Obsessive Compulsive Disorder (OCD) An anxiety disorder
Obsessions Are recurrent and persistent ideas, impulses or images that are experienced as intrusive and inappropriate and cause anxiety and distress. The patient recognises them as his/hr own thoughts, and may try to resist, but may find them impossible to remove.
In adults the most common obsessions are- Thoughts of contamination Pathological doubt (such as, if whether simple tasks have been properly completed) Thoughts of having physical symptoms Symmetry, for instance, of household objects Aggressive thoughts.
COMPULSIONS Are recurrent and persistent behaviours or mental acts undertaken to prevent, or reduce, anxiety or distress in the belief that they will prevent a dreaded event from occurring. They do not produce pleasure, and the tasks performed do not bring pleasure. If they are resisted, anxiety can increase.
Common compulsions Checking Washing Counting Needing to ask questions or make confessions Creating symmetry and order Needing to be precise.
Obsessions and compulsions are often linked, as thedesire to resist an obsessional thought produces acompulsive act. Linked obsessions and compulsions Obsession Compulsion Contamination Hand washing, avoidance of dust, germs or urine. Doubt (eg have I switched Repeated checking of the the iron off?) object (iron) in doubt. Need for symmetry Compulsive slowness in maintaining symmetry.
Other obsessions Fear of being responsible for someone’s death or illness. Obsessive thoughts – such as an endlessly repeated chain of thought, often about a possible event in the future.
Other compulsions Counting - such as counting up to 6 over and over again, doing everything 6 times. Touching – the need to touch a part of the body as part of a ritual
Obsessions and compulsions have some features in common The ideas or impulses are recurrent. They are a product of their own mind They are accompanied by feelings of dread The sufferer tries to fight them off Although Attempts to resist them may fade over time, the patient remains aware that they are both absurd.
OCD- a subject for humour? OCD has been used in films as a humorous device, such as by Jack Nicholson in the film “As Good as it Gets” http://www.youtube.com/watch?v=4yOpE MqnsCQ
OCD in film A more realistic portrayal of the illness was shown by Leonardo diCaprio in the film “The Aviator” http://www.youtube.com/watch?v=8dR8xV qSfXc
OCD – The Reality However, OCD is a disorder that causes great distress, as this clip shows http://www.youtube.com/watch?v=Rn1OYl Yzgm8
Criteria for diagnosis Repetitive and unpleasant obsessions or compulsions occur on most days for at least 2 weeks. They are acknowledged to originate from the patient’s own mind. At least one obsession or compulsion is seen as excessive or unreasonable Resistance is (or has been) attempted and at least one obsession or compulsion has been resisted unsuccessfully.
Although obsessions andcompulsions may relieve anxiety,they are not pleasurable and impairfunctioning, usually by wastingtime.
The 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.
Depression Over two thirds of patients with OCD experience major depression during their lives. In fact, having an obsessive compulsive personality leads to depressive disorders more than to the development of OCD.
Who gets OCD? Lifetime risk of developing the disorder - 2% Males and females are equally at risk Most common age of onset – under 25 years old.
Prognosis (progression of the disorder) OCD can be long lasting for about a third of sufferers. They remain incapacitated in spite of treatment. This is associated with- Development of this disorder at a young age The need for hospitalisation Severe depression
Causes of the disorder These may be either- Physiological or psychological
Physical causes We will look at possible physiological causes first
Genetic factors Family and twin studies have shown that there is a strong family link for 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 were more then twice as likely to develop OCD if their twin had OCD than were fraternal twins. A variation in the COMT gene has been identified in OCD sufferers.
Biochemical factors Serotonin deficiency – perhaps OCD sufferers have too little serotonin for their nerve cells to communicate effectively. SSRIs (drugs to increase the movement of serotonin between cells) have been shown to reduce OCD symptoms. PET scans show OCD sufferers have lower levels of serotonin. After taking SSRIs, PET scans show a return to normal levels of serotonin.
Brain dysfunction 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) PET scans support this and show SSRIs affect the metabolism in this area, reducing OCD symptoms.
Psychological causes Psychodynamic Freud- OCD arises when unacceptable wishes and impulses from the id are only partially repressed so cause anxiety. Ego defence mechanisms are used to reduce the anxiety. These defence mechanisms are used unconsciously and acts, such as hand washing, are thought to be an act to symbolically undo the unacceptable id impulses.
Cognitive explanation This can help to explain how the behaviours continue. The thoughts like “if I don’t do this something awful will happen” cannot be controlled by the sufferer. Such as compulsive hand washing to avoid becoming ill. Also - the possibility that compulsive behaviour is linked to a poor memory for having carried out actions is being investigated.
Behavioural explanation OCD develops as a way of reducing anxiety. Operant conditioning offers an explanation for this. negative reinforcement- washing hands reduces fear, so is repeated. Superstition hypothesis – such as footballers who have to be last on the pitch – this is associated with past success so failure to carry them out causes anxiety.
Johnny Wilkinson, the England Rugby Union starsays-“I always wear the same t-shirt under my Englandshirt. And I always go out to warm up, come back, putmy shoulder pads on before my England shirt.Ill never warm up in my England shirt.But this is more routine rather than thinking "if I dontdo this, todays going to go horribly wrong".People like to have their own routines to fight back thenerves to keep them sane.”
Bjorn Borg Five times Wimbledon champion, never shaved during a tournament, because the first time he won, he hadn’t shaved.
John Terry Wore the same pair of shin pads for 10 years.
Serena Williams Claimed she lost the 2007 Paris open because "I didnt tie my laces right and I didnt bounce the ball five times and I didnt bring my shower sandals to the court with me."
Paul Ince Had to be the last player to put on his shirt before the game. This was fine, until another player with the same ritual joined the team!
David Beckham Always wears long sleeved football shirts. Wears a new pair of boots for each game. David is aware he has OCD "I have to have everything in a straight line, or everything has to be in pairs. Ill put my Pepsi cans in the fridge and if theres one too many then Ill put it in another cupboard somewhere."
Treatment Cognitive Behavioural Therapy is the currently the most effective treatment for this disorder. http://www.ocdaction.org.uk/ocdaction/ind ex.asp?id=132
Message board of rituals http://www.healthboards.com/boards/show thread.php?t=281134&page=1