Obsessive Compulsive Disorder OCD) Presentation

OBSESSIVE
COMPULSIVE
DISORDER
(OCD)
AYESHA AZFAR

OUTLINE
What IS OCD?
History & Background
Case Information
Diagnostic Assessment
Treatment and Intervention

WHAT IS OCD?
• OCD is characterized by the presence of OBSESSIONS,
COMPULSIONS or BOTH
• Obsessions : are unwanted and disturbing thoughts, images or
impulses that suddenly pop into the mind and cause a great deal of
anxiety or distress.
• Compulsions: are deliberate behaviors (e.g. washing, checking,
ordering) or mental acts (e.g. praying, counting, repeating phrases)
that are carried out to reduce the anxiety caused by the obsessions.
(Anxietybc.com, 2015)

BACKGROUND
In DSM-IV-TR,
Obsessive-Compulsive
and Related Disorders
and Trauma-Related
Disorders were included
with Anxiety Disorders
DSM-5 creates new
chapters for Obsessive-
Compulsive and Related
Disorders and Trauma-
Related Disorders

PREVALENCE
In the United States
prevalence rates are
1.2%
Approximately 1% to
2% of the Canadian
population will have
an episode of OCD
Males and females
are almost equally
affected by the
disorder:
Males typically have
an earlier age of
onset (in childhood)
Females affected at
slightly higher rate in
adulthood
(Huffman and Dowdell, 2015)

UNPACKING
OCD WITH DR.
KEVIN CASEY

PRESENTING PROBLEM
• Dr. Kevin Casey is a 42 year old medical doctor who has presented for treatment of
OCD.
• He had been previously diagnosed with the disorder at the age of 12 and had been
managing it (with ups and downs), until his recent marriage and starting a new job
at Sacred Heart Hospital
• Eczematous eruptions related to excessive washing are also present
• Previous treatments that he has received for his condition are CT (Cognitive
Therapy) and medication such as Zoloft

CASE BACKGROUND
• Only child, who was first diagnosed at the age of 12
• May have been triggered by parents insistence that he wash his hands thoroughly because of severe
outbreak of influenza in schools
• During adolescence, developed “checking” behaviors such as turning on/off light switches, locks, faucets
to make sure they were closed.
• Developed a routine of counting clothes 3 times each before putting them on
• Arranged and sorted school supplies in a very specific manner in each class
• Symptoms become more severe in times of stress or life changes
• Fared relatively well in medical school as he read his medical books and journals over and over again, and
most tasks required repetition to perfect
• Once he entered his residency, the changing and fast paced nature of the job was too much and he had to
drop out

DIAGNOSTIC ASSESSMENT
• 300.3 (F42) Obsessive Compulsive Disorder, with good or fair insight
• 300.09 (F41.8) Other specified Anxiety Disorder, generalized anxiety not
occurring more days than not
• V62.89 (Z60.0) Phase of Life Problem
(American Psychiatric Association, 2013).

OBSESSIONS COMPULSIONS
Contamination
–Harm to self or others
–Need for symmetry/order
–Religious or moral
concerns
–Sexual or aggressive
–Lucky or unlucky
numbers
Cleaning
–Checking, counting,
repeating
–Ordering, straightening
–Praying, confessing,
reassurance seeking
–Touching, tapping, or
rubbing
–Hoarding
(Mayoclinic.org, 2016)

COMPULSIONS
ARE DESIGNED
TO NEUTRALIZE
AN OBSESSION
Mayoclinic.org, 2016)

SYMPTOMS
• Whenever Dr. Casey enters or exits a building, he must go in and out three times.When
he makes an entrance in a building he needs to step in with his left foot first, and exhale
simultaneously as his right foot plants.
• According to Dr. Casey, whenever he goes to the bathroom, the process involves going
home and scrubbing down his home toilet with industrial strength cleaner for an hour.
• When he signs something, he must do it several times and utter his name as he signs it.
• Each day at work, he must touch every object (and person) in his first patient's room and
say "Bink" repeatedly.
• Dr. Casey must put a new coaster on the top of a bottle after every time he takes a sip
from it.
• He will turn lights on and off multiple times to make sure they have been turned off

