Obsessive compulsive disorder

1. PREPARED BY
MRS. DIVYA PANCHOLI
ASSISTANT PROFESSOR, SSRCN, VAPI
MRS. DIVYA PANCHOLI 1

2. DEFINITION
•OBSESSION: an idea or thought that continually
preoccupies or intrudes on a person's mind.
•COMPULSION: the action or state of forcing or
being forced to do something; constraint.
MRS. DIVYA PANCHOLI 2

3. OBSESSIVE-COMPULSIVE DISORDER:
Obsessive-compulsive disorder is an anxiety
disorder in which people have recurring,
unwanted thoughts, ideas or sensations
(obsessions) that make them feel driven to do
something repetitively (compulsions).
MRS. DIVYA PANCHOLI 3

4. ETIOLOGY
•Genetic Factors
•higher concordance rate for monozygotic twins than for
dizygotic twins. Family studies of these patients have shown
that 35% of the first degree relatives of obsessive-compulsive
disorder patients are also affected with the disorder.
•Biochemical Influences
•neurotransmitter serotonin (5-HT) may be abnormal in
individuals with obsessive-compulsive disorder.
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5. Conti..
• Psychoanalytic Theory
• The psychoanalytic concept (Freud) views patients with
obsessive-compulsive disorder (OCD) as having regressed to
developmentally earlier stages of the infantile superego, whose
harsh exacting punitive characteristics now reappear as part of
the psychopathology.
• Freud also proposed that regression to the preoedipal anal
sadistic phase combined with the use of specific ego defense
mechanisms like isolation, undoing, displacement and reaction
formation, may lead to OCD
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6. Conti…
•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 obsessions.
•This decrease in anxiety positively reinforces the
compulsive acts and they become stable learned
behavior.
•This theory is more useful for treatment purposes.
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9. CLINICAL PICTURE
1. Obsessional thoughts :
These are words, ideas and , beliefs that intrude forcibly
into the patient's mind. They are usually unpleasant and
shocking to the patient and may be obscene.
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10. 2. Obsessional images :
These are vividly imagined scenes, often of a
violent or disgusting kind involving abnormal
sexual practices.
Conti…
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11. 3. Obsessional ruminations :
These involve internal debates in which
arguments for and against even the simplest
everyday actions are reviewed endlessly.
Conti…
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12. 4. Obsessional doubts:
• These may concern actions that may not have been completed adequately.
The obsession often implies some danger such as forgetting to turn off the
stove or not locking a door.
• It may be followed by a compulsive act such as the person making multiple
trips back into the house to check if the stove has been turned off.
• Sometimes these may take the for doubting the very fundamentals of beliefs,
such as, doubting the existence of God and so on.
Conti…
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13. 5. Obsessional impulses :
These are urges to perform acts usually of a
violent or embarrassing kind, such as injuring a
child, shouting in church etc.
Conti…
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14. 6. Obsessional rituals:
These may include both mental activities such as counting
repeatedly in a special way or repeating a certain form of words,
and repeated but senseless behaviors such as washing hands 20
or more times a day. Sometimes such compulsive acts may be
preceded by obsessional thoughts;
Conti…
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15. 7. Obsessive slowness:
Severe obsessive ideas or extensive compulsive
rituals characterize obsessional slowness in the
relative absence of manifested anxiety.
This leads to marked slowness in daily activities.
Conti…
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17. COURSE AND PROGNOSIS
•Course -usually long and fluctuating.
•Prognosis appears to be worse when the
onset is in childhood, the personality is
obsessional,
•symptoms are severe, compulsions are
bizarre, or there is a coexisting major
depressive disorder.
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18. TREATMENT
Pharmacotherapy
•Antidepressants (e.g.fluvoxamine, sertraline,
etc.)
•Anxiolytics (e.g.benzodiazepines)
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19. •Behavior Therapy
•Exposure and response prevention
•Thought stoppage
•Desensitization
•Aversive conditioning
•Supportive psychotherapy.
•ECT-for patients refractory to other forms of
treatment. MRS. DIVYA PANCHOLI 19

