Obsessive-compulsive disorder (OCD) is a mental disorder characterized by unwanted and repeated thoughts (obsessions) and behaviors (compulsions). It can range from mild to severe and negatively impact daily functioning if left untreated. While historically thought to be caused by religious or moral failings, modern research indicates OCD has biological and genetic causes involving abnormalities in brain circuits. Serotonin dysregulation and infections have also been linked to OCD development. Diagnosis requires obsessions, compulsions, or both according to diagnostic criteria and can be performed by a mental health professional.

2. Obsessive-
Compulsive Disorder
JYOTHIS PRAKASH

3. Introduction
• Obsessive–compulsive disorder (OCD) is
a mental disorder where people feel the
need to check things repeatedly, have certain
thoughts repeatedly, or feel they need to
perform certain routines repeatedly.
• People are unable to control either the
thoughts or the activities.

4. History
• In the 1600s it was thought of as symptoms of
religious melancholy and naughty thoughts.
• Pierre Janet and Sigmund Freud isolated OCD from
the disorders it was grouped with.
• Continuing research is being done about the
causes of OCD and better treatments.

5. Cont…
• Recent research on mice points toward a
genetic cause. A missing gene making a
certain protein caused the mice to scratch
and groom themselves compulsively until an
OCD drug was introduced.

6. Epidemiology
• Obsessive–compulsive disorder affects about
2.3% of people at some point in their life.
• Rates during a given year are about 1.2% and
it occurs worldwide.

7. Cont…
• It is unusual for symptoms to begin after the
age of thirty five and half of people develop
problems before twenty.
• Males and females are affected about
equally.

8. Definition
• Obsessive-compulsive disorder (OCD) is an anxiety
disorder in which people have unwanted and
repeated thoughts, feelings, ideas, sensations
(obsessions), or behaviours that make them feel
driven to do something (compulsions).

9. Cont…
• A person's level of OCD can be anywhere
from mild to severe, but if severe and left
untreated, it can destroy a person's capacity
to function at work, at school or even to lead
a comfortable existence in the home.

10. Signs & Symptoms
What is an obsession?
• Involuntary intrusive cognition.
• Types
 Doubts (74%)
 Thinking (34%)
 Fears (26%)
 Impulses (17%)
 Images (7%)
 Other (2%)

11. Obsessions-examples
• Doubt “Did I lock the door”
• Thought that he had cancer
• Thought / Image that he had knocked someone down
in his car
• Impulse + thought to shout obscenities in church
• Image of corpse rotting away
• Impulse to drink from inkpot and to strangle son

12. Themes in obsession…
• Obsessions often have common themes
– Contamination, dirt, disease, illness (46%)
– Violence and aggression (29%)
– Moral and religious topics (11%)
– Symmetry and sequence (27%)
– Sex (10%)
– Other (22%)
• The themes often reflect contemporary concerns (the devil,
germs, AIDS)

13. Compulsions
• Some people with OCD perform compulsive
rituals because they inexplicably feel they
have to, others act compulsively so as to
mitigate the anxiety that stems from
particular obsessive thoughts.

14. Cont…
• Excessive skin picking (i.e., dermatillomania)
or hair plucking (i.e.,trichotillomania) and
nail biting (i.e., onychophagia) are all on
the obsessive-compulsive spectrum.

15. Examples of compulsions…
• Scanning text for “life” having read “death”.
• Touching the ground after swallowing saliva.
• Driving back to check he hadn’t knocked
someone down in his car.
• Counting 6,5,8,3,7,4 in your head.
• Hand washing.

16. Linking Obsessions and
Compulsions

17. OCD Experiences
OCD Not OCD
A man who washes his hands 100
times a day until they are red and
raw
A woman who unfailingly
washer her hands before
every meal
A women who locks and relocks
her door before going to work
every day – for half an hour
A woman who double-
checks that her apartment
door and windows are
locked each night before she
goes to bed.
A college student who must tap
on the door frame of every
classroom 14 times before
entering
A musician who practices a
difficult passage over and
over again until its perfect
A man who stores 19 years of
newspapers “just in case” – with
no system for filling or retrieving
A woman who dedicates all
her spare time and money to
building her record
collection

18. Cognitive Performance-Recent
Research Findings
• A 2013 meta-analysis confirmed people with
OCD to have mild but wide-ranging cognitive
deficits; significantly regarding spatial memory,
to a lesser extent with verbal memory, fluency,
executive function and processing speed, while
auditory attention was not significantly affected.

19. Cont…
• Spatial memory had been evaluated by
results from Corsi block-tapping test, Rey-
Osterrieth Complex Figure Test-immediate
recall and Spatial Working Memory between
search errors.

20. Cont…
• Verbal memory had been evaluated by Verbal
Learning Test - delayed recall and Logical
Memory II.
• Verbal fluency was evaluated by Category
fluency and Letter fluency.