DSM 5 CRITERIA

ASSOCIATED
SYMPTOMS
Contamination
Pathological Doubt
Symmetry
Intrusive Thoughts
Hoarding
Harm
(www.nami.org, 2015)

DIFFERENTIAL DIAGNOSIS
Anxiety Related
Disorders
Major Depressive
Disorder
Obsessive
Compulsive
Personality
Disorder (OCPD)
Other Obsessive-
compulsive and
related disorders
Eating disorders Tics
Psychotic
Disorders

DIFFERENTIAL
DIAGNOSIS
CONSIDERED
Generalized Anxiety Disorder
(GAD)
Social Anxiety Disorder (Social
Phobia)
Obsessive Compulsive
Personality Disorder (OCPD)

• OCD and anxiety seem to share a similarity between
neural underpinnings and biomarkers and,
environmental and situational factors. A variety of
studies point to high comorbidity between the two
disorders – people with one often have the other as
well.Treatment strategies are quite similar as well
(Robinson, Smith and Segal, 2015).
• Rationale for rule out:
• Although client presents many of symptoms of GAD and clearly
suffers from anxiety, much of his anxiety is related to stress when
placed in new and changing circumstances. Past examples
include transitioning from middle to high school, university etc..,
starting a new job or entering a new relationship
GAD

SOCIAL ANXIETY DISORDER
(SOCIAL PHOBIA)
• Social anxiety is the fear of social situations that involve
interaction with other people. Social anxiety is the fear
and anxiety of being negatively judged and evaluated by
other people.
• The main diagnostic criteria for this order is a fear or
severe anxiousness of social situations. So far Dr. Casey has
not displayed severe symptoms and neither does he
actively seek to avoid all social situations.

OCPD
• Often confused with OCD. OCPD is a personality disorder and organization techniques and
repetitive behaviors are used as a means to achieve perfection, not to alleviate anxiety. People
with OCPD want to have control over themselves and everything that surrounds them.
OCPD OCD
• Ego Syntonic
• Absence of true obsessions and compulsions
• Rigid standards, morals and ethics
• Expect everyone to have the same standards as
well
• Ego Dystonic
• Behaviors develop as a way to alleviate anxiety
• An awareness of the maladaptiveness of the
compulsions
• Dr. Casey is very aware of his compulsions and
how they are a deterrent to his everyday life
(Thomsen et al., 2013)

TREATMENT & INTERVENTIONS
• The two main treatment strategies
include PHARMACOTHERAPY and PSYCHOTHERAPY
• Depending on the severity of symptoms, clinicians will
suggest therapy or a combination of both therapy and
pharmaceutical intervention. (Weidle et al., 2014)
• A lot of times, the treatment does not result in an
overall cure of the disorder, however, it does relieve the
intensity and severity of the symptoms.The goal is for the
individual to learn how to be able to return to their daily
life and not let the obsessions and compulsions disrupt
their daily functioning. (Robinson, Smith and Segal, 2015)

MEDICAL TREATMENTS
• Clinical trials have shown that drugs that impact on serotonin can significantly decrease OCD symptoms. (Garcia et al.,
2010)
• Examples of these SRIs include the following;
• clomipramine (Anafranil)
• flouxetine (Prozac),
• fluvoxamine (Luvox),
• Paroxetine (Paxil)
• sertraline (Zoloft).
• •Studies have shown that more than 3/4 of patients are helped by these medications to some degree.
• •In more than ½, medications relieve symptoms by diminishing the frequency and intensity of the obsessions and
compulsions.
• •Side effects can be an issue (Weight gain, dry mouth, nausea, diarrhea)
(Helpguide.org, 2015)

INTERVENTIONS
Behavior Therapy
Deep Brain Stimulations
Neuro surgery
Electroconvulsive
Therapy

RECOMMENDED TREATMENT FOR DR. CASEY
Continued use of
Pharmacological
treatment, as it has
proved beneficial
so far
Combination of
CBT and Exposure
and Response (or
ritual) Prevention
(ERP)

ERP (EXPOSURE RESPONSE PREVENTION)
• ERP is now usually administered as part of a broader program of CBT specifically designed for
OCD. Treatment proceeds on a step-by-step basis, with the therapy being guided by the
client’s ability to tolerate the anxiety and control compulsive acts (Foa, 2010).
• The client will rank orders OCD situations he perceives as threatening (contamination,
symmetry stc)
• The client is then systematically exposed to symptom triggers, of gradually increasing
intensity, while the individual is to suppress his or her usual ritualized response (washing
hands, turning lights on/off).
• When a patient does not respond in the face of a potent trigger, extinction of the response can
take place.

