Obsessive-compulsive disorder is a mental illness characterized by unwanted and distressing thoughts (obsessions) and repetitive behaviors (compulsions) that are performed to reduce anxiety from the obsessions. Common obsessions include contamination fears, doubts, and fears of harming others. Compulsions are behaviors like cleaning, checking, or ordering that are performed in response to obsessions. OCD is treated through medication and psychotherapy like cognitive behavioral therapy which exposes patients to anxiety-provoking situations to reduce compulsions over time. The causes of OCD are genetic and involve abnormalities in brain circuits involving the frontal lobes and basal ganglia.

1. Obsessive compulsivedisorder
mr .pritesh d patel
msc nursing in MHN

2. • INTRODUCTION •
• obsessive-compulsive disorder is a mental disorder whose
main symptoms include obsessions and compulsions,
driving the person to engage in unwanted, often-times
distress behaviors or thoughts. The obsessions are usually
related to a sense of harm, risk or injury. The common
Obsessions include concern about contamination, doubt,
fear of loss or letting go, fear of physically injuring
someone.It’s treatment is done through a combination of
psychiatric medications and psychotherapy.

3. • DEFINITIONS
• Obsessions are recurrent and persistent thoughts, impulses, or
images that cause distressing emotions such as anxiety or disgust.
These intrusive thoughts cannot be settled by logic or reasoning.
Typical obsessions include excessive concerns about contamination
or harm, the need for symmetry or exactness, or forbidden sexual or
religious thoughts.

4. Compulsions are repetitive behaviors or mental acts that
a person feels driven to perform in response to an
obsession. The behaviors are aimed at preventing or
reducing distress or a feared situation. Although the
compulsion may bring some relief to the worry, the
obsession returns and the cycle repeats over and over.
Some of the common compulsions include cleaning,
repeating, checking, ordering and arranging , Mental
compulsions e.t.c

5. (OCD) is a common, chronic and long-lasting disorder in
which a person has uncontrollable, reoccurring thoughts
(obsessions) and behaviors (compulsions) that he or she
feels the urge to repeat over and over. An obsession is
defined as an idea, impulse, or image which intrude into the
conscious aware repeatedly.

6. CAUSES OF THE DISORDER
• People with a first degree relative (parent or sibling)
with OCD have a 5 times greater risk of having the
illness. • identical twins have more chances of developing
OCD as compared to dizygotic twins.

7. : According to the Frued’s psychoanalytical
theory OCD arises when unacceptable wishes and impulses from the
id are only partially repressed. They cause anxiety. Ego defence
mechanisms are used to reduce the anxiety. These defence
mechanisms are used unconsciously in the form of acts, such as hand
washing. These acts are thought to be symbolically undo the
unacceptable id impulses.
This theory explains Obsessions as a conditioned
stimulus to anxiety. Compulsions have been described as learned
behavior that decreases the anxiety associated with the Obsessions.
This decrease in anxiety positively reinforces the compulsive acts and
they become stable learned behavior.

8. • there is evidence of abnormal
brain structure and activity in patients with OCD. • these
abnormalities are found in the pathway linking the lobes
(responsible for judgement) with the basal ganglia (which
are part of the system frontal for planning behaviour) •
Serotonin deficiency – OCD sufferers have too little
serotonin for their nerve cells to communicate effectively

9. CLASSIFICATION OF OCD
1. Predominantly absessive thought or rumination
2. Predominantly compulsive acts.
3. Mixed Obsessional thoughts and acts.

10. CLINICAL FEATURES OF OCD
1. (obsessional rituals) This is the most common
type. Here the obsession is of contamination with dirt,germs,
body excretions and the like. The compulsion is washing of
hands or thewhole body, repeatedly many times a day. It
usually spreads onto washing of clothes, bathroom, bedroom,
door knobs and personal articles, gradually. The person tries to
avoid contamination but unable to, so washing becomes a
ritual.

11. 2. (obsessional doubt) In this type the person has multiple doubts that
the activities may not have been completed adequately. for example the door has
not beenlocked, kitchen gas has been left open, counting of money was not exact
and etc.the compulsion, of course, is checking repeatedly to remove the doubt.
Anyattempts to stop the checking leads to mounting anxiety before one doubt has
been cleared, other doubts may creep in.
3. (intrusive thoughts) This syndrome is characterized by
repetitive intrusive thoughts, impulses or images which are not associated with
compulsive acts. The distress associated with these obsessions is dealt usually by
counter thought for e.g praying, undoing actions et.c a. Obsessional thoughts:
these are words . ideas and beliefs ghat intrude forcibly into the patients mind.
They are usually unpleasant and shocking to the patient and may be obscene and
blastophemous. E.g. Orderliness, sexual imagery repeated doubts et.c.

12. b. These are vividly imaginary scenes often of a violent or
disgusting kind involving abnormal sexual practice c. Obsessional impulses:
These are the urges to perform acts usually of a violenyt or embarrassing kind,
such as injuring a child, shouting in church etc c. Obsessional ruminations: These
involve internal debates in which arguments for and against even the simplest
everyday actions are reviewed endlessly.
4. (symmetry) It is characterized by several obsessive
ideas and or extensive compulsive rituals , in the relative absence of manifested
anxiety. this leads to marked slowness in daily activity. usually the person demand
on being need for symmetry and precise arranging so in order to neutralize it they
will continue ordering, arranging, balancing, straightening until "just right" or
perfect in their eyes.

