Obsessive-Compulsive Disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over. Symptoms: Compulsive behavior Obsessive-compulsive disorder is characterised by unreasonable thoughts and fears (obsessions) that lead to compulsive behaviours. OCD often centres on themes such as a fear of germs or the need to arrange objects in a specific manner. Symptoms usually begin gradually and vary throughout life. Treatment includes talk therapy, medication or both. Consult a doctor for medical advice.

1. WELCOME

2. OBSESSIVE-COMPULSIVE
DISORDER
PRESENTED BY : MRS. SUHANYA RAJ.V

3. DEFINITION
 Obsessive compulsive disorder(OCD) is an anxiety disorder
characterized by the presence of persistent and recurrent irrational
thoughts(obsessions), resulting in marked anxiety and repetitive
excessive behaviours(compulsions) as a way to try to decrease that
anxiety, in a way which interfere with the individuals’ daily
functioning or serve as a source of distress.
3

4. HISTORICAL BACKGROUND
 1838: Jean Etienne Esquarol – first case of obsessive doubting –grouped
with monomanias.
 Jean Pierre Falret – ‘The illness of the doubt’
 1867: Richard Von Kraft Ebing -- introduced it into German psychiatry
 1866: Morel – ‘Obsessive Neurosis’
 1903: Pierre Janet – concept of Psychasthenia
4

5. ICD 10 CLASSIFICATION
 F 42 : Obsessive compulsive disorder
 F42.0 : Predominantly obsessive thoughts or ruminations
 F42.1 : Predominantly compulsive acts
 F42.2 : Mixed obsessional thoughts and acts
 F42.8 : Other obsessional compulsive disorders
 F42.9 : Obsessive-compulsive disorder, unspecified.
5

6. EPIDEMIOLOGY
 Unmarried males
 Upper social strata with high intelligence
 Late third decades onset
 Life time prevalence is 2-3%
6

7. COURSE AND OUTCOME
 Classically it has a chronic course but, longitudinal profile shows
episodic
 Long term follow-up study result shows:
- 25% unimproved over time
- 50% had moderate to marked improvement
- 25% had recovered completely
7

8. ETIOLOGY
 Psychodynamic theory
 Behavioural theory
 Biological theory
8

9. Psychodynamic theory:
 Sigmund Freud found obsessions and phobias to be
psychogenetically related.
 This theory explains OCD by a defensive regression to anal-sadistic
phase of dev elopement with the use of isolation, undoing and
displacement to produce obsessive-compulsive symptoms.
9

10. Psychodynamic theory: 10

11. Behavioural theory:
 Obsessions : conditioned stimuli to anxiety
 Compulsions : learned behaviours which decrease the anxiety
associated with obsessions.
 This decrease in anxiety positively reinforces the compulsive acts
and they become ‘stable’, learned behaviours.
11

12. Biological theory:
 OCD occurs secondary to illness such as Von Economo’s encephalitis,
basal ganglia lesions, Gilles de la Tourette syndrome and
hypothalamic and third ventricle lesions.
 First degree relatives : 5-7% occurrance
 Biochemically, the central 5-HT system seems to be involved in OCD.
12

13. CHARACTERISTICS
OCD is characterized by recurrent obsessions and compulsions.
Obsession :-
1. An ideas, impulse or image which intrudes into conscious awareness repeatedly.
2. It is recognized as one’s own idea, impulse or image but is perceived as ego-alien.
3. It is recognized as irrational and absurd.
4. Patient tries to resist against it but is unable to.
5. Failure to resist, leads to marked distress.
13

14. CHARACTERISTICS
Compulsion :-
1. A form of behaviour which usually follows obsessions.
2. It is aimed at either preventing or neutralising the distress or fear arising
out of obsessions.
3. The behaviour is not realistic and is either irrational or excessive.
4. Insight is present, so the patient realises the irrationality of compulsion.
5. The behaviour is performed with a sense of subjective compulsions.
14

15. THE VICIOUS CYCLE OF OCD
OBSESSIVE
THOUGHT
ANXIETY
COMPULSIVE
BEHAVIOUR
TEMPORARY
RELIEF
15

16. CLINICAL FEATURES
 Washers
 Checkers
 Doubters and sinners
 Counters and arrangers
 Hoarders
16

17. CLINICAL FEATURES
 Washers : are afraid of contamination.
 Checkers : repeatedly check things associated with harm/danger.
 Doubters and sinners : demands perfectionism, and feared about
being punished for not doing things right.
 Counters and arrangers : obsessed with order and symmetry.
 Hoarders : compulsively hoard things that they don’t need to use.
17