21. Cont…
• Auditory attention was evaluated by the Digit
Span Test.
• Processing speed was evaluated by Trail
Making Test part A.

22. Associated conditions…
• obsessive–compulsive personality disorder
• major depressive disorder
• bipolar disorder
• generalized anxiety disorder
• anorexia nervosa
• social anxiety disorder
• bulimia nervosa
• Tourette syndrome

23. Cont…
• Asperger syndrome
• attention deficit hyperactivity disorder
• dermatillomania (compulsive skin picking)
• body dysmorphic disorder
• trichotillomania (hair pulling)

24. Cont…
• In 2009 it was reported that depression
among those with OCD is particularly
alarming because their risk of suicide is high;
more than 50 percent of people experience
suicidal tendencies, and 15 percent have
attempted suicide.

25. Cont…
• Depression is also extremely prevalent among
sufferers of OCD. One explanation for the high
depression rate among OCD populations was
posited by Mineka, Watson, and Clark (1998), who
explained that people with OCD (or any
other anxiety disorder) may feel depressed because
of an "out of control" type of feeling.

26. Causes…
• GENETIC FACTORS:
genetic factors account for 45–65% of OCD
symptoms in children diagnosed with the
disorder.
identical twins more often affected than non-
identical twins

27. Genetic Factors cont…
Individuals with OCD are more likely to have
first-degree family members exhibiting the
same disorders than do matched controls.
A mutation has been found in the human
serotonin transporter gene, hSERT, in
unrelated families with OCD.

28. • CHEMICAL AND BRAIN DYSFUNCTION
 The chemical messenger, Serotonin seems to be
heavily involved.
 According to research, Serotonin is involved with
biological processes such as mood, aggression, sleep,
appetite and pain. It also seems that Serotonin is
capable of connecting to nerve cells in the brain in
many different ways and so can cause many different
responses.
Causes…

29. Chemical and Brain Dysfunction
cont…
• It is not even fully established if it is all or
part of the Serotonin chemical or another
chemical entirely acting on it; or a
malfunction in one or more of the receptors
in the brain that Serotonin attaches to that
causes the OCD problems.

30. • INFECTION
A streptococcal infection of the throat is
known to occasionally result in the body
confusing healthy cells with the infection
and causing cellular damage.
Causes…

31. Infection cont…
• If this has happened with the brain, the body’s infection
fighting system can attack the outside of nerve cells in the
Basal Ganglia part of the brain with the result that OCD
symptoms occur.
• Some research suggests that these symptoms don’t seem to
last very long and the occurrence of this ‘infection OCD’
seems to be very rare.

32. Causes…
• DEPRESSION
 People with depression sometimes develop OCD
symptoms, and those with OCD very often develop
depression. Dealing with both together is very difficult
without clinical intervention and it is notoriously
difficult to undertake an exposure programme while the
depression is high.

33. Causes-Recent findings…
• OCD is no longer believed to be caused by life
experiences.
• Modern research suggests a biological and
neurological cause
• fMRI scans show the circuit connecting the amygdala,
frontal cortex, caudate nucleus (motor control), and
thalamus is abnormally active in people with OCD.

34. Causes-Recent Findings cont…
• Genetic research on families with OCD
members have found a genetic link.
• There’s a link between OCD and other tick
disorders such as Tourette’s disorder.

35. Causes-Recent Findings cont…
• Glutamate dysregulation has also been the subject
of recent research, although its role in the
disorder's etiology is not yet clear. Glutamate is
known to act as a cotransmitter with dopamine
in dopamine pathways that project out of
the ventral tegmental area.

36. Causes-Recent Findings cont…
• People with OCD evince increased grey
matter volumes in bilateral lenticular nuclei,
extending to the caudate nuclei, while
decreased grey matter volumes in bilateral
dorsal medial frontal/anterior cingulate gyri.

37. Causes-Recent Findings cont…
• Orbitofrontal cortex overactivity is
attenuated in people who have successfully
responded to SSRI medication, a result
believed to be caused by increased
stimulation of serotonin receptors 5-
HT2A and 5-HT2C.

38. Freud’s View
• A patient's mind responds
maladaptively to conflicts between
unacceptable, unconscious sexual or
aggressive id impulses and the
demands of conscience and reality.
• The ego defends against the id by
isolation and reaction formation.
• The imperfect success of the ego
gives rise to OCD symptoms.

39. Diagnosis
• Formal diagnosis may be performed by a
psychologist, psychiatrist, clinical social worker, or
other licensed mental health professional.
• To be diagnosed with OCD, a person must have
obsessions, compulsions, or both, according to
the Diagnostic and Statistical Manual of Mental
Disorders (DSM).