13. DIAGNOSIS OF OCD
• Suggested by demonstration of realistic behavior that
is irrationl or excessive.
• MRI and CT shows enlarged Basal Ganglia in some
patients. • PET(Positron emisaion Tomography) shows
incresed glucose metabolism in part of the basal ganglia.
• ICD-10 criteria

14. TREATMENT MODALITIES
1. Psychotherapy • Psychodynamic psychotherapy • Cognitive
Behavior therapy • Supportive therapy
2. Phrmcologicl treatment
3. ECT
4. Self help and coping
5. Psychosurgery
18. PSYCHODYNAMIC PSYCHOTHERAPY This can be used for
the patients who are psychologically oriented. The therapy is based
on psychoanalysis in which the patient is made conscious about
their unconscious thoughts and motivations thus gaining insight.

15. PSYCHODYNAMIC PSYCHOTHERAPY A woman comes to therapist stating
that she is chronically late and has done everything that she can to change this
through a variety of organizational tools and methods but to not avail. Her
behavior is interfering with her work and relationships. The therapist and client
discover that being early or even on time put her at risk of waiting for the
person that she was meeting. Waiting evoked uncomfortable needful feelings,
especially when she was waiting for someone on whom she was reliant. This in
part had roots in traumatic experiences in her childhood around being forgotten
by her parents and having to wait for them: in those situations she had felt
helpless, frightened and dependent. With the help of her therapist, she gradually
grew to tolerate her needful and dependent feelings and with that, no longer
needed to eliminate these feelings either by being late or through other
problematic behaviors.

16. COGNITIVE BEHAVIOR THERAPY During treatment sessions,
patients are exposed to the situations that create anxiety and provoke
compulsive behavior or mental rituals. Through exposure, patients learn
to decrease and then stop the rituals that consume their lives. They find
that the anxiety arising from their obsessions lessens without engaging
in ritualistic behavior. This technique works well for patients whose
compulsions focus on situations that can be re-created easily.2 2.
PHARMACOLOGICAL TREATMENT 1. Benzodiazepines •
Alprazolam(0.5-1mg/day) • Clonazepam(0.25-0.5 mg/day) 2.
Antidepressants Clomipramine(75-300mg/day) Fluoxetine(20-
80mg/day) Fluvoxamine(50-200mg/day) 3. Antipsychotics- these are
occassionally used in low doses in the treatment of severe anxiety e.g.
Haloperidol,Risperidine, Olanzepine.

17. 3. ELECTRO-CONVULSIVE THERAPY Electroconvulsive Therapy (ECT)In
the presence of severe depression with OCD, ECT may be needed. ECT is
particularly indicated when there is a risk of suicide and/or when there is a poor
response to the other modes of treatment.
4. SELF-HELP AND COPING Keeping a healthy lifestyle and being aware of
warning signs and what to do if they return can help in coping with OCD and
related disorders. Also, using basic relaxation techniques, such as meditation,
yoga, visualization, and massage, can help ease the stress and anxiety caused by
OCDPSYCHO SURGERY In severe chronic incapacitating cases, where all other
treatment have failed, Streotactile site speciefic brain surgery hs been reported to
be successful. These surgery includes: 1. Anterior cigulotomy 2. Capsulotomy 3.
Limbic leucotomy These surgery involve the separation of the frontal cortex from
deep limbic structure.

18. NURSING MANAGEMENT
. NURSING ASSESSMENT • Social impairment • Obsessive thought
(repetitive worries, repeating and counting images or words) •
Compulsive behaviour (repetitive activity, like touching, counting,
doing or undoing)
NURSING DIAGNOSIS 1. Severe anxiety related to absessional
thoughts and impulses as evidenced by repetitive actions and decresed
social functioning. 2. Ineffective individual coping relted to under
developed ego, punitive super ego, avoidance learning, possible
biochemical changes as evidenced by realistic behavior. 3. Altered role
performance related to the need to perform rituals, as evidenced by
inability to fulfill usual patterns of responsibility

19. 4. Chronic low self-esteem relted to the obsessiinal thoughts and rituals s
evidenced by social isolation and low self confidence.
5. Sleep pttern disturbnces related to the obsessional doubts and fears s
mnifested by repetitive checking of doors nd not sleeping prope
. TO REDUCE ANXIETY • Establish relationship through use of
empathy,warmth, and respect. • Acknowledge behavior without focusing
attention on it. Verbalize empathy toward client’s experience rather than
disapproval or criticism. • Assist client to learn stress management,
(e.g.,thought- stopping, relaxation exercises, imagery) • Give positive
reinforcement for noncompulsive behavior. • Assist client to find ways to
set limits on own behaviors.

20. 2. TO REDUCE OBSESSIVE COMPULSIVE BEHAVIOR • Work with ptient to
determine the type of situations that increase anxiety and result in such behvior. •
Meet the patient dependency needs. • Provide positive reinforcement. • Support
patients efforts to explore the meaning and purpose of behavior. • Provide
structured schedule activities for patient, including adequte time for performing
rituals. • Help the ptient lern wys of interrupting absessive thoughts.
31. 3. IMPROVE ROLE RELTED RESPONSIBILITIES • Determine patients
previous role within the family nd the extent to which the role is altered by the
illness. • Encourge patient to discuss conflicts evident within the family system. •
Explore availble options for changes for djustment in the role. • Practice through
role play. • Provide positive reinforcement.
32. DIFFERENCE FROM OTHER ANXIETY DISORDERS • phobias – the
stimulus that provokes the anxiety comes from an external object or situation. •
panic disorder or generalised anxiety disorder – panic attacks are unpredictable
and not linked to obsessional thoughts.