The document provides information about obsessive-compulsive disorder (OCD) including diagnostic criteria, prevalence, causes, types of obsessions and compulsions, treatment options, related disorders, and differences between OCD and obsessive-compulsive personality disorder (OCPD). Key points include that OCD affects 1.2% of the population, involves recurrent unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to reduce anxiety, has biological and environmental contributors, and is typically treated with medication and cognitive behavioral therapy.

2. objectives
• What is OCD
• Diagnostic criteria
• Normal vs abnormal
• How common is OCD
• Causes of OCD
• OCD related disorders
• Treatment
• What is not OCD
• OCD VS OCPD

3. What is OCD?
A serious anxiety-related condition where a person
experiences frequent intrusive and unwelcome persistant
thoughts, commonly referred to as obsessions. Resulting
in a person carrying out repetitive behaviors or rituals in
order to prevent a perceived harm and/or worry
,commonly referred as compulsions.

4. There are two significant aspects to

5. How common is OCD
• Based on current estimates for the UK population, there
are around three quarters of a million people living with
OCD at any one time.
• The condition affects as many as 12 in every 1,000
people (1.2% of the population) from young children to
adults, regardless of gender, social or cultural
background.

6. What Causes OCD?
Everyone experiences intrusive, random and strange
thoughts. Most people are able to dismiss them from
consciousness and move on.
But these random thoughts get “stuck” in the brains of
individuals with OCD; they’re like the brain’s junk mail. Most
people have a spam filter and can simply ignore incoming
junk mail.

7. But having OCD is like having a spam filter that
has stopped working – the junk mail just keeps
coming, and it won’t stop. Soon, the amount of
junk mail exceeds the important mail, and the
person with OCD becomes overwhelmed.

8. • There is a circuit in the brain which regulates primitive
aspects of our behavior such as aggression, sexuality,
and contamination.
• This circuit relays information from a part of brain called
the orbitofrontal cortex to another area called the
thalamus and includes other regions such as the caudate
nucleus of the basal ganglia.
• When this circuit is activated, these impulses are brought
to our attention and cause us to perform a particular
behavior that appropriately addresses the impulse.

9. OCD Brain
It has been suggested that OCD brain has difficulty turning
off or ignoring impulses from this circuit. This, in turn,
causes repetitive behaviors called compulsions and
uncontrollable thoughts called obsessions.
For instance, your brain may have trouble turning off
thoughts of contamination after leaving the restroom,
leading you to wash your hands again and again.

11. Causes
• Biological Factors
(Brain areas , neurotransmitters)
• Genetic Factors
• Environmental factors (infection ,stress …,)
• Behavioral Theory – Learned Theory
• Cognitive theory

12. Biological factors
Neurotransmitters:- abnormalities
in neurotransmitter systems
chemicals such serotonin,
dopamine, glutamate (and
possibly others) that send
messages between brain cells –
are also involved in the disorder.

13. Neuroimaging:-
Scans of those with OCD
show abnormal activity in
different parts of this
circuit including the
orbital frontal cortex,
cingulate cortex, and
caudate nucleus of the
basal ganglia.

14. Genetic factors
Genetic :- a study by the National Institutes of Health
examined DNA, and the results suggest that OCD may be
associated with an uncommon mutation of the human
serotonin transporter gene (hSERT).
Other research points to a possible genetic component, as
well. About 25% of OCD sufferers have an immediate family
member with the disorder.

15. • In addition, twin studies have indicated that if one twin
has OCD, the other is more likely to have OCD when the
twins are identical rather than non identical.
• Overall, studies of twins with OCD estimate that genetics
contributes approximately 45-65% of the risk for
developing the disorder.

16. Behavioral theory
• Learning theorists, suggest that behavioral conditioning
may contribute to the development and maintenance of
obsessions and compulsions.
• More specifically, they believe that compulsions are
actually learned responses that help an individual reduce
or prevent anxiety associated to obsessions.

17. Environmental factors
Infection :- some children begin to exhibit sudden-onset
OCD symptoms after bacterial or viral infection such as
strep throat or the flu.
Studies suggest the infection doesn’t actually cause OCD,
but triggers symptoms in children who are genetically
predisposed to the disorder.

18. Stress and parenting styles:- are environmental factors
that have been blamed for causing OCD. But no research
has ever shown that stress or the way a person interacted
with his or her parents during childhood causes OCD.
Stress can, however, be a factor in triggering OCD in
someone who is predisposed to it, and OCD symptoms can
worsen in times of severe stress.