40. Cont…
• According to ICD-10 criteria-
 For a definite diagnosis, obsessional or compulsive
acts, or both, must be present on most days for at
least 2 successive weeks and be a source of distress
or interference with activities. The obsessional
symptoms should have the following
charecteristics:

41. Cont…
1. They must be recognised as the individual’s
own thoughts or impulses;
2. There must be atleast one thought or act
that is still resisted unsuccessfully, even
though others may be present which the
sufferer no longer resists;

42. Cont…
• The thought of carrying out the act must not
in itself be pleasurable (simple relief of
tension or anxiety is not regarded as pleasure
in this sense);
• The thoughts, images, or impulses must be
unpleasantly repetitive.

43. Treatment
• Pharmacotherapy- treatment using drugs that affect
the neurotransmitter serotonin decrease the
symptoms of OCD.
• Selective serotonin reuptake inhibitors (SSRIs) such as
fluoxetine (Prozac) and sertraline (Zoloft) prevent
excess serotonin from being pumped back into
neurons causing it to bind to receptor sites that
regulate anxiety.

44. Cont…
• SSRIs are a second line treatment of
adult obsessive compulsive disorder (OCD)
with mild functional impairment and as first
line treatment for those with moderate or
severe impairment.

45. Cont…
• Disadvantage: Once medication is stopped, symptoms
usually re-occur so the person needs to be put on
medication indefinitely.
• The atypical antipsychotics such as quetiapine have also
been found to be useful when used in addition to an SSRI in
treatment-resistant OCD. However, these drugs are often
poorly tolerated, and have metabolic side effects that limit
their use. None of the atypical antipsychotics appear to be
useful when used alone.

46. Treatment
• Behavior Therapy- "exposure and response
prevention“ where the patient deliberately
confronts their feared object or idea.
• Ex: OCD hand washer touched “contaminated”
object and is forced to not wash hands until
anxiety goes down.

47. Cont…
• Behavior therapy is successful for most patients as
long as the therapist is fully trained and the person
is highly motivated and has a positive attitude. It
lasts longer after treatment than drug therapy.
• Cognitive-behavioral- therapy emphasizing
changing the OCD’s patient’s beliefs and thinking
patterns.

48. • Cognitive behavioral therapy (CBT) has been shown to be
the most effective type of psychotherapy for this disorder.
• The patient is exposed many times to a situation that
triggers the obsessive thoughts, and learns gradually to
tolerate the anxiety and resist the urge to perform the
compulsion.
• Medication and CBT together are considered to be better
than either treatment alone at reducing symptoms.
Treatment cont…

49. Cont…
• Psychotherapy can also be used to:
– Provide effective ways of reducing stress
– Reduce anxiety
– Resolve inner conflicts

50. Nursing Management
• Diagnoses Nursing Care Plans For Obsessive
Compulsive Disorder
Anxiety
Chronic low self-esteem
Fear
Ineffective coping

51. Cont…
Ineffective role performance
Impaired social interaction
Risk for injury
Social isolation

52. Some interesting facts…
• English footballer David Beckham has been outspoken
regarding his struggle with OCD. He said that he has to count
all of his clothes, and his magazines have to lie in a straight
line.
• British poet, essayist, and lexicographer Samuel Johnson is
an example of a historical figure with a retrospective
diagnosis of OCD. He had elaborate rituals for crossing the
thresholds of doorways, and repeatedly walked up and
down staircases counting the steps.

53. Research Findings…
• Nutrition deficiencies may also contribute to OCD and
other mental disorders. Vitamin and mineral supplements
may aid in such disorders and provide nutrients necessary
for proper mental functioning.
• μ-Opioids, such as hydrocodone and tramadol, may improve
OCD symptoms. Administration of opiate treatment may be
contraindicated in individuals concurrently
takingCYP2D6 inhibitors such as fluoxetine and paroxetine.

54. Cont…
• Much current research is devoted to the therapeutic
potential of the agents that affect the release of the
neurotransmitter glutamate or the binding to its receptors.
These include riluzole, memantine, gabapentin, N-
acetylcysteine, topiramate and lamotrigine.

56. References
– "What is Obsessive-Compulsive Disorder (OCD)?". Retrieved 27 May2015.
– Diagnostic and statistical manual of mental disorders : DSM-5 (5 ed.).
Washington: American Psychiatric Publishing. 2013. pp. 237–
242. ISBN 9780890425558.
– Angelakis, I; Gooding, P; Tarrier, N; Panagioti, M (25 March 2015).
"Suicidality in obsessive compulsive disorder (OCD): A systematic review and
meta-analysis.". Clinical Psychology Review 39: 1–
15. doi:10.1016/j.cpr.2015.03.002. PMID 25875222.
– Fenske JN, Schwenk TL (August 2009). "Obsessive compulsive disorder:
diagnosis and management". Am Fam Physician 80 (3): 239–
45. PMID 19621834.