Obsessive-Compulsive Disorder (OCD) Psychology Talk


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Obsessive-Compulsive Disorder is an anxiety disorder that includes obsessions (repetitive intrusive thoughts, images or impulses that cause the individual distress) and compulsions (ritualistic or repetitive behaviours or mental actions used to reduce or eliminate distress). David Rosenstein focuses on how the condition develops, the various treatments available and some of the latest developments in our understanding of Obsessive-Compulsive Disorder.

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Obsessive-Compulsive Disorder (OCD) Psychology Talk

  1. 1. Obsessive Compulsive (Spectrum) Disorder OCD David Rosenstein
  2. 2. What is OCD • Obsessions: • Intrusive and repetitive thoughts, images and/or impulses which produce distress (anxiety). • Unwelcome and irrational • Compulsions • Repetitive behaviors or rituals (physical and/or mental actions) in an attempt to reduce distress (anxiety) • Difficult to control
  3. 3. OCD as a spectrum •OCD is being considered as a spectrum disorder: • Degree’s of severity • Overlapping anxiety conditions/disorders • Different kinds of OCD subtypes (one person’s OCD is different from another)
  4. 4. OCD as a spectrum • Other conditions considered to be more like OCD such as: • Hair pulling (Trichotillomania) • Skin Picking (Dermatillomania) • Compulsive Hoarding/Acquiring • Some forms of Social Anxiety Disorder • Pathological Gambling (Sub-forms)? • Body Dysmorphic Disorder
  5. 5. Obsessions and Compulsions: Obsessions Compulsions Contamination Cleansing Scrupulosity Eliminating Harm/Sexual Checking Symmetry/Order Equalizing Pure Doubt Reassurance Responsibility Magical/Superstitious Jealousy Counting/Arranging Magical/Superstitious Hoarding/Acquiring Picking/Pulling Voluntary Tick/Movement
  6. 6. Why it can be a problem • Time consuming • Causes significant psychological distress • Interferes: social, work, family or other important area • Disabling • Leads to depression and/or substance use disorders
  7. 7. OCD in South Africa •Prevalence is believed to be the same as overseas (SASH study) 3(-5%) •Often misdiagnosed or not diagnosed •Poor training about OCD and not many individuals trained to treat OCD
  8. 8. OCD in South Africa • Some areas (SES) have little/no awareness • Apparently no difference in culture or race in prevalence (more research needed) • 60% of all persons with a diagnosable anxiety disorder never see a mental health professional – they may turn to their family physician, religious leader or another family member for help
  9. 9. When does it begin? • Mean age of onset = 20 y/o • However strong evidence for developmental origins (childhood) • Fluctuating course through life • Stress ‘brings it out’ • On average, people with OCD see 3-4 doctors and spend over 9 years seeking treatment before they receive a correct diagnosis
  10. 10. What causes OCD •Genetic causes. No single gene identified, but a number of genes play a role •Anxiety sensitivity •Often a family member will have OCD or an anxiety disorder (occasionally another psychiatric condition) •Differences in brain functioning
  11. 11. PET of OCD Brain
  12. 12. What causes OCD •Some classical conditioning models •OCD as learned responses to stressors and anxiety
  13. 13. Serotonin and OCD
  14. 14. Stress as onset •Stress is not a cause of OCD, but an aspect of it’s onset •Stress or early life trauma’s are linked to the onset and development of OCD and related disorders
  15. 15. Treatment •Most effective treatment currently is cognitive behavior therapy (CBT) and specifically exposure and response prevention (ERP) •Medication treatments (SSRI’s) •Combination treatment •Third wave approaches (mindfulness)
  16. 16. CBT for OCD •Exposure and response intervention •Exposure – person remains in contact with something they usually fear until their anxiety is diminished (habituation)
  17. 17. ERP – Response prevention •Ritual postponement •Roll it over •Ritual/Compulsion abstinence •Ritual/Compulsion interference (“mess it up”)
  18. 18. ERP – Exposure •In Vivo (to life) Exposure •Imaginal Exposure • Scripting • Diffusion (for thought fusions) •Interoceptive Exposure
  19. 19. OCD Manager
  20. 20. iCounselor: OCD
  21. 21. OCD Test: YBOCS
  22. 22. How families can help •Family can assist by: • Not judging or becoming angry with OCD behavior • Reduce the amount of reassurance • Assist with exposures and fear approach behaviors • Empathy
  23. 23. OCD and the family
  24. 24. Disclosure •OCD can be very difficult to disclose •Some call it the secret illness •Disclosure to the ‘right individuals’ can provide tremendous relief •Reduces suicidality •Provides greater access to support •Demystifies and reduces stigma associated wit mental illness overall