TREATMENT GOALS AND OBJECTIVES
• To promote the unlearning of the strong link that has existed between having an urge and
giving into the urge.
• The client’s wife should be involved when possible, and they may have to be willing to
change their responses to the patient (eg, not provide requested reassurance to irrational
doubts).
• To be useful in working on a client’s resistance to accepting recommended treatments
• Helping the client to appreciate the interpersonal effects that his OCD symptoms are having
on others.

THANKYOU!!!
•Thoughts
•Comments
•Questions

REFERENCES
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5.
Washington, D.C: American Psychiatric Association.
• Anxietybc.com. (2015).What Is Obsessive-Compulsive Disorder? | Anxiety BC. [online] Available at:
http://www.anxietybc.com/resources/ocd.php
• Foa, E.B., (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialougues Clinical
Neuroscience, 12, 199-207
• Garcia AM Sapyta JJ Moore PS Freeman JB et al (2010). Predictors and moderators of treatment outcome in the
Pediatric Obsessive Compulsive Treatment Study (POTS I). Journal of the American Academy of Child and
Adolescent Psychiatry 49, 1024–1033. https://doi.org/10.1016/j.jaac.2010.06.013
• Helpguide.org. (2015). Obsessive-Compulsive Disorder (OCD): Symptoms, Behavior, and Treatment. [online]
Available at: http://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder-ocd.htm
• Huffman, K. and Dowdell, K. (2015). Psychology In Action. 11th ed. Hoboken, NJ:Wiley Custom Learning Solutions,
pp.462, 481-484.

REFERENCES
• Mayoclinic.org. (2016). Obsessive-compulsive disorder (OCD) Tests and diagnosis - Mayo Clinic. [online] Available at:
http://www.mayoclinic.org/diseases-conditions/ocd/basics/tests-diagnosis/con-20027827
• Nichols, H. (2014).What is obsessive-compulsive disorder (OCD)? What causes obsessive-compulsive behavior?. [online]
Medical News Today. Available at: http://www.medicalnewstoday.com/articles/178508.php
• Robinson, L., Smith, M. and Segal, J. (2015). Obsessive-Compulsive Disorder (OCD): Symptoms, Behavior, and Treatment.
[online] Helpguide.org. Available at: http://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder- ocd.htm
• Thomsen, P.,Torp, N., Dahl, K., Christensen, K., Englyst, I., Melin, K., Nissen, J., Hybel, K.,Valderhaug, R.,Weidle, B.,
Skarphedinsson, G., Bahr, P. and Ivarsson,T. (2013).The Nordic long-term OCD treatment study (NordLOTS): rationale, design, and
methods. Child and Adolescent Psychiatry and Mental Health, [online] 7(1), p.41. Available at: http://dx.doi.org/10.1186/1753-
2000-7-41
• Weidle, B., Ivarsson,T.,Thomsen, P., Lydersen, S. and Jozefiak,T. (2014). Quality of life in children with OCD before and after
treatment. European Child & Adolescent Psychiatry, [online] 24(9), pp.1061-1074. Available at:
http://dx.doi.org/10.1007/s00787-014-0659-z
• www.nami.org. (2015).The Invisible Disease: An OCD Account. [online] Available at: http://www.nami.org/Personal- Stories/The-
Invisible-Disease-An-OCD-

Obsessive Compulsive Disorder OCD) Presentation

More Related Content

Similar to Obsessive Compulsive Disorder OCD) Presentation

Recently uploaded

Obsessive Compulsive Disorder OCD) Presentation