even
on time put her at risk of waiting for the person that she was
meeting. Waiting evoked uncomfortable needful feelings,
especially when she was waiting for someone on whom she
was reliant. This in part had roots in traumatic experiences
in her childhood around being forgotten by her parents and
having to wait for them: in those situations she had felt
helpless, frightened and dependent. With the help of her
therapist, she gradually grew to tolerate her needful and
dependent feelings and with that, no longer needed to
eliminate these feelings either by being late or through
other problematic behaviors.
Presented By Ms Mamta Bisht

20. INDIVIDUAL PSYCHOTHERAPY
• Discuss the difficulties of the client and help them
understand their anxiety and methods to deal
with them.
• Logical and rational explanations are given to the
anxiety producing situations.
• Psychoeducation.
Presented By Ms Mamta Bisht

21. COGNITIVE BEHAVIOR THERAPY
• During treatment sessions, patients are exposed to
the situations that create anxiety and provoke
compulsive behavior or mental rituals.
• Through exposure, patients learn to decrease and
then stop the rituals that consume their lives.
• They find that the anxiety arising from their
obsessions lessens without engaging in ritualistic
behavior.
Presented By Ms Mamta Bisht

22. BEHAVIOR THERAPY
Thought stopping: the client is asked to yell or
scream in his mind to “stop” whenever unwanted
thoughts arise.
Systematic desensitization and reciprocal
inhibition:
1. Training relaxation technique prior to exposure
to the stimulus.
2. The client is gradually (step wise step) exposed
to the anxiety producing stimulus.
Implosive flooding: the therapist describes the
anxiety producing situation in vivid detail so that the
client can imagine the situation. The therapy is
continued until a topic no longer produces anxiety.
Presented By Ms Mamta Bisht

23. 2. PHARMACOLOGICAL TREATMENT
1. Benzodiazepines
• Alprazolam(0.5-1mg/day)
• Clonazepam(0.25-0.5 mg/day)
2. Antidepressants
Clomipramine(75-300mg/day)
Fluoxetine(20-80mg/day)
Fluvoxamine(50-200mg/day)
3. Antipsychotics- these are occasionally used in
low doses in the treatment of severe anxiety
e.g. Haloperidol,Risperidone, Olanzapine.
Presented By Ms Mamta Bisht

24. 3. ELECTROCONVULSIVE THERAPY
Electroconvulsive Therapy (ECT)In the presence of
severe depression with OCD, ECT may be needed.
ECT is particularly indicated when there is a risk of
suicide and/or when there is a poor response to
the other modes of treatment.
Presented By Ms Mamta Bisht

25. 4. SELF-HELP AND COPING
Keeping a healthy lifestyle and being aware of
warning signs and what to do if they return can
help in coping with OCD and related disorders.
Also, using basic relaxation techniques, such as
meditation, yoga, visualization, and massage, can
help ease the stress and anxiety caused by OCD
Presented By Ms Mamta Bisht

26. NURSING MANAGEMENT

27. NURSING ASSESSMENT
• Social impairment
• Obsessive thought (repetitive worries, repeating
and counting images or words)
• Compulsive behaviour (repetitive activity, like
touching, counting, doing or undoing)
Presented By Ms Mamta Bisht

28. NURSING DIAGNOSIS
1. Severe anxiety related to obsessional thoughts
and impulses as evidenced by repetitive actions
and decreased social functioning.
2. Ineffective individual coping related to
underdeveloped ego, possible biochemical
changes as evidenced by realistic behavior.
3. Altered role performance related to the need to
perform rituals, as evidenced by inability to
fulfil usual patterns of responsibility
Presented By Ms Mamta Bisht

29. 4. Chronic low self-esteem related to the
obsessional thoughts and rituals s evidenced by
social isolation and low self confidence.
5. Sleep pattern disturbances related to the
obsessional doubts and fears manifested by
repetitive checking of doors and not sleeping
properly.
Presented By Ms Mamta Bisht

30. 1. TO REDUCE ANXIETY
• Establish relationship through use of
empathy,warmth, and respect.
• Acknowledge behavior without focusing attention
on it. Verbalize empathy toward client’s
experience rather than disapproval or criticism.
• Assist client to learn stress management,
(e.g.,thought-stopping, relaxation exercises,
imagery)
• Give positive reinforcement for non compulsive
behavior.
• Assist client to find ways to set limits on own
behaviors.
Presented By Ms Mamta Bisht

31. 2. TO REDUCE OBSESSIVE COMPULSIVE
BEHAVIOR
• Work with patient to determine the type of
situations that increase anxiety and result in such
behavior.
• Meet the patient dependency needs.
• Provide positive reinforcement.
• Support patients efforts to explore the meaning
and purpose of behavior.
• Provide structured schedule activities for patient,
including adequate time for performing rituals.
• Help the patient learn ways of interrupting
obsessive thoughts.
Presented By Ms Mamta Bisht

32. 3. IMPROVE ROLE RELATED
RESPONSIBILITIES
• Determine patient's previous role within the
family and the extent to which the role is altered
by the illness.
• Encourage patient to discuss conflicts evident
within the family system.
• Explore available options for changes for
adjustment in the role.
• Practice through role play.
• Provide positive reinforcement.
Presented By Ms Mamta Bisht

33. BODY DYSMORPHIC DISORDER
• Body dysmorphic disorder is characterized by
preoccupation with one or more perceived defects
or flaws in physical appearance that are not
observable or appear only slight to others.
• There is an excessive, exaggerated belief that the
body is deformed or defective in some specific
way.
• It may include imagined or slight flaws of the face
or head, shape of nose, facial asymmetry e.t.c
Presented By Ms Mamta Bisht

34. HOARDING DISORDER
Hoarding disorder is characterized by a persistent
difficulties in discarding or parting with possessions
even those of little or no value
due to perceived need to save
them.
Individual may hoard any books,
wrappers, packing bags, food,
animals etc.
Presented By Ms Mamta Bisht

35. TRICHOTILLOMANIA (HAIR PULLING DISORDER)
• Trichotillomania is defined as a recurrent pulling
out of one’s hair resulting in hair los.
• Common sites: scalp , eyebrows, eyelids,
eyelashes
• More common among females (college students)
Presented By Ms Mamta Bisht

36. TRICHOTILLOMANIA (HAIR PULLING DISORDER)
These behaviors may be preceded or
accompanied by various emotional states, such as
anxiety, tension or boredom.
Presented By Ms Mamta Bisht

37. EXCORIATION DISORDER (SKIN PICKING
DISORDER)
• Excoriation disorder is characterized by a
compulsion to repeatedly pick their own skin,
which results in skin lesions.
• Individuals may pick at healthy skin, minor skin
irregularities (pimples), lesions and scars.
• These behaviors may be preceded or
accompanied by various emotional states, such as
anxiety, tension or boredom.
Presented By Ms Mamta Bisht