20. EXPOSURE AND RESPONSE PREVENTION
• This is vivo exposure procedure combined with response
prevention techniques.
• For example compulsive handwashers are encouraged to
touch contaminated objects and then refrain from
washing in order to break the negative reinforcement
chain (hand washing reducing the anxiety i.e. negative
reinforcement).
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21. THOUGHT STOPPAGE
Thought stopping is a technique to help an individual to
learn to stop thinking unwanted thoughts. Following are the
steps in thought stopping:
 Sit in a comfortable chair, bring to mind the unwanted
thought concentrating on only one thought per procedure.
 As soon as the thought forms, give the command 'Stop!'
Follow this with calm and deliberate relaxation of muscles
and diversion of thought to something pleasant.
Repeat the procedure to bring the unwanted thought under
control. MRS. DIVYA PANCHOLI 21

22. NURSING MANAGEMENT
•Assessment should focus on the collection of physical,
psychological and social data.
•The nurse should be particularly aware of the impact of
obsessions and compulsions on physical functioning,
mood, self-esteem and normal coping ability.
•The defense mechanisms used, thought content or
process, potential for suicide, ability to function and
social support systems available should also be noted.
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23. Problems
•Anxiety
•Chronic low self-esteem
•Fear
•Ineffective coping
•Ineffective role performance
•Impaired social interaction
•Risk for injury
•Social isolation
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24. Nursing Interventions
Approach the patient unhurriedly.
• Provide an accepting atmosphere; don't show shock, amusement,
or criticism of the ritualistic behavior.
• Allow the patient time to carry out the ritualistic behavior (unless
it's dangerous) until he can be distracted into some other activity.
Blocking this behavior raises anxiety to an intolerable level.
• Keep the patient's physical health in mind. For example, compulsive
hand washing may cause skin breakdown, and rituals or
preoccupations may cause inadequate food and fluid intake and
exhaustion. Provide for basic needs, such as rest, nutrition, and
grooming, if the patient becomes involved in ritualistic thoughts
and behaviors to the point of self-neglect.
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25. • Let the patient know you're aware of his behavior. For
example, you might say, I noticed you've made your bed
three times today; that must be very tiring for you. Help the
patient explore feelings associated with the behavior. For
example, ask him, What do you think about while you are
performing your chores?
• Make reasonable demands, and set reasonable limits; make
their purpose clear. Avoid creating situations that increase
frustration and provoke anger, which may interfere with
treatment.
Conti…
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26. •Explore patterns leading to the behavior or recurring
problems.
•Listen attentively, offering feedback.
•Encourage the use of appropriate defense mechanisms to
relieve loneliness and isolation.
•Engage the patient in activities to create positive
accomplishments and raise his self-esteem and confidence.
•Encourage active diversional resources, such as whistling or
humming a tune, to divert attention from the unwanted
thoughts and to promote a pleasurable experience.
Conti…
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27. • Assist the patient with new ways to solve problems and to develop more
effective coping skills by setting limits on unacceptable behavior (for example,
by limiting the number of times per day he may indulge in obsessive behavior).
Gradually shorten the time allowed. Help him focus on other feelings or
problems for the remainder of the time.
• Identify insight and improved behavior (reduced compulsive behavior and
fewer obsessive thoughts). Evaluate behavioral changes by your own and the
patient's reports.
• Identify disturbing topics of conversation that reflect underlying anxiety or
terror.
• Observe when interventions don't work; reevaluate and recommend
alternative strategies.
• Monitor effects of pharmacologic therapy.
Conti…
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28. You can refer following link also
• https://www.youtube.com/watch?v=07-oawGxLQc
• https://www.youtube.com/watch?v=I8Jofzx_8p4&t=30s
• https://www.youtube.com/watch?v=5E5APvjMlOw
• https://www.youtube.com/watch?v=epDVMBNXsXY
• https://www.youtube.com/watch?v=B46EdJApFmI
• https://www.youtube.com/watch?v=TD-xPiwtyHA
MOVIES REALTED TO OCD
• Matchstick Men –OCD
• The Aviator-OCD
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