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OBSESSIVE
COMPULSIVE
NEUROSIS
Obsessions & Compulsions
 Obsessions are recurrent (and persistent)
contents of consciousness (words, ideas,
beliefs, thoughts, images, impulses), which are
intrusive and are recognized as senseless.
 Compulsions are obsession changed to action
(repetitive, purposeful and intentional
behaviours that are carried out according to
certain rules or in a stereotyped way.
Epidemiology
• A very rare disorder.
• Prevalence rates are around 0.05% of overt
disorder though
• Unrecognized milder forms may be more common.
• Obsessional symptoms are much more prevalent
(14%), particularly children (eg. rituals )
• Sex distribution is equal
• Onset in adolescence or young adults;
presentation delayed (7yrs).
• Higher social class, intelligence and educational
attainment.
Aetiology- Genetic
• up to 1/3 of relations have obsessional traits
• Predisposition. - Obsessive (or Anankastic)
personality: excessive cleanliness and order,
conscientious, strict ethical code, rules, rigid,
methodological, punctual, indecisive or doubts.
Pedantic, thorough, consistent, attention to
detail, perfectionist; dislikes half done tasks or
interruptions; inflexible, non-adaptable, likes
predictable & secure world; intolerant. Devoted
to work instead of pleasure (advantageous in
certain professions and occupations).
Aetiology-Environmental
• Psychoanalytic - According to Freud
regression to anal stage.
• Parental over-concern with toilet training,
cleanliness, and order; strict discipline & control
of sexual & aggressive impulses. Reared in
atmosphere where approval depends on
conformity, model behaviour, academic
performance rather than love and affection.
• Obsessional orderliness may be a defensive
mechanic to hope with stress, loss of control or
deterioration in cognitive capacity due to organic
brain disease or injury.
CLINICAL PICTURE- Obsession
• Obsessional symptoms- Thoughts, ideas, beliefs, ruminations,
images, impulses that repeatedly intrude into consciousness
against the patients will. Though (s)he recognizes them as
his/her own (viz. schizophrenia thought insertion), (s)he regards
them as senseless or silly (good insight, reality sense); and
tries to resist their occurrence.
• The common obsessional contents or themes are to do with:
– Contamination - dirt, germs, poison, toxins, catching an illness.
– Harm - accidental or deliberate impulse, such RTA or stabbing a child,
committing suicide (may take precaution or avoidance behaviour).
– Doubt - repetitive, inconclusive, and circular arguments and counter
arguments (to do or not to do); ponders endlessly about decisions,
ruminates and worries.
– Hypochondriacal - disease or illness: repeated checking for signs (e.g.
lump in breast)
– Other - ideas, phrases, music, images of violent or sexual torture, death,
decay, insects, snakes, obscenities or blasphemy (religous); which
causes distress.
CLINICAL PICTURE- Compulsion
• Compulsions are repetitive acts or rituals based on
obsessional thoughts. Their performance may transiently
relieve some tension and anxiety (which builds up if the
action is resisted) and is never pleasurable.
– The action usually has a symbolic value in undoing, preventing,
neutralizing or dispelling an obsessional fear or thought (e.g. hand
washing to clean contamination); may be magical thinking
(Superstition) (e.g. rituals such as counting to a certain number will
prevent an accident)
– Rituals may consist of repeating, checking, cleaning, avoiding or
striving for perfection. (e.g. hand washing rituals, personal hygiene,
dressing, checking doors and windows, counting)
– Recognized as senseless, silly, absurd; tries to resist but anxiety and
tension builds up (severe struggle); gives into action but relief of
anxiety only transient. Causes considerable distress, are time-
consuming (hours) and significantly interfere with daily life or
relationships. Incapacitating.
Differential Diagnosis
• Depression - secondary to obsessional illness,
coincidental or primary (with obsessional
symptoms)?
• Anxiety - underlies OCD (Obsessive
Compulsive Disorder).
• Schizophrenia -Thought insertion, bizarre
rituals and obsessions (insight in OCD).
• Other compulsive activities - eating disorders,
pathological gambling, alcohol and drug abuse,
certain sexual activities. These are pleasurable
but not OCD.
• Organic illness -post encephalitic state, brain
injury, dementia-"Organic orderliness".
Treatment
• Physical -
– Drugs – Antidepressants, particularly if depression
present
• Pure 5-HT uptake blockers have specific action in obsessional
disorders (i.e. serotonergic system may be involved in obsession
e.g. Clomipramine, SSRI. )
– ECT - specially when depression is present.
• Behaviour therapy
– Thought stopping technique
– Response prevention (Apotrepic therapy )
– Modelling / Flooding-exposure (in imagination, vivo) to
feared object e.g. dirt.
– Rubber band
– Paradoxical intention
• Surgery - stereotactic limbic Leucotomy
Course & Prognosis
• Usually continuous course with
fluctuations.
• Exacerbations with stress or
depression.
• May decrease with age.