18. Washers Checkers
Doubters and sinners
HoardersCounters and arrangers
18

19. DIAGNOSIS
 Demonstration of irrational or excessive ritualistic nehaviours
 MRI and CT shows enlarged basal ganglia
 PET scan shows increased glucose metabolism in part of basal
ganglia
 ICD 10 criteria
 Yale Brown Obsessive Compulsive Scale(Y-BOCS)
19

20. DIFFERENTIAL DIAGNOSIS
 Schizophrenia
 Depression
 Phobic disorder
 Obsessive compulsive personality disorder
 Obsessive compulsive spectrum disorders
 Physical illnesses
 Others
20

21. TREATMENT
 Psychotherapy
 Behaviour and cognitive behaviour therapy
 Pharmacotherapy
 Electroconvulsive therapy
 Psychosurgery
21

22. TREATMENT
 Psychotherapy
o Psychoanalytic psychotherapy
o Supportive psychotherapy
22

23. TREATMENT
Behaviour and cognitive behaviour therapy
o Modelling
o Thought-stopping
o Systematic desensitisation
o Relaxation techniques
o Aversive conditioning
o Exposure and response prevention
23

24. TREATMENT
 Pharmacotherapy
o Benzodiazepines [Alprazolam, Clonazepam]
o Antidepressants(SSRIs)
- Clomipramine(75-300/day)
- Fluoxetine(25-80mg/day)
- Fluvoxamine(50-200mg/day)
- Paroxetine(20-40mg/day)
- Sertaline(50-200mg/day)
o Antipsychotics [Haloperidol, Risperidone, Olanzapine, Aripiprazole, Pimozide]
24

25. TREATMENT
 Electroconvulsive therapy
o Indicated in severe depression with OCD and a risk of suicide along
withpoor response to other modes of treatment.
25

26. TREATMENT
 Psychosurgery
o Stereotactic limbic leucotomy
o Stereotactic subcaudate tractotomy
26

27. SELF-TREATMENT GUIDELINES :
RELABEL: recognize that obsessive thoughts and urges
are the result of OCD.
REATTRIBUTE : realize that the intensity and
intrusiveness of the thought or urge is caused by OCD;
probably due to a biochemical imbalance.
REFOCUS : work around OCD thoughts by focusing
your attention on something else, at least for a few
minutes.
REVALUE : do not take the OCD thought at face value.
27

28. NURSING MANAGEMENT
1. Nursing Assessment :
Nurse should detail into the following:
 Physical, psychological and social data
 Impact on physical functioning, mood, self esteem and normal
coping ability
 Defense mechanisms used, thought process and content, risk for
suicide, ability to function, available social support systems.
28

29. NURSING MANAGEMENT
2. Nursing Diagnosis :
 Severe anxiety related to earlier life conflicts as evidenced by
repetitive actions/recurring thoughts/decreased social functioning.
 Ineffective coping related to under developed ego/punitive super ego
as evidenced by ritualistic behaviour/obsessive thoughts/inability to
meet basic needs.
 Impaired role performance related to the need to perform rituals as
evidenced by inability to fulfil usual patterns of responsibility.
29

30. SUMMARY
Obsessive compulsive disorder is an anxiety disorder in which a person
has intrusive ideas, thoughts, or images that occur repeatedly, and in
which he or she feels driven to perform certain behaviours over and
over again. Having an OCD may cause a person to have trouble
carrying out daily activities. Negative comments or criticism can make
OCD worse, while a calm, supportive environment with a combination
of different therapies can help improve the outcome of treatment.
30

31. RECAPITULATION 31

32. 32

33. CONCLUSION 33

34. 34

35. BIBLIOGRAPHY
 Banjamin James Sadock and Virgina Sadock. Kaplan Sadock Synopsis
of Psychiatry.Lippincott.
 Mary C.Townsend.Psychiatric Mental health Nursing.Concepts of care
in evidence based practice.Jaypee.
 Niraj Ahuja.A short text book of Psychiatry.Jaypee.
 M.S. Bhatia.Essentials of Psychiatry.CBS publishers.
 R.R.Kavitha.Mental Health Nursing.Frontline publishers.
 WHO.ICD 10 Classification of mental behavioural disorders.
35

36. BIBLIOGRAPHY
 http://www.helpguide.org/obsessive-compulsive disorder/
 http://haznos.org/2015/ocd-an-introduction/
 http://en.m.Wikipedia.org/wiki/obsesseive-compulsive disorder
 http://www.lifeextension.com/protocols/emotional-health/obsessive-
compulsive-disorder/
 http://www.nhs.uk/conditions/obsessive-compulsive-disorder-ocd/
36

37. BIBLIOGRAPHY
 Jedidiah Siev.Perceived decision making styles among individuals
with obsessive compulsive and hoarding disorder[internet]:Journal of
obsessive compulsive related disorders;volume 23,October 2019.
Availablefrom:http://www.sciencedirect.com/science/article/pii/s22113
64919300582
37

38. 38