Obsessive Compulsive Disorder (OCD) is an anxiety disorder marked by persistent unwanted thoughts and repetitive behaviors, often performed to alleviate anxiety. Diagnosis requires meeting specific criteria outlined in the DSM-IV-TR, and symptoms can lead to significant distress and impairment. Treatment options include behavioral therapy, cognitive therapy, and medications, with a focus on managing compulsive behaviors and reducing anxiety.

1. OBSESSIVE AND COMPULSIVE DISORDER
Prepared by:-
Mrs. Arunjyoti Baruah.
Assoc. Prof & HOD
Dept. of Psychiatric Nursing
LGBRIMH, Tezpur

2. INTRODUCTION:-
 Obsessive compulsive disorder, OCD is an anxiety
disorder and is characterized by recurrent, unwanted
thoughts (obsessions) and /or repetitive behaviors
(compulsions).
 Repetitive behaviors such as hand washing, counting,
checking, or cleaning are often performed with the hope
of preventing obsessive thoughts or making them go
away.
 Performing these so called “rituals”, however provides
only temporary relief, and not performing them markedly
increases anxiety.

3. Signs and symptoms:-
 Persistent, unwelcome
thoughts or images, or
by the urgent need to
engage in certain
rituals.
 They may be obsessed
with germs or dirt, and
wash their hands over
and over.
 They may be filled with
doubt and feel the need
to check things
repeatedly.

4. Diagnostic criteria:-
 To be diagnosed with OCD, a person must have
obsessions and/or compulsions, according to the
DSM-IV-TR diagnostic criteria.
 Obsessions-
 Recurrent and persistent thoughts, impulses, or
images that are experienced as intrusive and that
cause marked anxiety or distress.
 The thoughts, impulses, or images are not simply
excessive worries about real-life problems.

5. Cont---
 The person attempts to
ignore or suppress such
thoughts, impulses, or
images, or to neutralize
them with some other
thought or action.
 The person recognizes
that the obsessional
thoughts, impulses, or
images are a product of
his or her own mind, and
are not based in reality.

6. Compulsions:-
 Repetitive behaviors or
mental acts that the person
feels driven to perform in
response to an obsession, or
according to rules that must
be applied rigidly.
 The behaviors or mental
acts are aimed at preventing
or reducing distress or
preventing some dreaded
event or situation; however
these behaviors or mental
acts are not actually
connected to the issue, or
they are excessive.

7. Cont---
 In addition to these criteria, at some point during the
course of the disorder, the individual must realize that
his/her obsessions or compulsions are unreasonable
or excessive.
 Moreover, the obsessions or compulsions must be
time-consuming (taking up more than one hour per
day), cause distress, or cause impairment in social,
occupational, or school functioning.
 OCD often causes feelings similar to those of
depression.

8. Related conditions:-
 OCD is often confused with the separate condition
obsessive-compulsive personality disorder. The two
are not the same condition.
 OCD is ego dystonic, meaning that the disorder is
incompatible with the sufferer’s self-concept.
 Because disorders that are ego dystonic go against
an individual’s perception of his/herself, they tend to
cause much distress.
 OCPD, on the other hand, is ego syntonic-marked by
the individual’s acceptance that the characteristics
displayed as a result of this disorder are compatible
with his/her self-image. It does not cause distress.

9. Etiological theories:-
I. Psychodynamics-
 Freud placed origin for obsessive-compulsive
characteristics in anal stage of development. The
child is mastering bowel and bladder control at this
stage and derives pleasure from controlling his/her
own body and indirectly the actions of others.
 Erikson’s comparable stage for this disorder is
autonomy versus shame and doubt. The child learns
that to be neat and tidy and to handle bodily wastes
properly gains parental approval and to be messy
brings criticism and rejection.

10. Cont---
 The defensive mechanisms used in obsessive-
compulsive behaviors are unconscious attempts by
the client to protect the self from internal anxiety.
II. Biological-
 Although biological and neurophysiological influences
in the etiology of anxiety disorders have been
investigated, no relationship has yet been
established.
 The mind-body connection is well accepted, but it is
difficult to establish whether the biological changes
cause anxiety or the emotional state causes
physiological manifestations.

11. Cont---
III. Family dynamics-
 The individual exhibiting dysfunctional behavior is
seen as the representation of family system
problems.
 Multiple factors contribute to anxiety disorders.

12. Treatment-
 According to the Expert Consensus Guidelines for
the treatment of obsessive-compulsive disorder are
as follows-
 Behavioral therapy.
 Cognitive therapy.
 Medications are first line treatments for OCD.
 Psychodynamic psychotherapy may help in
managing some aspects of the disorder but there are
no controlled studies that demonstrate effectiveness
of psychoanalysis or dynamic psychotherapy in OCD.

13. Cont---
1. Behavior therapy-
 The specific technique used is called exposure and
ritual prevention (also known as “exposure and
response prevention”) or ERP; this involves gradually
learning to tolerate the anxiety associated with not
performing the ritual behavior without going back and
checking again (ritual prevention).
2. Medication-
 SSRIs such as paroxetine, sertraline, fluoxetine,
fluvoxamine as well as the tricyclic antidepressants,
in particular clomipramine.

14. Cont---
 Benzodiazepines are also used in treatment.
Although widely prescribed, benzodiazepines have
not been demonstrated as an effective treatment for
OCD and may be habit forming in those with a history
of substance abuse.
 Alternative drug treatments- the naturally occurring
sugar inositol has been suggested as a treatment for
OCD.

15. Nursing management:-
 Client assessment data base-
- activity/rest.
- ego integrity.
- pre-onset.
- hygiene.
- neurosensory.
- social interactions.
 Nursing planning & implementation-
- assist client to recognize onset of anxiety.
- explore the meaning and purpose of the behavior with
the client

16. Cont---
- assist client to limit ritualistic behaviors.
- help client learn alternative responses to stress.
- encourage family participation in therapy program.