This document provides an overview of obsessive compulsive disorder (OCD). It defines OCD as a psychiatric condition characterized by recurrent obsessions and/or compulsions. The document discusses the epidemiology, etiology, pathophysiology, classification, clinical presentation, diagnosis, and management of OCD. It describes common obsessions and compulsions seen in OCD and reviews pharmacological and non-pharmacological (cognitive behavioral therapy) treatment approaches.

1. OBSESSIVE COMPULSIVE DISORDER
Presentation by
M. Jagadeesh,
Pharm.D,
Intern.

2. CONTENTS
• Definition
• Epidemiology
• Aetiology
• Pathophysiology
• Classification
• Clinical Presentation
• Diagnosis
• Management
• Pharmacological therapy
• Non Pharmacological therapy

3. DEFINITION
It is a Psychiatric condition characterized by the recurrent Obsessions or
Compulsions or both.
OBSESSIONS
1. Recurrent and persistent thoughts, urges, or
images that are experienced, at some time
during the disturbance, as intrusive and
unwanted, and that in most individuals
cause marked anxiety or distress.
2. The individual attempts to ignore or
suppress such thoughts, urges, or images, or
to neutralize them with some other thought
or action (i.e. by performing a compulsion).
COMPULSIONS
1. Repetitive behaviours (e.g. hand washing,
ordering, checking) or mental acts (e.g.
praying, counting, repeating words silently)
that the individual feels driven to perform
in response to an obsession or according to
rules that must be applied rigidly.
2. The behaviours or mental acts are aimed at
preventing or reducing anxiety or distress,
or preventing some dreaded event or
situation; however, these behaviours or
mental acts are not connected in a realistic
way with what they are designed to
neutralize or prevent, or are clearly
excessive.

4. EPIDEMIOLOGY
 The lifetime prevalence rate of OCD is estimated at( USA)
 2.3% in adults and around 1%-2.3% in children and adolescents under 18
 Sub-clinical” cases of OCD (around 5% of the population)
 Few epidemiological differences across different countries and even
between European and Asian populations
 Notably, 30-50% of patients develop OCD starting in childhood

5. Aetiology & Pathophysiology
Genetic
SLC1A1 Gene
-Encoding the
neuronal
glutamate
transporter.
-Mutations of
SLC1A1 in
people with
OCD which
appear to
increase uptake
of glutamate.
hSERT Gene
Mutation
s in this
gene
significan
tly less
serotonin
available
within
the
synapse.
Neurological
-Key areas of the brain
that have demonstrated
unusual activity in
sufferers that may be
involved in the
development of
symptoms of OCD
include the:
-Orbitofrontal cortex
-Anterior cingulate
cortex
-Striatum
-Thalamus
-Anterior cingulate gyrus
-Caudate nucleus
-Basal ganglia.
Behavioural
Fear
Cognitive
-Exaggerated
responsibility
-Exaggerated
importance of
thoughts
-Control of
thoughts
-Exaggerated
danger
limitation
-Exaggerated
perfectionism
-Intolerance of
uncertainty
Environmental
-Abuse
-Changes in
living situation
-Illness
-Death of a
family
member or
friend
-Changes or
problems in
school or work
-Relationship
worries.

6. C
L
A
S
S
I
F
I
C
A
T
I
O
N

8. Contamination
•Body fluids (examples: urine, feces)
•Germs/disease (examples: herpes, HIV)
•Environmental contaminants (examples: asbestos radiation)
•Household chemicals (examples: cleaners solvents)
•Dirt
Losing Control
•Fear of acting on an impulse to harm oneself
•Fear of acting on an impulse to harm others
•Fear of violent or horrific images in one’s mind
•Fear of blurting out obscenities or insults
•Fear of stealing things
Harm
•Fear of being responsible for something terrible happening (examples: fire burglary)
•Fear of harming others because of not being careful enough (example: dropping something on the ground that might cause
someone to slip and hurt him/herself)
Obsessions Related to Perfectionism
•Concern about evenness or exactness
•Concern with a need to know or remember
•Fear of losing or forgetting important information when throwing something out
•Inability to decide whether to keep or to discard things
•Fear of losing things
COMMON OBSESSIONS IN OCD

9. Washing and Cleaning
•Washing hands excessively or in a certain way
•Excessive showering, bathing, tooth-brushing, grooming ,or toilet
routines
•Cleaning household items or other objects excessively
•Doing other things to prevent or remove contact with
contaminants
Checking
•Checking that you did not/will not harm others
•Checking that you did not/will not harm yourself
•Checking that nothing terrible happened
•Checking that you did not make a mistake
•Checking some parts of your physical condition or body
Repeating
•Rereading or rewriting
•Repeating routine activities (examples: going in or out doors,
getting up or down from chairs)
•Repeating body movements (example: tapping, touching, blinking)
•Repeating activities in “multiples” (examples: doing a task three
times because three is a “good,” “right,” “safe” number)
Mental Compulsions
•Mental review of events to prevent harm (to oneself others, to
prevent terrible consequences)
•Praying to prevent harm (to oneself others, to prevent terrible
consequences)
•Counting while performing a task to end on a “good,” “right,” or
“safe” number
•“Cancelling” or “Undoing” (example: replacing a “bad” word with a
“good” word to cancel it out)
Other Compulsions
•Putting things in order or arranging things until it “feels right”
•Telling asking or confessing to get reassurance
COMMON COMPULSIONS IN OCD

11. DSM-5 DIAGNOSTIC CRITERIA FOR
OBSESSIVE-COMPULSIVE DISORDER
A.Presence of obsessions, compulsions, or both
B. The obsessions or compulsions are time-consuming (e.g. take >1 h/d) or
cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the
physiological effects.
D.The disturbance is not better explained by the symptoms of another
mental disorder.

12. MANAGEMENT
NON PHARMACOLOGICAL THERAPY
• Cognitive- Behavioural therapy (CBT)
 The psychological treatment of choice for OCD
 Effective in both adults and children
 Particularly exposure with response prevention

13. PHARMACOLOGICAL THERAPY

15. Charles Darwin Leonardo Dicaprio Billy Bob Thornton Jessica Alba
Donald Trump Howard SternDavid Beckham
FAMOUS PEOPLE WITH OCD

16. REFERENCES
1. Lack CW , World J Psychiatry. 2012 Dec 22;2(6):86-90.
2. Dilip V. Jeste et all, DSM-V, American Psychiatric Association, 2013.
3. NICE Guidelines for OCD, 2015.
4. Hall, Justin_ Premji, Azra-Toronto notes 2015 _ comprehensive
medical reference and review for the Medical Council of Canada
Qualifying Exam part 1 and the United States Medical Licensing
Exam.
5. http://www.medicalnewstoday.com/articles/178508.php
6. http://primarypsychiatry.com/issue/2005/