• Believed to be poor prognosis but 40%
become symptom free
• 10-15% deteriorate (give up
resistance)

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Obsessive compulsive neurosis

  • 2. Obsessions & Compulsions  Obsessions are recurrent (and persistent) contents of consciousness (words, ideas, beliefs, thoughts, images, impulses), which are intrusive and are recognized as senseless.  Compulsions are obsession changed to action (repetitive, purposeful and intentional behaviours that are carried out according to certain rules or in a stereotyped way.
  • 3. Epidemiology • A very rare disorder. • Prevalence rates are around 0.05% of overt disorder though • Unrecognized milder forms may be more common. • Obsessional symptoms are much more prevalent (14%), particularly children (eg. rituals ) • Sex distribution is equal • Onset in adolescence or young adults; presentation delayed (7yrs). • Higher social class, intelligence and educational attainment.
  • 4. Aetiology- Genetic • up to 1/3 of relations have obsessional traits • Predisposition. - Obsessive (or Anankastic) personality: excessive cleanliness and order, conscientious, strict ethical code, rules, rigid, methodological, punctual, indecisive or doubts. Pedantic, thorough, consistent, attention to detail, perfectionist; dislikes half done tasks or interruptions; inflexible, non-adaptable, likes predictable & secure world; intolerant. Devoted to work instead of pleasure (advantageous in certain professions and occupations).
  • 5. Aetiology-Environmental • Psychoanalytic - According to Freud regression to anal stage. • Parental over-concern with toilet training, cleanliness, and order; strict discipline & control of sexual & aggressive impulses. Reared in atmosphere where approval depends on conformity, model behaviour, academic performance rather than love and affection. • Obsessional orderliness may be a defensive mechanic to hope with stress, loss of control or deterioration in cognitive capacity due to organic brain disease or injury.
  • 6. CLINICAL PICTURE- Obsession • Obsessional symptoms- Thoughts, ideas, beliefs, ruminations, images, impulses that repeatedly intrude into consciousness against the patients will. Though (s)he recognizes them as his/her own (viz. schizophrenia thought insertion), (s)he regards them as senseless or silly (good insight, reality sense); and tries to resist their occurrence. • The common obsessional contents or themes are to do with: – Contamination - dirt, germs, poison, toxins, catching an illness. – Harm - accidental or deliberate impulse, such RTA or stabbing a child, committing suicide (may take precaution or avoidance behaviour). – Doubt - repetitive, inconclusive, and circular arguments and counter arguments (to do or not to do); ponders endlessly about decisions, ruminates and worries. – Hypochondriacal - disease or illness: repeated checking for signs (e.g. lump in breast) – Other - ideas, phrases, music, images of violent or sexual torture, death, decay, insects, snakes, obscenities or blasphemy (religous); which causes distress.
  • 7. CLINICAL PICTURE- Compulsion • Compulsions are repetitive acts or rituals based on obsessional thoughts. Their performance may transiently relieve some tension and anxiety (which builds up if the action is resisted) and is never pleasurable. – The action usually has a symbolic value in undoing, preventing, neutralizing or dispelling an obsessional fear or thought (e.g. hand washing to clean contamination); may be magical thinking (Superstition) (e.g. rituals such as counting to a certain number will prevent an accident) – Rituals may consist of repeating, checking, cleaning, avoiding or striving for perfection. (e.g. hand washing rituals, personal hygiene, dressing, checking doors and windows, counting) – Recognized as senseless, silly, absurd; tries to resist but anxiety and tension builds up (severe struggle); gives into action but relief of anxiety only transient. Causes considerable distress, are time- consuming (hours) and significantly interfere with daily life or relationships. Incapacitating.
  • 8. Differential Diagnosis • Depression - secondary to obsessional illness, coincidental or primary (with obsessional symptoms)? • Anxiety - underlies OCD (Obsessive Compulsive Disorder). • Schizophrenia -Thought insertion, bizarre rituals and obsessions (insight in OCD). • Other compulsive activities - eating disorders, pathological gambling, alcohol and drug abuse, certain sexual activities. These are pleasurable but not OCD. • Organic illness -post encephalitic state, brain injury, dementia-"Organic orderliness".
  • 9. Treatment • Physical - – Drugs – Antidepressants, particularly if depression present • Pure 5-HT uptake blockers have specific action in obsessional disorders (i.e. serotonergic system may be involved in obsession e.g. Clomipramine, SSRI. ) – ECT - specially when depression is present. • Behaviour therapy – Thought stopping technique – Response prevention (Apotrepic therapy ) – Modelling / Flooding-exposure (in imagination, vivo) to feared object e.g. dirt. – Rubber band – Paradoxical intention • Surgery - stereotactic limbic Leucotomy
  • 10. Course & Prognosis • Usually continuous course with fluctuations. • Exacerbations with stress or depression. • May decrease with age. • Believed to be poor prognosis but 40% become symptom free • 10-15% deteriorate (give up resistance)