19. Cognitive theory
Trigger
stimulus
Neutralizati
on and
compulsions
Faulty
appraisal
and beliefs
Anxiety
perceived
control
Unwanted
mental
intrusions
Meaning of
obsessions

20. Appraisal of obsessions
- Inflated responsibility.
- Over importance of thoughts (thought action fusion)
- Overestimated of threat.
- Need for control over thoughts.
- Intolerance of uncertainty.
- Perfectionism.

21. Inflated
responsibility :-
The belief that one
has the power to
bring about or
prevent a crucial
negative outcome
to oneself or
others.

22. OCD pt had an intrusive
thoughts that he was
contaminated ,he belief that he
had washing himself
excessively or he will become
life threateningly ill ,he also
fears spreading the illness to
his family
Example

23. Over importance of thoughts
Belief that just
having a
thought means
its important in
some way

24. fusion
I am not control on
myself I am danger
Thought are equivalent
to action
the belief that having a
thought will increase
the likelihood of the
feared outcome will
occur. “Having violent
thoughts is almost as
committing violent
acts.”

26. Over estimation of threat
OCD sufferer overestimate the probability or severity of
threat or harm

27. Example
One patient had a problem
whenever she left her house ,
she belief that she might had
left her iron or the stove
burner on ,which would
result in her house burned
down.

28. Need to control over
thoughts
OCD people place excessive
value on having complete
control over intrusive
thoughts , images and
impulses , they belief this is
both desirable and possible.
Try to not think about
purple elephant

29. Intolerance of uncertainty
They believe they need to be
certain
, they feel unable to cope with
uncertainty and unpredictable
changes ,they have difficulty in
functioning in an ambiguous
situations

30. Example
One OCD patient had intrusive thought that she ran over
pedestrian with on her car when she heard a pop .
She belief that she had an over certain if a pop was
pedestrian , otherwise she predicted she wouldn't be able
to function at work, she beg too anxious worrying whether
or not she actually did hit somebody.

31. OCD people tend to
belief that there is a
perfect solution to
every problem, that
doing something
perfectly is not only
possible but
necessary .and they
think even small
mistakes can have a
serious

32. OCD patient had an intrusive thought that he send out
newsletter with an obvious mistake ,he fears this mistakes
will look him careless and he will get fired.
His perfectionism will lead him read a newsletters over and
over before sending them
He tries to eliminate any possibility of the slightest error.
Example

33. Obsessions

34. Obsessions are recurrent persistent and uncontrollable
- Thoughts
- Images
- Impulses or urges
Or a combination of all these. They’re experienced as
intrusive, and unwanted, and cause anxiety and significant
distress interfering with the patients ability to function on a
day-to-day basis as they are incredibly difficult to ignore.

35. People with OCD usually realize that their obsessional
thoughts are irrational, but at the same time feels so very real
and they believe the only way to relieve the anxiety caused by
them is to perform compulsive behaviors.
These compulsive behaviors are carried out to prevent
perceived harm happening to themselves or to a loved one,
even when there is No correlation between their thoughts and
compulsive behavior.

36. Examples of common obsessions include:
- Contamination :- Worrying that you or
something/someone/somewhere is contaminated.
- Symmetry:- Worrying that everything must look and feel
arranged at a specific position
- Harming :- Worrying about causing physical or sexual
harm to yourself or others.

37. - Sexual orientation :- Unwanted and unpleasant
sexual thoughts and feelings about sexuality or the
fear of acting inappropriately towards children.
- Unwanted and intrusive thoughts:- about violence,
Religious

38. • - Worrying that something terrible will happen.
• - Fear of something bad happening unless checked (i.e.
property will be broken into/burn down).
• - Worrying that you have caused an accident whilst
driving.
• - Having the unpleasant feeling that you are about to
shout out obscenities in public.

39. Obsessions Percentage
Contamination from dirt, germs, viruses
(e.g. HIV), bodily fluids or faeces,
chemicals, sticky substances, dangerous
materials
37.80%
Fear of harm (e.g. door locks are not safe) 23.60%
Excessive concern with order or symmetry 10.00%
Obsessions with the body or physical
symptoms
7.20%
Religious, sacrilegious or blasphemous
thoughts
5.90%
Sexual thoughts (e.g. being a paedophile
or a homosexual)
5.50%
Urge to hoard useless or worn out
possessions
4.80%
Thoughts of violence or aggression (e.g.
stabbing one’s baby)
4.30%

40. Compulsions

41. Feeding your dog at a
dinner table

42. Compulsions are repetitive somewhat stereotypic overt
rituals(hand washing ,checking or they can be covert
mental acts(repeated words ,counting silently ). most often
compulsions are triggered by obsessions

43. • overt compulsion (i.e. observable by others), such as
checking that a door is locked ,repeated washing , or
symmetry of certain motor actions.
• covert compulsions (an unobservant mental act), such as
repeating a specific phrase in the mind, mental counting,
compulsive visualization and substitution of distressing
mental images or ideas with neutralizing alternatives.

