Obsessive-Compulsive Disorder is an anxiety disorder that includes obsessions (repetitive intrusive thoughts, images or impulses that cause the individual distress) and compulsions (ritualistic or repetitive behaviours or mental actions used to reduce or eliminate distress). David Rosenstein focuses on how the condition develops, the various treatments available and some of the latest developments in our understanding of Obsessive-Compulsive Disorder.

1. Obsessive Compulsive
(Spectrum) Disorder
OCD
David Rosenstein

3. What is OCD
• Obsessions:
• Intrusive and repetitive thoughts, images
and/or impulses which produce distress
(anxiety).
• Unwelcome and irrational
• Compulsions
• Repetitive behaviors or rituals (physical and/or
mental actions) in an attempt to reduce
distress (anxiety)
• Difficult to control

4. OCD as a spectrum
•OCD is being considered as a
spectrum disorder:
• Degree’s of severity
• Overlapping anxiety conditions/disorders
• Different kinds of OCD subtypes (one
person’s OCD is different from another)

5. OCD as a spectrum
• Other conditions considered to be
more like OCD such as:
• Hair pulling (Trichotillomania)
• Skin Picking (Dermatillomania)
• Compulsive Hoarding/Acquiring
• Some forms of Social Anxiety Disorder
• Pathological Gambling (Sub-forms)?
• Body Dysmorphic Disorder

6. Obsessions and Compulsions:
Obsessions Compulsions
Contamination Cleansing
Scrupulosity Eliminating
Harm/Sexual Checking
Symmetry/Order Equalizing
Pure Doubt Reassurance
Responsibility Magical/Superstitious
Jealousy Counting/Arranging
Magical/Superstitious Hoarding/Acquiring
Picking/Pulling
Voluntary Tick/Movement

7. Why it can be a problem
• Time consuming
• Causes significant psychological distress
• Interferes: social, work, family or other
important area
• Disabling
• Leads to depression and/or substance use
disorders

8. OCD in South Africa
•Prevalence is believed to be the same
as overseas (SASH study) 3(-5%)
•Often misdiagnosed or not diagnosed
•Poor training about OCD and not
many individuals trained to treat OCD

9. OCD in South Africa
• Some areas (SES) have little/no
awareness
• Apparently no difference in culture or
race in prevalence (more research
needed)
• 60% of all persons with a diagnosable
anxiety disorder never see a mental
health professional – they may turn to
their family physician, religious leader or
another family member for help

10. When does it begin?
• Mean age of onset = 20 y/o
• However strong evidence for developmental
origins (childhood)
• Fluctuating course through life
• Stress ‘brings it out’
• On average, people with OCD see 3-4 doctors
and spend over 9 years seeking treatment
before they receive a correct diagnosis

11. What causes OCD
•Genetic causes. No single gene
identified, but a number of genes play
a role
•Anxiety sensitivity
•Often a family member will have OCD
or an anxiety disorder (occasionally
another psychiatric condition)
•Differences in brain functioning

12. PET of OCD Brain

13. What causes OCD
•Some classical conditioning
models
•OCD as learned responses to
stressors and anxiety

14. Serotonin and OCD

15. Stress as onset
•Stress is not a cause of OCD, but an
aspect of it’s onset
•Stress or early life trauma’s are linked
to the onset and development of OCD
and related disorders

16. Treatment
•Most effective treatment currently is
cognitive behavior therapy (CBT) and
specifically exposure and response
prevention (ERP)
•Medication treatments (SSRI’s)
•Combination treatment
•Third wave approaches (mindfulness)

17. CBT for OCD
•Exposure and response intervention
•Exposure – person remains in contact
with something they usually fear until
their anxiety is diminished
(habituation)

18. ERP – Response prevention
•Ritual postponement
•Roll it over
•Ritual/Compulsion abstinence
•Ritual/Compulsion interference
(“mess it up”)

19. ERP – Exposure
•In Vivo (to life) Exposure
•Imaginal Exposure
• Scripting
• Diffusion (for thought fusions)
•Interoceptive Exposure

20. OCD Manager

21. iCounselor: OCD

22. OCD Test: YBOCS

23. How families can help
•Family can assist by:
• Not judging or becoming angry with
OCD behavior
• Reduce the amount of reassurance
• Assist with exposures and fear
approach behaviors
• Empathy

24. OCD and the family

25. Disclosure
•OCD can be very difficult to disclose
•Some call it the secret illness
•Disclosure to the ‘right individuals’
can provide tremendous relief
•Reduces suicidality
•Provides greater access to support
•Demystifies and reduces stigma
associated wit mental illness overall