44. • Patients continue to perform compulsions until they have
reached to (State) that signals them to stop the
compulsions , these states might be :-
- A reduction in anxiety.
- A feeling of certainty .
- A sense of completeness.
- A just right feeling.

45. Compulsion Percentage
Checking (e.g. gas taps) 28.8%
Cleaning, washing 26.5%
Repeating acts 11.1%
Mental compulsions (e.g. special words
or prayers repeated in a set manner)
10.9%
Ordering, symmetry or exactness 5.9%
Hoarding/collecting 3.5%
Counting 2.1%

47. Normal VS abnormal
The obsessions and compulsions must cause :-
• - Marked distress
• - Are time consuming(more than 1hourday)
• - Interfere with social and occupational functioning .

49. 16 yrs old male patient has intrusive recurrent thoughts
that everything on his life whatever (his timing or
stuff)inside his house must be symmetrical and arranged
orderly
Otherwise his family will be hurt or his day will end by
unknown catastrophic event
Anxiety and distress

50. He has compelled every day before going to his school to
repeatedly arrange everything inside his house in a specific
order, he feel that he is responsible not only for his room but
he has to order and arrange the other rooms as well if he saw
them not arranged as he want that is why sometimes he
avoid to enter other rooms (if he was late)
Temporary anxiety relive
Disturbance Going school late ,fighting with his
younger sister ,repeated school absenteeism.

51. 30 yrs old female Pt ,she has recurrent intrusive
thoughts(obsessions) that she is worthless and lower than
other people ,these thoughts very distressing and
disturbing her as well as causing anxiety .
Obsessions anxiety ??? Relive anxiety

52. She has mentally compelled to imagine herself by images
of being a business woman, owner of a big famous
company ,and a very rich woman has luxury possessions
,cars and servants Temporary anxiety relieve.
Disturbance she decide to divorce and leaving her
kids (she think if she was single ,she will be able to be
worthy, and assert herself

53. Obsessive-Compulsive
Related Disorders
• Skin Pricking Disorder (Excoriation):
• Hair-Pulling Disorder (trichotillomania):
• Body Dysmorphic Disorder:
• OCD and Related Disorders Induced By a
Substance/Medication or Due to Another Medical
Condition:

54. TreatmentPharmacotherapy :-
Antidepressant :-
- SSRI (serotonin uptake inhibitors)
- SSRI + Antipsychotic (low dose)
- SSRI +TCA (tricyclic antidepressant)
Psychotherapy :-
- CBT (cognitive behavioral therapy)
- ERP (Exposure and response prevention)
- Dialectical Behavior Therapy (DBT)

55. • Psychosurgery (bilateral capsulotomy).
• Deep brain stimulation. involves implanting a device that
sends electrical impulses into the brain. Unlike
the capsulotomy surgery, deep brain stimulation is
reversible, and does not permanently damage tissue. In
2009, the Food and Drug Administration approved the
use of deep brain stimulation for OCD.

56. What is not OCD?
• OCD is also not about football, shopping, sex or other
enjoyable activities.
• OCD is also not about collectors who have a special interest
in a subject, such as collecting stamps, coins, books by a
favorite author
• Compulsive behaviors seen in, compulsive liars, shoppers,
gamblers or sexaholics are other examples of something
that are not part of OCD.
They are more likely to be addictive problems and are
considered to be Impulse Control Disorders

57. compulsive personality
disorder)
• An excessive need for perfection and a hard stiff control
over not only their environment, but the nature of
interpersonal relationships
• A preoccupation with details, rules, lists, and order to the
extent that they may miss the major objective of an
activity
• An excessive devotion to work at the expense of family
or friends

58. • A rigidity and inflexibility with regards to morals, ethics,
values, and/or the adherence to rules
• The inability to get rid of items that no longer have value
(hoarding).
• The inability to be generous to others

59. OCD VS OCPD

60. • OCPD, the behaviors are not directed by thoughts they are
unable to control or irrational behaviors they repeat over and
over again, often with no apparent aim.
• people with OCPD fully believe that their actions have an
aim and purpose.
• Persons with OCPD will usually not seek help because they
don't see that anything they are doing is particularly
abnormal or irrational.
• Because OCPD is defined by inflexibility, the behaviors tend
to be persistent and unchanging over the long term.